PrEP Awareness in the Context of HIV/AIDS Conspiracy Beliefs Among Black/African American and Hispanic/Latino MSM in Three Urban US Cities.

We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18-29 (50%), 30-39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38-0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.

Brief Report: Quantitative Assessment of Brief Messages About HIV Pre-exposure Prophylaxis Among HIV-Infected and HIV-Uninfected Black/African American and Hispanic/Latino MSM.

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is efficacious; however, many men who have sex with men (MSM) (especially racial/ethnic minorities) are still unaware of and underuse it. METHODS: The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n = 937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n = 607) and a PrEP message tailored for HIV-infected MSM (n = 330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS: Among HIV-uninfected MSM, black (vs Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs 70% respectively, P < 0.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (P > 0.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report that the PrEP message enhanced their intent to use condoms in the future. DISCUSSION: Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media.

Effects of Brief Messages About Antiretroviral Therapy and Condom Use Benefits Among Black and Latino MSM in Three U.S. Cities.

This pilot study examined effects of HIV prevention messages about self and partner benefits of antiretroviral therapy (ART) and condom effectiveness on increased intentions for behavior change. Data were from Messages4Men, a study examining prevention messages among 320 HIV-positive and 605 HIV-negative Black and Latino MSM. Men completed a computer-based assessment after message exposure, and multivariable models controlled for risky sex and demographics. A majority of HIV-positive men reported increased intentions for ART use; 22% reported partner benefit information was new. HIV-positive men with a detectable viral load had significantly greater adjusted odds of reporting intentions for ART use. Over half of HIV-negative MSM reported ART benefit information was new, and 88% reported increased intentions to discuss ART use with infected partners. Black MSM anticipated they would increase condom use in response to the self and partner benefit messages. Tailored messages on benefits of ART are needed for MSM.

Mobile Phone and Internet Use Mostly for Sex-Seeking and Associations With Sexually Transmitted Infections and Sample Characteristics Among Black/African American and Hispanic/Latino Men Who Have Sex With Men in 3 US Cities.

BACKGROUND: Men who have sex with men (MSM) have a relatively high prevalence of sexually transmitted infections (STIs). This study examines the association of self-reported STIs and use of mobile phones and/or computer-based Internet to meet sexual partners among black and Hispanic/Latino MSM in the United States. METHODS: Black and Hispanic/Latino MSM (N = 853) were recruited from 3 US cities (Chicago, IL; Kansas City, MO; and Fort Lauderdale, FL) via online and community outreach. Men completed a computer-assisted, self-interview assessment on demographics, use of mobile phones and computer-based Internet for sex-seeking, sexual risk behavior, and self-reported bacterial STIs in the past year. Multivariable logistic regression was used to model independent associations of STIs and use of these technologies to meet sexual partners. RESULTS: Twenty-three percent of the sample reported having an STI in the past year; 29% reported using a mobile phone and 28% a computer-based Internet mostly for sex-seeking; and 22% reported using both. Number of male sexual partners (past year) was associated with any STI (adjusted odds ratio, 1.03; 95% confidence interval, 1.01-1.06). Adjusting for human immunodeficiency virus status, number of male sexual partners (past year), and demographic variables, men who reported use of both mobile phones and computer-based Internet for sex-seeking had increased odds of reporting an STI (adjusted odds ratio, 2.59; 95% confidence interval, 1.75-3.83), as well as with separate reports of chlamydia, gonorrhea, and syphilis (P's < 0.05). CONCLUSIONS: Enhanced community education regarding STI prevention, testing, and treatment options are necessary among this subpopulation of MSM who may benefit from messaging via Internet and mobile phone application sites.

Reactions and Receptivity to Framing HIV Prevention Message Concepts About Pre-Exposure Prophylaxis for Black and Latino Men Who Have Sex with Men in Three Urban US Cities.

Men who have sex with men (MSM) of color are disproportionately affected by HIV in the United States. Pre-exposure prophylaxis (PrEP) using antiretroviral medications is a newer biomedical prevention modality with established efficacy for reducing the risk of acquiring HIV. We conducted formative qualitative research to explore audience reactions and receptivity to message concepts on PrEP as part of the development of prevention messages to promote PrEP awareness among black and Latino MSM in the United States. In 2013, 48 black and 42 Latino (total study sample = 90) mixed HIV serostatus MSM from Chicago, Ft. Lauderdale, and Kansas City participated in either an individual interview or focus group discussion. Men were recruited online and at community-based organizations in each city. We elicited feedback on the comprehensibility, credibility, and relevance of two draft messages on PrEP. The messages included efficacy estimates from iPrEx, a phase III clinical trial to ascertain whether the antiretroviral medication tenofovir/emtricitabine disoproxil fumarate (commercially known as Truvada®) could safely and effectively prevent HIV acquisition through sex among MSM and transgender women. With participants' consent, the interviews and focus groups were recorded and transcribed. The data were then summarized and analyzed using a qualitative descriptive approach. The majority of men were unfamiliar with PrEP. It was suggested that additional information about the medication and clinical trials establishing efficacy was needed to enhance the legitimacy and relevancy of the messages. Participants sought to form an opinion of PrEP that was grounded in their own interpretation of the efficacy data. However, confusion about nonadherence among clinical trial subjects and individual versus average risk limited comprehension of these messages. Thematic overlaps suggest that message believability was connected to participants' ability to derive meaning from the PrEP efficacy data. Despite being concerned that other MSM would interpret the messages to mean that condom use was unnecessary while taking PrEP, participants themselves primarily understood PrEP as a supplement rather than a replacement for condoms. Based on their experience with taking antiretroviral medication, HIV-positive men considered condom use a more feasible form of HIV prevention than PrEP. Participants' responses suggest that more information about PrEP and the clinical trial would support the legitimacy of PrEP and the messages as a whole. These details may enhance believability in the concept of PrEP and reinforce confidence in the validity of the efficacy result.

Portuguese American gay men in southeastern Massachusetts: cultural scripts and risk for HIV.

In this study, we examined the lived experiences of an understudied subgroup, Portuguese American gay men, within the context of sexual script theory. We employed a phenomenological study design with eight men to provide a more in-depth analysis of their sociocultural sexual behaviours. Recruitment was conducted through word of mouth and a snowball approach beginning with two well-known HIV education and prevention outreach centres in southeastern Massachusetts. In this study, the sexual scripts of the participants were conceptualised within the three domains of cultural, interpersonal and intrapsychic scripts. Our findings suggest the three scripts are constantly interacting and informing one another. This ongoing negotiation influences the way our participants position their sexuality within the broader context of their everyday life within the US Portuguese community. Participants script their sexuality while they navigate multiple but separate entities within their culture, their religion and their families. Learning from these experiences could have important implications for the development of HIV prevention programmes for specific subgroups of men who have sex with men.

Effects of Brief Messaging About Undiagnosed Infections Detected through HIV Testing Among Black and Latino Men Who Have Sex With Men in the United States.

We examined intent to get tested for HIV infection and use condoms among n = 604 uninfected black and Latino men who have sex with men after receiving brief information messaging that 1 in 10 minority men who have sex with men had HIV infection and did not know it. Information awareness, newness, believability, HIV testing cost willingness, and associated demographic variables were also assessed.

Interdisciplinary HIV care in a changing healthcare environment in the USA.

HIV remains a complex disease that requires comprehensive, coordinated care to ensure optimal outcomes. In the USA, interdisciplinary models of care have developed over time to optimize treatment outcomes. These models may be increasingly important in an era of healthcare reform in the USA. A qualitative study of nine clinical sites funded by the Ryan White HIV/AIDS Program (RWHAP), the federally funded "safety net" program for uninsured and underinsured people living with HIV, was undertaken to identify components of successful models of interdisciplinary HIV care. Findings suggest that these include: (1) patient-centered, one-stop-shop approaches with integrated or co-located services; (2) diverse teams of clinical and nonclinical providers; (3) a site culture that promotes a stigma reducing environment for clients; (4) the availability of a comprehensive array of medical, behavioral health, and psychosocial services; (5) effective communication strategies, including electronic health records (EHRs); and (6) a focus on quality. The importance of RWHAP funding in sustaining these programs is highlighted.

Metabolic Depression is Delayed and Mitochondrial Impairment Averted during Prolonged Anoxia in the ghost shrimp, Lepidophthalmus louisianensis (Schmitt, 1935).

Lepidophthalmus louisianensis burrows deeply into oxygen-limited estuarine sediments and is subjected to extended anoxia at low tides. Large specimens (>2 g) have a lethal time for 50% mortality (LT(50)) of 64 h under anoxia at 25º C. Small specimens (<1 g) have a significantly higher LT(50) of 113 h, which is the longest ever reported for a crustacean. Whole body lactate levels rise dramatically under anoxia and exceed 120 µmol g.f.w.(-1) by 72 h. ATP, ADP, and AMP do not change during 48 h of anoxia, but arginine phosphate declines by over 50%. Thus arginine phosphate may help stabilize the ATP pool. Surprisingly, when compared to the aerobic resting rate, ATP production under anoxia is unchanged during the first 12 h, and drops to only about 50% between 12 and 48 h. Finally, after 48 h of anoxia, a major metabolic depression to less than 5% occurs. Downregulation of metabolism is delayed in L. louisianensis compared to many invertebrates that exhibit facultative anaerobiosis. Bioenergetic constraints as a result of eventual metabolic depression led to ionic disturbances like calcium overload and compromised membrane potential of mitochondria. Because these phenomena trigger apoptosis in mammalian species, we evaluated the susceptibility of ghost shrimp mitochondria to opening of the mitochondrial permeability transition pore (MPTP) and associated damage. Energized mitochondria isolated from hepatopancreas possess a pronounced capacity for calcium uptake. Exogenous calcium does not stimulate opening of the MPTP, which potentially could reduce cell death during prolonged anoxia.

Immune defense reduces respiratory fitness in Callinectes sapidus, the Atlantic blue crab.

Crustacean gills function in gas exchange, ion transport, and immune defense against microbial pathogens. Hemocyte aggregates that form in response to microbial pathogens become trapped in the fine vasculature of the gill, leading to the suggestion by others that respiration and ion regulation might by impaired during the course of an immune response. In the present study, injection of the pathogenic bacterium Vibrio campbellii into Callinectes sapidus, the Atlantic blue crab, caused a dramatic decline in oxygen uptake from 4.53 to 2.56 micromol g-1 h-1. This decline in oxygen uptake is associated with a large decrease in postbranchial PO2, from 16.2 (+/-0.46 SEM, n=7) to 13.1 kPa (+/-0.77 SEM, n=9), while prebranchial PO2 remains unchanged. In addition, injection of Vibrio results in the disappearance of a pH change across the gills, an indication of reduced CO2 excretion. The hemolymph hydrostatic pressure change across the gill circulation increases nearly 2-fold in Vibrio-injected crabs compared with a negligible change in pressure across the gill circulation in saline-injected, control crabs. This change, in combination with stability of heart rate and branchial chamber pressure, is indicative of a significant increase in vascular resistance across the gills that is induced by hemocyte nodule formation. A healthy, active blue crab can eliminate most invading bacteria, but the respiratory function of the gills is impaired. Thus, when blue crabs are engaged in the immune response, they are less equipped to engage in oxygen-fueled activities such as predator avoidance, prey capture, and migration. Furthermore, crabs are less fit to invade environments that are hypoxic.

Effects of hypercapnic hypoxia on the clearance of Vibrio campbellii in the Atlantic blue crab, Callinectes sapidus Rathbun.

Callinectes sapidus, the Atlantic blue crab, encounters hypoxia, hypercapnia (elevated CO(2)), and bacterial pathogens in its natural environment. We tested the hypothesis that acute exposure to hypercapnic hypoxia (HH) alters the crab's ability to clear a pathogenic bacterium, Vibrio campbellii 90-69B3, from the hemolymph. Adult male crabs were held in normoxia (well-aerated seawater) or HH (seawater with PO(2) = 4 kPa; PCO(2) = 1.8 kPa; and pH = 6.7-7.1) and were injected with 2.5 x 10(4) Vibrio g(-1) body weight. The animals were held in normoxia or in HH for 45, 75, or 210-240 min before being injected with Vibrio, and were maintained in their respective treatment conditions for the 120-min duration of the experiment. Vibrio colony-forming units (CFU) ml(-1) hemolymph were quantified before injection, and at 10, 20, and 40 min afterward. Total hemocytes (THC) ml(-1) of hemolymph were counted 24 h before (-24 h), and at 10 and 120 min after injection. Sham injections of saline produced no change in the bacterial or hemocyte counts in any treatment group. Among the groups that received bacterial injections, Vibrio was almost completely cleared within 1 h, but at 10-min postinjection, Vibrio CFU ml(-1) hemolymph was significantly higher in animals held in HH for 75 and 210-240 min than in those held in normoxia. Within 10 min after crabs were injected with bacteria, THC ml(-1) significantly decreased in control and HH45 treatments, but not in the HH75 and HH210-240 treatments. By 120 min after injection of bacteria, hemocyte counts decreased in all but the HH45 group. These data demonstrate that HH significantly impairs the ability of blue crabs to clear Vibrio from the hemolymph. These results also suggest that HH alters the normal role of circulating hemocytes in the removal of an invading pathogen.