Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men.

PURPOSE: The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). DESIGN: Cross-sectional measure validation. SETTING: Participants from Miami, FL. SUBJECTS: 290 LSMM from the DÍMELO study. MEASURES: Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. ANALYSIS: All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. RESULTS: Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. CONCLUSION: Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.

PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research.

HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.

Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida.

Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.

A Rapid Environmental Scan of South Florida HIV Organizations' Mpox Messaging During the August 2022 Peak of the U.S. Outbreak.

The 2022 outbreak of mpox disproportionately impacted men who have sex with men and people living with HIV. As such, HIV organizations were uniquely situated to reach populations affected by mpox. However, the extent to which these organizations pivoted to address mpox, and what form mpox messaging took, is unknown. We conducted a rapid environmental scan of 29 HIV or sexual health organizations to assess the frequency and content of mpox messaging in August 2022, the peak of the mpox outbreak in Miami, FL. Approximately half of the organizations provided mpox messaging, most of which was accurate. Only 5% of the messages were in Spanish and 4% in Spanish and Haitian Creole. Our findings suggest HIV organizations' pivot to mpox messaging may have been delayed overall and in reaching Spanish- and Haitian Creole-speaking communities. Results could inform modifications to mpox messaging campaigns and future outbreaks that disproportionately affect minoritized communities.

RESUMEN: El brote de la viruela del mono en 2022 afectó desproporcionadamente a hombres que tienen relaciones sexuales con hombres y personas que viven con el VIH. Como tal, las organizaciones dedicadas al VIH estaban en una posición única para llegar a las poblaciones afectadas por la viruela del mono. Sin embargo, no se sabe en qué medida estas organizaciones cambiaron su enfoque para abordar la viruela del mono y qué forma tomó la mensajería sobre a la viruela del mono. Realizamos un escaneo ambiental rápido de 29 organizaciones de VIH o salud sexual para evaluar la frecuencia y el contenido de la mensajería sobre la viruela del mono en agosto de 2022, en el pico del brote de la viruela del mono en Miami, Florida. Aproximadamente la mitad de las organizaciones proporcionaron mensajería sobre la viruela del mono, la mayoría de la cual era precisa. Solo el 5% de los mensajes estaban en español y el 4% en español y criollo haitiano. Nuestros hallazgos sugieren que el cambio de enfoque de las organizaciones de VIH hacia la mensajería sobre la viruela del mono puede haber sido en general demorado y que no llegó adecuadamente a las comunidades de habla hispana y criollo haitiano. Los resultados podrían informar modificaciones en las campañas de mensajería sobre la viruela del mono y en futuros brotes que afecten desproporcionadamente a comunidades minorizadas.

Collagenase Clostridium histolyticum Treatment Improves Degree of Curvature in Peyronie's Disease with Calcified Plaques.

BACKGROUND: Peyronie's disease (PD) is a fibrotic condition of the penis characterized by abnormal plaque formation. Intralesional collagenase Clostridium histolyticum (CCh) is effective in noncalcified PD; however, its effectiveness in calcified PD is not well characterized. OBJECTIVE: To assess curvature improvement in calcified PD plaques treated with CCh. DESIGN, SETTING, AND PARTICIPANTS: We prospectively evaluated men with calcified PD electing CCh treatment at our institution from October 2018 to November 2020. We assessed curvature with artificial erection and goniometer before and at least 3 mo after treatment. We classified the type of plaque calcification based on ultrasound. INTERVENTION: Intralesional CCh. Each treatment cycle consisted of two CCh injections (0.58 mg) into the plaque at the point of maximal penile curvature. The second injection was performed 72 h to 1 wk later, after which participants began modeling. All men were intended to receive a total of eight injections in four cycles, each 6 wk apart. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Change in penile curvature after CCh was measured. We assessed for differences in outcomes based on the number of injections and type of calcification. Unless otherwise specified, data are presented as medians (interquartile range). RESULTS AND LIMITATIONS: Sixty men with calcified PD elected CCh; 47 had complete follow-up data. Thirty-nine men completed treatments with eight injections, while the remaining discontinued after a median of five (four to six) injections. There was no difference in response between type 2 and type 3 plaques. Curvature significantly improved by 17.5° (37.5-10.0°) in patients who completed treatment and by 15.0° (20.0-0.0°) in those who discontinued. Limitations include a small sample. CONCLUSIONS: Men with calcified PD plaques improve with CCh treatment and show similar improvements regardless of calcification type. PATIENT SUMMARY: In this study, we evaluated the efficacy of collagenase Clostridium histolyticum (CCh) treatment in calcified Peyronie's disease (PD) plaques. We found that treatment in calcified plaques demonstrated significant improvement in curvature and the grading of calcification did not impact the degree of curvature improvement. We conclude that participants with calcified PD plaques can benefit from nonsurgical CCh treatment.

Impact of COVID-19 on HIV service delivery in Miami-Dade County: a mixed methods study.

BACKGROUND: Facilitating access to HIV prevention and treatment is imperative in Miami-Dade County (MDC), a U.S. HIV epicenter. With COVID-19, disruptions to these services have occurred, leading HIV organizations to innovate and demonstrate resilience. This study documented COVID-19 related disruptions and resilient innovations in HIV services within MDC. METHODS: This mixed methods cross-sectional study included HIV test counselors in MDC. In the quantitative component (N=106), participants reported COVID-19 impacts on HIV service delivery. Data visualization examined patterns within organizations and throughout the study period. Generalized estimating equation modeling examined differences in service disruptions and innovations. In the qualitative component, participants (N=20) completed interviews regarding COVID-19 impacts on HIV services. Rapid qualitative analysis was employed to analyze interviews. RESULTS: Quantitative data showed that innovations generally matched or outpaced disruptions, demonstrating resilience on HIV service delivery during COVID-19. HIV testing (36%, 95%CI[28%, 46%]) and STI testing (42%, 95%CI[33%, 52%]) were most likely to be disrupted. Sexual/reproductive health (45%, 95%CI[35%, 55%]), HIV testing (57%, 95%CI[47%,66%]), HIV case management (51%, 95%CI[41%, 60%]), PrEP initiation (47%, 95%CI[37%,57%]), and STI testing (47%, 95%CI[37%, 57%]) were most likely to be innovated. Qualitative analysis revealed three orthogonal themes related to 1) disruptions (with five sub-components), 2) resilient innovations (with four sub-components), and 3) emerging and ongoing health disparities. CONCLUSIONS: HIV organizations faced service disruptions during COVID-19 while also meaningfully innovating. Our findings point to potential changes in policy and practice that could be maintained beyond the immediate impacts of COVID-19 to enhance the resilience of HIV services. Aligning with the US Ending the HIV Epidemic Plan and the National Strategy for HIV/AIDS, capitalizing on the observed innovations would facilitate improved HIV-related health services for people living in MDC and beyond.

Latino sexual minority men's intersectional minority stress, general stress, and coping during COVID-19: A rapid qualitative study.

Introduction: Sexual minority men face mental health, substance use, and HIV disparities, all of which can be understood by minority stress and intersectionality theories. With the emergence of COVID-19 and considering its disproportionate impact on Latinx and sexual minority communities, Latino sexual minority men (LSMM) may be facing unique consequences of this new pandemic that intersect with pre-COVID disparities. The purpose of the current study is to explore the impact of the COVID-19 pandemic on LSMM's intersectional minority stress, general stress, and coping, filling a gap in the current literature. Methods: The current rapid qualitative study explores the impact of COVID-19 on LSMM in South Florida who reported being HIV-negative (N=10) or living with HIV (N=10). Results: The rapid analysis revealed themes of exacerbated intersectional minority stress and general stress in the context of COVID-19, some of which was related to the impact of pre-COVID-19 disparities in the LSMM community. Participants reported a variety of coping responses, some of which participants found helpful and others (e.g., substance use) which further exacerbated disparities. Conclusion: The findings underscore the need to scale up and disseminate behavioral health resources to LSMM to address the impact of the COVID-19 pandemic on this community's health and well-being.

The impact of perceived stress on the hair follicle: Towards solving a psychoneuroendocrine and neuroimmunological puzzle.

While popular belief harbors little doubt that perceived stress can cause hair loss and premature graying, the scientific evidence for this is arguably much thinner. Here, we investigate whether these phenomena are real, and show that the cyclic growth and pigmentation of the hair follicle (HF) provides a tractable model system for dissecting how perceived stress modulates aspects of human physiology. Local production of stress-associated neurohormones and neurotrophins coalesces with neurotransmitters and neuropeptides released from HF-associated sensory and autonomic nerve endings, forming a complex local stress-response system that regulates perifollicular neurogenic inflammation, interacts with the HF microbiome and controls mitochondrial function. This local system integrates into the central stress response systems, allowing the study of systemic stress responses affecting organ function by quantifying stress mediator content of hair. Focusing on selected mediators in this "brain-HF axis" under stress conditions, we distill general principles of HF dysfunction induced by perceived stress.

Latinx Sexual Minority Men's Access to HIV and Behavioral Health Services in South Florida During COVID-19: A Qualitative Study of Barriers, Facilitators, and Innovations.

ABSTRACT: Despite the availability of HIV prevention and treatment tools, HIV disparities continue to affect Latinx sexual minority men (LSMM). Behavioral health concerns further exacerbate HIV disparities among LSMM. This study used rapid qualitative analysis to understand factors influencing LSMM's access to HIV and behavioral health services during coronavirus disease 2019 (COVID-19). Participants included LSMM with (n = 10) and without HIV (n = 10). The analysis identified 15 themes. Themes revealed that LSMM's access was disrupted by new and worsening barriers resulting from COVID-19, such as anxiety about COVID-19 exposure, confusion and disruptions to services, and new structural challenges. Other themes highlight positive changes, such as telehealth and relaxed clinic protocols, which enhanced LSMM's access to services during COVID-19. The findings suggest the need for HIV and behavioral health clinics to innovate and ensure LSMM's continued access to services during and beyond COVID-19.

"Let's Hook Up When the Pandemic is Over:" Latinx Sexual Minority Men's Sexual Behavior During COVID-19.

COVID-19 led to substantial changes in individuals' lives due to preventive measures, including social distancing and "stay at home" orders. One type of social interaction likely impacted is intimacy and sexual relationships. Sexual minority men have long navigated the impact of another pandemic, HIV, on their sexual lives. This study explored the impact of COVID-19 on Latinx sexual minority men's (LSMM) sexual behaviors in South Florida, an HIV and COVID-19 epicenter. A rapid qualitative analysis of semi-structured interviews with LSMM (N = 20) revealed five themes: (1) increased sex with a primary partner, (2) fewer sexual partners, (3) continued pre-COVID-19 sexual activity, often following "quarantine fatigue," (4) opportunities and challenges related to navigating COVID-19 prevention and sex, and (5) using sexual networking apps in new ways. The findings suggest LSMM's resilience and their ongoing health needs during COVID-19, with implications for interventions to promote LSMM's safe and satisfying sex.