Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland.

BACKGROUND: The approval of long-acting pre-exposure prophylaxis PrEP (LA-PrEP) in the United States brings opportunities to overcome barriers of oral PrEP, particularly among sexual and gender minority communities who bear a higher HIV burden. Little is known about real-time decision-making among potential PrEP users of LA-PrEP post-licensure. METHODS: We held focus group discussions with people assigned male at birth who have sex with men in Baltimore, Maryland to explore decision-making, values, and priorities surrounding PrEP usage. A sexual and gender minority-affirming health center that provides PrEP services supported recruitment. Discussions included a pile-sorting activity and were audio-recorded. Recordings were transcribed and analyzed iteratively, combining an inductive and deductive approach. RESULTS: We held five focus groups from Jan-June 2023 with 23 participants (21 cisgender men who have sex with men, two transgender women who have sex with men; mean age 37). Among participants, 21 were on oral PrEP, one was on injectable PrEP, and one had never taken PrEP. Most had never heard about LA-PrEP. When making decisions about PrEP, participants particularly valued efficacy in preventing HIV, side effects, feeling a sense of security, and ease of use. Perceptions varied between whether oral or injectable PrEP was more convenient, but participants valued the new opportunity for a choice in modality. Factors influencing PrEP access included cost, individual awareness, provider awareness, and level of comfort in a healthcare environment. Participants emphasized how few providers are informed about PrEP, placing the burden of being informed about PrEP on them. Comfort and trust in a provider superseded proximity as considerations for if and where to access PrEP. CONCLUSIONS: There is still low awareness about LA-PrEP among sexual and gender minority communities; thus, healthcare providers have a critical role in influencing access to LA-PrEP. Despite this, providers are still vastly underinformed about PrEP and underprepared to support clients in contextualized ways. Clients are more likely to engage in care with affirming providers who offer non-judgmental conversations about sex and life experiences. Provider education in the United States is urgently needed to better support clients in choosing a PrEP modality that is right for them and supporting adherence for effective HIV prevention.

Developing an mHealth program to improve HIV care continuum outcomes among young Black gay and bisexual men.

BACKGROUND: Young Black gay and bisexual men (YBGBM) in the United States face significant disparities in HIV care outcomes. Mobile health (mHealth) interventions have shown promise with improving outcomes for YBGBM across the HIV care continuum. METHODS: We developed an mHealth application using human-centered design (HCD) from 2019-2021 in collaboration with YBGBM living with HIV and with HIV service providers. Our HCD process began with six focus groups with 50 YBGBM and interviews with 12 providers. These insights were used to inform rapid prototyping, which involved iterative testing and refining of program features and content, with 31 YBGBM and 12 providers. We then collected user feedback via an online survey with 200 YBGBM nationwide and usability testing of a functional prototype with 21 YBGBM. RESULTS: Focus groups and interviews illuminated challenges faced by YBGBM living with HIV, including coping with an HIV diagnosis, stigma, need for social support, and a dearth of suitable information sources. YBGBM desired a holistic approach that could meet the needs of those newly diagnosed as well as those who have been living with HIV for many years. Program preferences included video-based content where users could learn from peers and experts, a range of topics, a community of people living with HIV, and tools to support their health and well-being. Providers expressed enthusiasm for an mHealth program to improve HIV care outcomes and help them serve clients. Rapid prototyping resulted in a list of content topics, resources, video characteristics, community features, and mHealth tools to support adherence, retention, goal setting, and laboratory results tracking, as well as tools to help organization staff to support clients. Online survey and usability testing confirmed the feasibility, acceptability, and usability of the content, tools, and features. CONCLUSIONS: This study demonstrates the potential of a video-based mHealth program to address the unique needs of YBGBM living with HIV, offering support and comprehensive information through a user-friendly interface and videos of peers living with HIV and of experts. The HCD approach allowed for continuous improvements to the concept to maximize cultural appropriateness, utility, and potential effectiveness for both YBGBM and HIV service organizations.

The importance of developmental assets in HIV prevention behaviors among young black men who have sex with men (MSM).

Developmental assets are critical to the health and wellbeing of youth. The current study examines the influence of developmental assets on PrEP use and HIV testing among YBMSM ages 18-24. Using a cross-sectional survey of YBMSM (N = 225), this study explored the role of external (e.g., family support, other adult support) and internal (e.g., personal responsibility) assets in explaining HIV prevention behaviors. Participants were recruited from Mechanical Turk (M-Turk) internet-based platform, social media sites, and community-based organizations. A path analysis was conducted to investigate the direct/indirect effects of internal and external assets on PrEP use and HIV testing. Family support (ß = 0.40, p < 0.001) and other adult support (ß = 0.22, p = 0.004) were both associated with personal responsibility. Personal Responsibility (ß = 0.15, p = 0.03) and positive identity (ß = 0.28, p < 0.001) were both associated with an increase HIV testing. Personal responsibility was positively associated with increased PrEP use (ß = 0.30, p < 0.001). Our study results indicated that external assets play a role in helping to build internal assets that support increased HIV testing and PrEP use among YBMSM. Our findings suggest the need for strength-based interventions that help YBMSM build assets and increase HIV prevention behaviors.

Survey of pain and stigma experiences in people diagnosed with mpox in Baltimore, Maryland during 2022 global outbreak.

A high prevalence of mpox in men who have sex with men and in people with HIV, plus visually striking and contagious lesions, have raised concerns for mpox stigma. 24 PCR-confirmed mpox patients were surveyed over the course of three months, utilizing an mpox stigma scale adapted from the HIV Stigma Scale plus assessment of pain, analgesic efficacy, and healthcare experiences. Participants were cis-male (100%), with male sexual partners (96%), mostly African-American (88%), and living with HIV (79%). Patients answered 4-16 of 24 (mean 10) stigma questions affirmatively, particularly related to negative effects of mpox on the LGBTQ community. 79% reported pain, most commonly of limbs and perianal area, with perianal pain being rated most severe. The most effective pain relief occurred with opioids (100% major relief, n = 2) and tecovirimat (63% major relief, 25% moderate, n = 16). Patients were satisfied with care provided at the studied clinics, but had negative experiences at all other mentioned sites.

Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France.

Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February - August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) "sexual activity/medical engagement") that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients' profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.

Measuring intersectional HIV, sexual diversity, and gender non-conformity stigma among healthcare workers in Ghana: scale validation and correlates of stigma.

BACKGROUND: Men who have sex with men (MSM) are at heightened risk for HIV acquisition, yet they may delay or avoid HIV testing due to intersectional stigma experienced at the healthcare facility (HCF). Few validated scales exist to measure intersectional stigma, particularly amongst HCF staff. We developed the Healthcare Facility Staff Intersectional Stigma Scale (HCF-ISS) and assessed factors associated with stigma in Ghana. METHODS: We analyzed baseline data from HCF staff involved in a study testing a multi-level intervention to reduce intersectional stigma experienced by MSM. Data are from eight HCFs in Ghana (HCF Staff n = 200). The HCF-ISS assesses attitudes and beliefs towards same-sex relationships, people living with HIV (PLWH) and gender non-conformity. Exploratory factor analysis assessed HCF-ISS construct validity and Cronbach's alphas assessed the reliability of the scale. Multivariable regression analyses assessed factors associated with intersectional stigma. RESULTS: Factor analysis suggested an 18-item 3-factor scale including: Comfort with Intersectional Identities in the Workplace (6 items, Cronbach's alpha = 0.71); Beliefs about Gender and Sexuality Norms (7 items, Cronbach's alpha = 0.72); and Beliefs about PLWH (5 items, Cronbach's alpha = 0.68). Having recent clients who engage in same-gender sex was associated with greater comfort with intersectional identities but more stigmatizing beliefs about PLWH. Greater religiosity was associated with stigmatizing beliefs. Infection control training was associated with less stigma towards PLWH and greater comfort with intersectional identities. CONCLUSIONS: Achieving the goal of ending AIDS by 2030 requires eliminating barriers that undermine access to HIV prevention and treatment for MSM, including HCF intersectional stigma. The HCF-ISS provides a measurement tool to support intersectional stigma-reduction interventions.

"It was unusual but amazing": demand creation for PrEP among adolescents' men who have sex with men (MSM) and transgender women (TGW) in Brazil.

This study aimed to analyze the challenges in demand creation for participation in an HIV pre-exposure prophylaxis (PrEP) project in two Brazilian capitals. This qualitative study was conducted with men who have sex with men and transgender women aged 15 to 19 years who lived in two Brazilian state capitals. For this analysis, 27 semi-structured interviews carried out from 2019 to 2020 were evaluated by reflexive thematic content analysis. For participants, PrEP demand creation was essential for their interaction, mediation, bonding, and attachment and proved effective for PrEP acceptability and adherence. Adolescents' narratives showed that the strategies promoted HIV combination prevention, opened up opportunities for recruitment meetings, helped to negotiate with and convince individuals to use PrEP, strengthened peer education, and evoked a feeling of "being with" and "walking together" despite the challenges. Face-to-face or online interactions using social technologies played a crucial role in recruiting adolescents for the project, expanding knowledge on PrEP and other combination prevention strategies and access to health services and self-care.

Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men.

BACKGROUND: The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS: The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS: Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS: This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

Perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP) as an STI-prevention strategy among gay and bisexual men (GBM) in the United States: Results from a qualitative study.

OBJECTIVE: To leverage qualitative data to explore gay and bisexual men's (GBM) perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP). Doxy-PEP is a novel biomedical STI-prevention strategy that helps reduce the risk of acquiring bacterial STIs. Little is known about Doxy-PEP's acceptability in the U.S., nor how best to engage those most vulnerable to STIs in taking up this nascent prevention strategy. METHOD: Between July and September of 2023, 24 GBM from across the U.S. completed qualitative interviews about their perceptions regarding Doxy-PEP. Interviews were analyzed using a codebook approach to thematic analysis. RESULTS: Participants were generally interested in using Doxy-PEP, but were concerned about the potential for antibiotic resistance, side-effects, medication interactions to occur, along with stigmatizing discourse around its use. Meanwhile, participants were motivated by the simplicity of Doxy-PEP and the protection it could confer on both an individual and community-level- as well as its potential to reduce STI-related anxiety. Finally, participants desired additional information on Doxy-PEP to address their concerns. CONCLUSIONS: There is a need for clear guidelines and expanded public health messaging on Doxy-PEP in the U.S.

An mHealth Intervention for Gay and Bisexual Men's Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunica): Protocol for a Randomized Controlled Trial.

BACKGROUND: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunica intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunica holds promise for reducing gay and bisexual men's co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. OBJECTIVE: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunica in a national trial. METHODS: To test Comunica's efficacy, 305 gay and bisexual men were randomized to receive Comunica or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men's identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. RESULTS: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. CONCLUSIONS: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunica presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52853.

Main Partner Relationships and the HIV Care Cascade: Examining the Predictive Utility of Sexual Agreements, Partner Concordance, and Drug Use Among Sexual Minority Men Living With HIV in the USA.

BACKGROUND: The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. PURPOSE: This study evaluated associations between relational covariates (relationship status, sexual agreements, and seroconcordance) and HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load (VL) testing, and VL detectability) above and beyond cannabis and stimulant drug use. METHODS: Adult SMM (n = 36,874) living with HIV in the USA were recruited between November 1, 2017 and March 15, 2020 through social networking applications. They completed a cross-sectional survey online. RESULTS: Nonmonogamous SMM with serodiscordant partners were most likely to have an ART prescription. Those with seroconcordant partners (regardless of sexual agreements) were least likely to be adherent. While relational covariates were not associated with VL testing, SMM in nonmonogamous relationships with serodiscordant partners were significantly more likely to have an undetectable VL. Those in monogamous relationships with seroconcordant partners were significantly less likely to have an undetectable VL. CONCLUSIONS: SMM with seroconcordant partners and monogamous sexual agreements may experience diminished interpersonal motivation for HIV care engagement. HIV care cascade retention messages that emphasize the prevention of onward transmission may have limited relevance for these SMM. Novel intervention strategies are needed to enhance HIV care outcomes in this population, ideally ones that incorporate attention to drug use.

The majority of people living with HIV in the USA are sexual minority men (SMM). Whereas substantial work has examined HIV prevention in male couples, relatively little has examined relationship factors associated with HIV care outcomes. This study examined whether relationship status, main partner serostatus (seroconcordant vs. serodiscordant), and sexual agreements (monogamous vs. nonmonogamous) were associated with HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load testing, and viral load detectability) above and beyond cannabis and stimulant drug use. We surveyed adult SMM (n = 36,874) living with HIV in the USA between November 2017 and March 2020. Across outcomes where significant between-group differences were observed, results generally indicated partnered SMM with serodiscordant partners­particularly those in nonmonogamous relationships­were more likely to be retained in the HIV care cascade; meanwhile, SMM with seroconcordant partners­particularly those in monogamous relationships­were most vulnerable to attrition in the HIV care cascade. Given this pattern of findings, it is conceivable that efforts to motivate linkage and retention along the HIV care cascade have emphasized the prevention of onward transmission while failing to capitalize on or acknowledge health enhancement as an additional (and coequal) source of motivation.

Sexual satisfaction, an indicator of sexual health and well-being? Insights from STI/HIV prevention research in European men who have sex with men.

INTRODUCTION: Although sexual health has been holistically defined to include sexual satisfaction, it has been largely absent in health services and sexual and reproductive health and rights programmes in many parts of the world. We propose sexual satisfaction as a useful indicator, as one of the proxy measures for sexual health and well-being and as a component of well-being in general. METHODS: The Sialon II project is a multicentre biological and behavioural cross-sectional community-based survey implemented across 13 European cities during 2013-2014 among men who have sex with men. Sexual satisfaction was explored using one single item: 'How satisfied are you with your sex life?' A multivariable multilevel logistic random-intercept model was estimated to identify factors associated with reporting positive sexual satisfaction versus negative sexual satisfaction. RESULTS: Age, the number of partners and self-reported HIV status were not significantly associated with sexual satisfaction in the multivariate model. Participants reporting an insertive role or reported both an insertive and receptive role during the last anal intercourse were more likely to be sexually satisfied, compared with a receptive role. Participants reporting anal intercourse with a condom were more likely to be satisfied than those declaring no anal intercourse in the last 6 months, but no significant association was found compared with anal intercourse without condom. Knowledge of HIV-serostatus concordance with the last sexual partner was positively correlated with sexual satisfaction. Having had sexual intercourse with non-steady partners only in the last 6 months was negatively correlated. The more positive participants perceived their work/school, parents and friends/acquaintances' attitudes towards gay or bisexual persons, the higher the odds they were satisfied with their sexual life. CONCLUSION: Using a single item on sexual satisfaction in a bio-behavioural study, our analysis has shown that it is associated with individual, interpersonal and social/structural factors and has proven its usefulness as a sexual health indicator among men who have sex with men.

Intentions of healthcare seeking and self-isolation for MPOX among men who have sex with men in China: a national cross-sectional study.

Linking identified MPOX cases to care is essential for MPOX control. This study aims to investigate the intentions of healthcare seeking and self-isolation for MPOX among men who have sex with men (MSM) in China. A cross-sectional online survey was conducted in early August 2023 in China. Respondents were recruited by community-based organizations (CBOs), collecting information on demographics, health status, behavioural and psychological characteristics. Univariate and multivariate logistic regression analyses were performed to examine the predictors of intentions to seek healthcare and self-isolate for MPOX within the MSM population. A total of 7725 participants were recruited, with a median age of 30 years. 92.21% of the participants would seek healthcare for MPOX-like symptoms, but only 52.50% intended to self-isolate if diagnosed. Intentions to seek healthcare were lower among those with MPOX-like symptoms in the past 3 months (standardized prevalence ratio (SPRs) = 0.82, 95% CI: 0.74-0.89) and the willingness to self-isolate was reduced among those diagnosed with MPOX in the past 3 months (SPRs = 0.65, 95% CI: 0.48-0.87). Participants free of sexually transmitted infections (STIs) and those aware of their HIV status were more likely to seek healthcare and self-isolate than those with STIs or unaware of their HIV status. Regular followers of MPOX information and those perceiving a low risk of infection were more inclined to take preventive measures. These findings highlight the need for targeted MPOX prevention strategies for high-risk groups and the importance of addressing barriers in infectious disease prevention response.

Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City.

Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.

HIV self-testing knowledge, attitudes, and practices among Asian-born gay, bisexual, and other men who have sex with men in Australia: a qualitative study.

Background: Achieving virtual elimination of HIV transmission in Australia requires a combination of high treatment rates and high testing coverage among individuals at risk of acquiring HIV. HIV self-testing (HIVST) is an additional testing approach for key populations. Objective: We aimed to examine the knowledge, attitudes, and practices of HIVST among Asian-born gay, bisexual and other men who have sex with men (GBMSM). Methods: This qualitative study used semi-structured interviews of overseas-born GBMSM of Asian background in Australia. Participants were recruited from personal networks, social media platforms, snowballing, and the Melbourne Sexual Health Centre. Twenty-five participants were purposively sampled with a range of ages and previous levels of experience with HIVST. Interview transcripts were imported into Nvivo 12 for data management. Results: The age of the participants ranged from 19 to 44 years, with a median of 30 years. Most were unaware of HIVST before the interview, and only a few had ever used one. All had limited sexual health knowledge (i.e., HIV testing, PrEP) before they arrived in Australia. Upon learning about HIVST during the interview, many expressed willingness to use HIVST, but in limited circumstances, such as traveling overseas, interim testing while taking on-demand PrEP, and point-of-sex testing. Almost all were open to distributing HIVST to their casual partners or friends, especially those they knew who engaged in high-risk sexual practice (i.e., condomless anal sex) and were not engaged in sexual healthcare. About half still preferred conventional serology testing because of regular HIV testing as part of PrEP prescription and the need for testing for other sexually transmitted infections. Conclusion: HIVST may be an acceptable additional testing approach for HIV testing among Asian-born GBMSM. Peer education and secondary distribution may help raise HIVST awareness and use.

The Pre-Exposure Prophylaxis Stigma Scale: Measurement Properties of an Adaptation in German and French.

Objectives: This study aimed to adapt and validate the HIV PrEP Stigma Scale (HPSS) in French and German languages (HPSS-FR/DE) and assess its applicability across diverse linguistic and cultural contexts. Methods: The original scale was adapted to French and German and administered through an online survey in multiple European nations. A four-factor structure was extracted from the data, including negative social consequences, social pressure, self-support, and external support. The scale's construct validity, reliability, and cross-linguistic consistency were evaluated. Results: The adapted HPSS-FR/DE demonstrated robust psychometric properties, good construct validity, acceptable reliability, and consistent measurement across different languages. This adaptation enhances its utility in multicultural settings, offering a comprehensive tool to assess PrEP-related stigma. Conclusion: This study provides a suitable tool to address PrEP stigma in multicultural environments to enhance PrEP uptake and adherence among men who have sex with men. Moreover, it lays the groundwork for further investigations into PrEP stigma across diverse populations and cultural settings, enabling the development of targeted public health interventions and policies to combat this issue effectively.

Prevalence and factors associated with psychological distress among key populations in Nigeria.

BACKGROUND: Stigmatization and discrimination within healthcare settings deter key populations (KPs) from seeking mental health and psychosocial support (MHPS). Consequently, understanding the prevalence, associated factors, and impact of the MHPSS intervention on psychological distress among Nigeria's KPs is crucial. METHOD: This is a cross-sectional study focused on KPs, including Female Sex Workers (FSW), Men who have Sex with Men (MSM), and People Who Inject Drugs (PWID) enrolled in Heartland Alliance LTD/GTE across 17 One-Stop Shops (OSS) in six states of Nigeria. Data were extracted from the databases of the OSS. PD was assessed using the Mental Health Screening Form III (MHSF-III). Descriptive statistics and univariable and multivariable binary logistic regression models were done using IBM-SPSS version 28. RESULTS: The prevalence of PD among the KPs was 9.7%. Higher rates were observed among FSWs (12.0%). Of the 22310 KPs, the prevalence of PD was 9.7%. The major dependants of PD include being a PWID with PD prevalence of 8.5% and AOR of 1.95 (95% CI: 0.60-0.98, p = 0.015), alcohol intake with PD prevalence of 97.7% and AOR of 21.83 (95% CI: 15.13-56.83, p<0.001), and having experienced gender-based violence with PD prevalence of 99.0% and AOR of 25.70(95% CI: 17.10-38.73, p<0.001). All Participants (100%) were given brief intervention, and 1595 of 2159 (73.8%) were referred for further psychological intervention. The services with the highest proportion were psychoeducation (21.20%), followed by coping skills training (17.70%) and motivational enhancement (12.90%). CONCLUSION: The study highlights the critical need for targeted mental health interventions among KPs in Nigeria, primarily focusing on those with a history of substance abuse and gender-based violence. Despite universal brief interventions, the proportion enrolled in further Psychosocial support indicates a need to improve mental health service utilization among the KPs in Nigeria.

Factors associated with help-seeking regarding sexual orientation concerns among Japanese gay and bisexual men: results from a cross-sectional survey.

OBJECTIVE: This study investigates Japanese gay and bisexual men's experiences of seeking help for emotional support from others regarding their sexual orientation concerns. It examines the relationship between their help-seeking and presence of gay and bisexual peers, duration between questioning their sexual orientation and accepting it, and experience of coming out to family members by multiple logistic regression analysis. RESULTS: We conducted a cross-sectional survey using a self-reported paper questionnaire. There were 360 valid responses. Eighty-two respondents (22.8%) had experience of help-seeking for emotional support, and this was associated with age, occupation, presence of gay/bisexual friends, and experience of coming out to family members about their sexual orientation. Respondents sought the most help from their male friends (70.0%), followed by female friends (25.0%), mothers (17.5%), and the Internet (16.3%). Even after controlling for age and occupation, experience of help-seeking for emotional support was higher among participants who had gay/bisexual friends when they were aware of their sexual orientation, took < 1 year from questioning to realizing their sexual orientation, and had come out to their family about their sexual orientation.

Male homoparenting and its challenges: an integrative literature review. / Parentalidade homoafetiva masculina e seus desafios: uma revisão integrativa da literatura.

This study aims to elucidate the challenges faced in the exercise of male homoparenting, through an integrative literature review. Following PRISMA guidelines, empirical studies from the last 22 years were analyzed, independently collected by four researchers using the PubMed and APA PsychNet databases, with the descriptors "Homosexuality, Male" and "Father". The results reveal the unique and complex reality faced by homosexual men in the parental context. While some studies highlight significant challenges, such as stigmas and social prejudices, others do not observe such difficulties. The decision to become a father among homosexual men is influenced by factors specific to their reality, in a context where parenthood is not widely accepted. The findings of this study emphasize the need to understand the complex interactions among individual, social, and cultural factors in male homoparenting. In summary, this study highlights the need for inclusive and diversity-sensitive approaches to support family well-being.

Este estudo visa elucidar os desafios enfrentados no exercício da parentalidade homoafetiva masculina por meio de uma revisão integrativa da literatura. Seguindo as recomendações PRISMA, foram analisados estudos empíricos dos últimos 22 anos, extraídos das bases de dados PubMed e APA PsychNet. Os descritores "Homosexuality, Male" e "Father" foram empregados para a seleção de artigos relevantes, processo realizado independentemente por dois pesquisadores. Os resultados indicam uma complexidade nas experiências parentais de homens homossexuais, variando entre desafios significativos, como estigmas e preconceitos sociais, e situações sem dificuldades notáveis. A decisão de assumir a paternidade nesse grupo é fortemente influenciada por fatores específicos à realidade homoafetiva, inserida em um contexto social frequentemente não acolhedor. Os achados destacam a importância de compreender as interações entre aspectos individuais, sociais e culturais na formação da homoparentalidade masculina. Este estudo sublinha a necessidade de políticas e práticas inclusivas e sensíveis à diversidade, visando o apoio ao bem-estar familiar em contextos homoafetivos.

Trends in HIV prevalence and risk factors among men who have sex with men in Mozambique: implications for targeted interventions and public health strategies.

BACKGROUND: Men who have sex with Men (MSM) are known to contribute to increased HIV prevalence as an integral part of key populations with high vulnerability to HIV/AIDS due to their sexual behaviours. Mozambique conducted two rounds of bio-behavioral surveys (BBS) in this population with the main objective of estimating HIV prevalence and associated risk behaviors among MSM in Mozambique. The present study aims to estimate the trend of HIV prevalence and determine the correlations of HIV infection among MSM. METHODS: A repeated cross-sectional analytical study was conducted from secondary data from the first and second rounds of BBS in Mozambique conducted in 2011 and 2020-2021 respectively. Each round used a similar methodology which allowed for comparison between the two surveys. Chi-square test and logistic regression was used to compare the HIV prevalence between the BBS rounds, identify factors associated with HIV, and assess changes in HIV prevalence across selected risk factors. RESULTS: There was a significant increase in HIV prevalence among MSM (7.1-14.9%), living in Maputo (9.3-14.7%), uncircumcised (11.7-25.1%), and those who reported two sexual partners in the last year (5.2-14.4%). In contrast, there was a decrease in prevalence among adult MSM aged between 25 and 29 years (24.7-13.9%), aged 30 years or older (45.7-27.7%), married (29.1-16.8%), with higher education (16.7-5.9%) and moderate perception of HIV risk (10.9-3.4%). Multivariable analysis showed that factors such as age, marital status, religion, sexual identity, circumcision, and the use of lubrication during anal sex are significantly associated with the risk of HIV infection. CONCLUSIONS: This study underscores the continuing need for HIV prevention and education efforts. The rise in prevalence among specific population segments and the sustained presence of risk factors emphasize the requirement for holistic strategies tailored to the unique requirements of each subgroup. Understanding trends and risk factors is crucial to guiding public health policies and designing efficacious prevention programs that aim to curtail HIV transmission while enhancing the well-being of those impacted by the condition.