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1.
J Int AIDS Soc ; 27(7): e26323, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38982574

RESUMO

INTRODUCTION: Chemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk factors, including condomless sex and reduced adherence to pre-exposure prophylaxis or antiretroviral therapy (ART). In the Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This study aims to compare recent and lifetime chemsex engagement in association with self-reported HIV status among Filipino men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people living with HIV engaged in chemsex. METHODS: A cross-sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demographic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association between self-reported HIV status and chemsex engagement. RESULTS: Among the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to those not engaged in drug use and chemsex (average age 31-33 vs. 29 years old; p<0.05). Methamphetamine was the most common drug for people who reported using drugs. An HIV-positive status was associated with recent chemsex engagement (aOR = 5.18, p<0.05) and a history of STIs (aOR = 2.09, p<0.05). The subgroup analysis showed that 79% (166/200) of persons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence in the logistic regression analyses. CONCLUSIONS: Chemsex behaviour, particularly recent chemsex engagement, is significantly associated with self-reported HIV status. The emerging data on MSM engaged in chemsex require integration of a more person-centred, comprehensive and robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks, alongside proper medical management.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Adesão à Medicação , Humanos , Masculino , Filipinas/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Infecções por HIV/epidemiologia , Estudos Transversais , Adulto , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Adesão à Medicação/estatística & dados numéricos , Adulto Jovem , Pessoa de Meia-Idade , Adolescente , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Antirretrovirais/uso terapêutico , Fatores de Risco
2.
J Int AIDS Soc ; 27 Suppl 2: e26240, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38982888

RESUMO

INTRODUCTION: Measuring the coverage of HIV prevention services for key populations (KPs) has consistently been a challenge for national HIV programmes. The current frameworks and measurement methods lack emphasis on effective coverage, occur infrequently, lack timeliness and limit the participation of KPs. The Effective Programme Coverage framework, which utilizes a programme science approach, provides an opportunity to assess gaps in various coverage domains and explore the underlying reasons for these gaps, in order to develop targeted solutions. We have demonstrated the application of this framework in partnership with the KP community in Nairobi, Kenya, using an expanded Polling Booth Survey (ePBS) method. METHODS: Data were collected between April and May 2023 among female sex workers (FSWs) and men who have sex with men (MSM) using (a) PBS, (b) bio-behavioural survey and (c) focus group discussions. Data collection and analysis involved both KP community and non-community researchers. Descriptive analysis was performed, and proportions were used to assess the programme coverage gaps. The data were weighted to account for the sampling design and unequal selection probabilities. Thematic analysis was conducted on the qualitative data. RESULTS: The condom programme for FSW and MSM had low availability (60.2% and 50.9%), contact (68.8% and 65.9%) and utilization (52.1% and 43.9%) coverages. The pre-exposure prophylaxis (PrEP) programme had very low utilization coverage for FSW and MSM (4.4% and 2.8%), while antiretroviral therapy utilization coverage was higher (86.6% and 87.7%). Reasons for coverage gaps included a low peer educator-to-peer ratio, longer distance to the clinics, shortage of free condoms supplied by the government, experienced and anticipated side effects related to PrEP, and stigma and discrimination experienced in the facilities. CONCLUSIONS: The Effective Programme Coverage framework allows programmes to assess coverage gaps and develop solutions and a research agenda targeted at specific domains of coverage with large gaps. The ePBS method works well in collecting data to understand coverage gaps rapidly and allows for the engagement of the KP community.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Profissionais do Sexo , Humanos , Quênia , Masculino , Infecções por HIV/prevenção & controle , Profissionais do Sexo/estatística & dados numéricos , Profissionais do Sexo/psicologia , Adulto , Feminino , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto Jovem , Inquéritos e Questionários , Adolescente , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde
3.
Hum Vaccin Immunother ; 20(1): 2371179, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38972858

RESUMO

The Victorian Government introduced a time-limited human papillomavirus (HPV) catch-up program for gay, bisexual, and other men who have sex with men (GBMSM) aged ≤ 26 years in 2017-2019. We conducted a retrospective observational study to examine the accuracy of the self-report of HPV vaccination status using computer-assisted self-interviewing versus their immunization history via electronic health records. We included GBMSM aged 23-30 years visiting the Melbourne Sexual Health Centre (MSHC) in 2020-2021 because they were age-eligible for the HPV catch-up program in Victoria, Australia. Individuals who were unsure about their vaccination status were categorized as 'unvaccinated'. Of the 1,786 eligible men, 1,665 men self-reported their HPV vaccination status: 48.8% (n = 812) vaccinated, 17.4% (n = 289) unvaccinated, and 33.9% (n = 564) unsure. Self-reported HPV vaccination had a sensitivity of 61.3% (95%CI: 58.3 to 64.2%; 661/1079), a specificity of 74.2% (95%CI: 70.5 to 77.7%; 435/586), a positive predictive value of 81.4% (95%CI: 78.6 to 84.0%; 661/812), a negative predictive value of 51.0% (95%CI: 47.6 to 54.4%; 435/853), and an accuracy of 52.6% (95%CI: 50.1 to 55.0%). Our results showed that only half of GBMSM know and report their HPV vaccination status correctly. Novel approaches such as digital vaccine passports may be useful for individuals to accurately report their vaccination status to guide accurate clinical decisions and management.


Assuntos
Homossexualidade Masculina , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Autorrelato , Vacinação , Humanos , Masculino , Vacinas contra Papillomavirus/administração & dosagem , Adulto , Infecções por Papillomavirus/prevenção & controle , Adulto Jovem , Estudos Retrospectivos , Homossexualidade Masculina/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Vitória , Minorias Sexuais e de Gênero/estatística & dados numéricos , Papillomavirus Humano
4.
Front Cell Infect Microbiol ; 14: 1412753, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38979508

RESUMO

Background: Monkeypox virus (MPXV) is spreading globally and nearly half of the infected people were human immunodeficiency virus (HIV) positive. Therefore, an in-depth understanding of the effects of HIV infection on the outcomes of MPXV infection is urgently needed. This study aimed to explore the clinical features, viral dynamics, and antibody response to MPXV infections in men who had sex with men (MSM) with and without HIV co-infection. Design or methods: MPXV-infected patients diagnosed by PCR were recruited in this study and were divided into MPXV and MPXV + HIV groups based on whether they were co-infected with HIV. Clinical data and samples were collected during of the hospital stay and follow up interviews. The symptoms and signs, laboratory examinations, viral shedding in various body fluids or swabs, antibody dynamics were tracked and compared between the two groups. Results: A total of 41 MPXV patients were recruited through June 2023 to September 2023 in Guangzhou. The MPXV group and MPXV + HIV group comprised 20 and 21 MSM, respectively. Patients in the two groups exhibited similar clinical characteristics except for pruritus and eschar, both were significantly fewer in MPXV + HIV group than in MPXV only group. Among the 355 clinical samples collected, MPXV DNA was detected in 100% of scabs, 97.4% of skin swabs, and 92.3% of exudate swabs from lesions, while the positive rate was 87.5% from oropharyngeal swabs, 59% from saliva, 51.3% from anal swabs, 50% from feces, 30.6% from urine samples, 37.5% of semen, and 28.2% from sera. Dynamics analysis revealed that viral DNA was undetectable in most patients 20 days after symptom onset. IgM and IgG antibodies to MPXV were detected in all patients with 3-5 days earlier in the MPXV group than in the MPXV + HIV group. Conclusion: This cohort analysis based on a large outbreak among MSM in Guangzhou indicated no obvious differences in clinical symptoms, viral DNA data, but antibody responses were 3-5 days later in mpox patients with HIV infection.


Assuntos
Anticorpos Antivirais , Coinfecção , Infecções por HIV , Homossexualidade Masculina , Monkeypox virus , Mpox , Humanos , Masculino , Infecções por HIV/complicações , Infecções por HIV/imunologia , Infecções por HIV/epidemiologia , China/epidemiologia , Adulto , Anticorpos Antivirais/sangue , Coinfecção/virologia , Coinfecção/epidemiologia , Mpox/epidemiologia , Mpox/imunologia , Monkeypox virus/imunologia , Monkeypox virus/genética , Eliminação de Partículas Virais , Pessoa de Meia-Idade , Formação de Anticorpos , Carga Viral , Adulto Jovem
5.
BMC Public Health ; 24(1): 1741, 2024 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-38951768

RESUMO

Nitrite inhalants (poppers) are associated with HIV transmission and commonly used among young men who have sex with men (YMSM), a group at increased risk for HIV. Significant research gaps exist in understanding the context in which YMSM use poppers. Qualitative interviews were conducted with 15 YMSM (22-31 years) with HIV to better understand the context in which poppers are used and their impacts on HIV care outcomes, such as care retention and antiretroviral adherence. The Social Ecological Model was applied to understand intrapersonal, interpersonal, community, and system level influences on popper use. Factors influencing popper use included: ubiquity of popper use in sexual settings, introduction to poppers by casual sexual partners, patient-HIV provider communication surrounding poppers, neighborhood, substance use and HIV care systems, and the legal status of poppers. Implications for clinical care, public health, policy, and future research are discussed.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Pesquisa Qualitativa , Humanos , Masculino , Infecções por HIV/tratamento farmacológico , Adulto , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto Jovem , Nitritos/efeitos adversos , Entrevistas como Assunto
6.
BMC Public Health ; 24(1): 1765, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956521

RESUMO

BACKGROUND: Several studies have demonstrated the population-level effectiveness of oral PrEP in reducing the risk of HIV infection. However, oral PrEP utilization among MSM in China remains below 1%. While existing literature has primarily focused on oral PrEP preference and willingness, there is limited exploration of the underlying factors contributing to oral PrEP cessation in China. This study aims to fill this gap by investigating the factors associated with oral PrEP cessation among MSM in China. METHODS: Assisted by MSM community organizations, we collected 6,535 electronic questionnaires from 31 regions across China, excluding Taiwan, Hong Kong, and Macau. The questionnaire focused on investigating MSM's awareness, willingness, usage, and cessation of oral PrEP. Additionally, 40 participants were randomly chosen for key informant interviews. These qualitative interviews aimed to explore the reasons influencing MSM discontinuing oral PrEP. RESULTS: We eventually enrolled 6535 participants. Among the 685 participants who had used oral PrEP, 19.70% (135/685) ceased oral PrEP. The results indicated that individuals spending > ¥1000 on a bottle of PrEP (aOR = 2.999, 95% CI: 1.886-4.771) were more likely to cease oral PrEP compared to those spending ≤ ¥1000. Conversely, individuals opting for on-demand PrEP (aOR = 0.307, 95% CI: 0.194-0.485) and those using both daily and on-demand PrEP (aOR = 0.114, 95% CI: 0.058-0.226) were less likely to cease PrEP compared to those using daily PrEP. The qualitative analysis uncovered eight themes influencing oral PrEP cessation: (i) High cost and low adherence; (ii) Sexual inactivity; (iii) Lack of knowledge about PrEP; (iv) Trust in current prevention strategies; (v) Poor quality of medical service and counseling; (vi) PrEP stigma; (vii) Partner and relationship factors; (viii) Access challenges. CONCLUSIONS: The cessation of oral PrEP among MSM in China is associated with various factors, including the cost of oral PrEP medication, regimens, individual perception of HIV risk, stigma, and the quality of medical services. It is recommended to provide appropriate regimens for eligible MSM and develop tailored combinations of strategies to enhance PrEP awareness and acceptance among individuals, medical staff, and the MSM community. The findings from this study can support the refinement of HIV interventions among MSM in China, contributing to efforts to reduce the burden of HIV in this population.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Profilaxia Pré-Exposição , Pesquisa Qualitativa , Humanos , Masculino , Profilaxia Pré-Exposição/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , China , Adulto , Infecções por HIV/prevenção & controle , Adulto Jovem , Administração Oral , Inquéritos e Questionários , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Adolescente
8.
J Int AIDS Soc ; 27 Suppl 1: e26265, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38965982

RESUMO

INTRODUCTION: Improving the delivery of existing evidence-based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state-level policy changes; however, suboptimal implementation can be addressed directly through interventions designed to improve the reach, effectiveness, adoption or maintenance of available interventions. Our objective was to estimate the cost-effectiveness and potential epidemiological impact of six real-world implementation interventions designed to address these barriers and increase the scale of delivery of interventions for HIV testing and pre-exposure prophylaxis (PrEP) in three US metropolitan areas. METHODS: We used a dynamic HIV transmission model calibrated to replicate HIV microepidemics in Atlanta, Los Angeles (LA) and Miami. We identified six implementation interventions designed to improve HIV testing uptake ("Academic detailing for HIV testing," "CyBER/testing," "All About Me") and PrEP uptake/persistence ("Project SLIP," "PrEPmate," "PrEP patient navigation"). Our comparator scenario reflected a scale-up of interventions with no additional efforts to mitigate implementation and structural barriers. We accounted for potential heterogeneity in population-level effectiveness across jurisdictions. We sustained implementation interventions over a 10-year period and evaluated HIV acquisitions averted, costs, quality-adjusted life years and incremental cost-effectiveness ratios over a 20-year time horizon (2023-2042). RESULTS: Across jurisdictions, implementation interventions to improve the scale of HIV testing were most cost-effective in Atlanta and LA (CyBER/testing cost-saving and All About Me cost-effective), while interventions for PrEP were most cost-effective in Miami (two of three were cost-saving). We estimated that the most impactful HIV testing intervention, CyBER/testing, was projected to avert 111 (95% credible interval: 110-111), 230 (228-233) and 101 (101-103) acquisitions over 20 years in Atlanta, LA and Miami, respectively. The most impactful implementation intervention to improve PrEP engagement, PrEPmate, averted an estimated 936 (929-943), 860 (853-867) and 2152 (2127-2178) acquisitions over 20 years, in Atlanta, LA and Miami, respectively. CONCLUSIONS: Our results highlight the potential impact of interventions to enhance the implementation of existing evidence-based interventions for the prevention and diagnosis of HIV.


Assuntos
Análise Custo-Benefício , Infecções por HIV , Homossexualidade Masculina , Profilaxia Pré-Exposição , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/diagnóstico , Masculino , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/economia , Epidemias/prevenção & controle , Estados Unidos/epidemiologia , Adulto , Georgia/epidemiologia , Los Angeles/epidemiologia , Florida/epidemiologia , Adulto Jovem , Teste de HIV/métodos
10.
Indian J Public Health ; 68(2): 251-261, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38953814

RESUMO

With increasing importance being given to preexposure prophylaxis (PrEP) for human immunodeficiency virus prevention among men who have sex with men (MSM) and transgender persons (TG), we undertook a systematic review and meta-analysis of PrEP awareness and acceptability among these key populations in India, and their sociodemographic and behavioral determinants. The systematic review was registered with PROSPERO (CRD42023390508). Studies were included if they provided quantitative data on PrEP awareness or acceptability among MSM or TG in India. MEDLINE, Scopus, Web of Science, and Embase were searched from inception to February 29, 2024, using keywords and database-specific terms. Relevant websites were also searched. Critical appraisal was done using the Joanna Briggs Institute Checklist for Prevalence Studies. Random-effects meta-analysis was done for common outcomes reported by the studies. Reporting was as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement. Ten studies providing cross-sectional data, mostly from South West India, were included for qualitative synthesis. All were conducted in settings where PrEP was not available. The pooled prevalence among MSM and TG was 18.7% (95% confidence interval [CI] 8.7%, 28.7%) for awareness and 79.8% (95% CI 57.4%, 100.0%) for willingness to use daily oral PrEP. This review highlights the felt need for PrEP among MSM and TG in India. Further research is needed to understand user attitudes in different parts of the country.


Assuntos
Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Profilaxia Pré-Exposição , Pessoas Transgênero , Humanos , Masculino , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Índia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , Feminino
11.
J Acquir Immune Defic Syndr ; 96(5): 439-446, 2024 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-38985441

RESUMO

BACKGROUND: Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSILs). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years old, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH). SETTING: We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, CA. METHODS: One hundred twenty-nine MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with a biopsy of visible lesions. RESULTS: Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (odds ratio: 45.1, 95% confidence interval: 15.8-129); other oncogenic HPV types (odds ratio: 5.95, 95% confidence interval: 2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status. CONCLUSION: The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remains very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening.


Assuntos
Neoplasias do Ânus , Infecções por HIV , Homossexualidade Masculina , Infecções por Papillomavirus , Lesões Intraepiteliais Escamosas , Humanos , Masculino , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/complicações , Pessoa de Meia-Idade , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Prevalência , Lesões Intraepiteliais Escamosas/virologia , Lesões Intraepiteliais Escamosas/epidemiologia , Lesões Intraepiteliais Escamosas/patologia , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/virologia , Idoso , São Francisco/epidemiologia , Canal Anal/virologia , Canal Anal/patologia , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação
12.
PLoS One ; 19(7): e0306280, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38950031

RESUMO

BACKGROUND: In the Republic of Ireland, the COVID-19 crisis led to sexual health service closures while clinical staff were redeployed to the pandemic response. Gay, bisexual and other men who have sex with men (gbMSM) face pre-existing sexual health inequalities which may have been exacerbated. The aim of this study is to understand sexual health service accessibility for gbMSM in Ireland during the COVID-19 crisis. METHODS: EMERGE recruited 980 gbMSM in Ireland (June-July 2021) to an anonymous online survey investigating well-being and service access through geo-location sexual networking apps (Grindr/Growlr), social media (Facebook/Instagram/Twitter) and collaborators. We fit multiple regression models reporting odds ratios (ORs) to understand how demographic and behavioural characteristics (age, sexual orientation, HIV testing history/status, region of residence, region of birth and education) were associated with ability to access services. RESULTS: Of the respondents, 410 gbMSM accessed sexual health services with some or no difficulty and 176 attempted but were unable to access services during the COVID-19 crisis. A further 382 gbMSM did not attempt to access services and were excluded from this sample and analysis. Baseline: mean age 35.4 years, 88% gay, 83% previously tested for HIV, 69% Dublin-based, 71% born in Ireland and 74% with high level of education. In multiple regression, gbMSM aged 56+ years (aOR = 0.38, 95%CI:0.16, 0.88), not previously tested for HIV (aOR = 0.46, 95%CI:0.23, 0.93) and with medium and low education (aOR = 0.55 95%CI:0.35, 0.85) had lowest odds of successfully accessing services. GbMSM with HIV were most likely to be able to access services successfully (aOR = 2.68 95%CI:1.83, 6.08). Most disrupted services were: STI testing, HIV testing and PrEP. CONCLUSIONS: Service access difficulties were found to largely map onto pre-existing sexual health inequalities for gbMSM. Future service development efforts should prioritise (re)engaging older gbMSM, those who have not previously tested for HIV and those without high levels of education.


Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Homossexualidade Masculina , Saúde Sexual , Humanos , Masculino , COVID-19/epidemiologia , Irlanda/epidemiologia , Adulto , Pessoa de Meia-Idade , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , SARS-CoV-2/isolamento & purificação , Pandemias , Infecções por HIV/epidemiologia , Idoso , Bissexualidade/estatística & dados numéricos
13.
Infect Dis (Lond) ; 56(8): 589-605, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38958049

RESUMO

BACKGROUND: The ongoing multi-country mpox outbreak in previously unaffected countries is primarily affecting sexual networks of men who have sex with men. Evidence is needed on the effectiveness of recommended preventive interventions. To inform WHO guidelines, a systematic review and qualitative evidence synthesis were conducted on mpox preventive behavioural interventions to reduce: (i) sexual acquisition; (ii) onward sexual transmission from confirmed/probable cases; and (iii) utility of asymptomatic testing. METHODS: Medline, EMBASE, PubMed, Cochrane and WHO trial databases, grey literature and conferences were searched for English-language primary research published since 1 January 2022. A reviewer team performed screening, data extraction and bias assessment. A qualitative thematic synthesis explored views and experiences of engagement in prevention in individuals at increased risk. RESULTS: There were 16 studies: 1 on contact-tracing, 2 on sexual behaviour, and 13 on asymptomatic testing. Although MPXV was detected in varying proportions of samples (0.17%-6.5%), the testing studies provide insufficient evidence to fully evaluate this strategy. For the qualitative evidence synthesis, four studies evaluated the experiences of most affected communities. Preferences about preventive interventions were shaped by: mpox information; the diversity of sexual practices; accessibility and quality of mpox testing and care; and perceived cost to wellbeing. CONCLUSIONS: Evidence on the effectiveness of interventions to prevent the sexual transmission of mpox remains scarce. Limited qualitative evidence on values and preferences provides insight into factors influencing intervention acceptability. Given global and local inequities in access to vaccines and treatment, further research is needed to establish the effectiveness of additional interventions.


Assuntos
Comportamento Sexual , Humanos , Masculino , Homossexualidade Masculina/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , Busca de Comunicante , Surtos de Doenças/prevenção & controle , Pesquisa Qualitativa
14.
BMC Public Health ; 24(1): 1617, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886691

RESUMO

BACKGROUND: Especially in high HIV prevalence contexts, such as Zambia, effective biomedical prevention tools are needed for priority populations (PPs), including key populations (KPs), who are at higher risk. HIV pre-exposure prophylaxis (PrEP) has been scaled up nationally in Zambia, but little is known about barriers to PrEP use among specific PPs to date. METHODS: To understand barriers and facilitators to PrEP use in Zambia, we conducted a qualitative case study of PrEP services to PPs including sero-discordant couples (SDCs), female sex workers (FSWs), and men who have sex with men (MSM) in Livingstone. The study conducted in 2021 included in-depth interviews (n = 43) guided by the socio-ecological model, and focus group discussions (n = 4) with clinic and community-based providers and PrEP-eligible clients including users and non-users across PP groups. We used thematic analysis to analyze data using codes derived both deductively and inductively. RESULTS: We found multilevel barriers and facilitators to PrEP use. Cross-cutting barriers shared across PP groups included amplifying effects of PrEP being mistaken for antiretroviral drugs used to treat HIV, including anticipated stigma, and concerns about side-effects based on both misinformation and experience. In addition, stigmatized identities, particularly that of MSM, served as a barrier to PrEP use. The fear of being mislabeled as having HIV was of greatest concern for FSWs. Facilitators to PrEP use primarily included the importance of confidential, KP-sensitive services, and the role of informed, supportive family, friends, and peers. Participants across all PP groups urged expanded education efforts to increase awareness of PrEP within the general population toward mitigating concerns of being mislabeled as living with HIV. CONCLUSION: To our knowledge, this is the first qualitative study of the PrEP cascade among multiple PPs in Zambia. This study provides important explanation for the low rates of PrEP continuation found in earlier demonstration trials among KPs in Zambia. The study also offers recommendations for programming efforts going forward such as inclusive PrEP awareness campaigns, expanded KP sensitivity training, and related efforts to thwart PrEP stigma while expanding access.


Assuntos
Grupos Focais , Infecções por HIV , Profilaxia Pré-Exposição , Pesquisa Qualitativa , Profissionais do Sexo , Humanos , Zâmbia , Profilaxia Pré-Exposição/estatística & dados numéricos , Masculino , Infecções por HIV/prevenção & controle , Feminino , Adulto , Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Estigma Social , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto Jovem , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Fármacos Anti-HIV/uso terapêutico , Entrevistas como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Pessoa de Meia-Idade , Acessibilidade aos Serviços de Saúde
15.
Emerg Infect Dis ; 30(7): 1416-1419, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38916584

RESUMO

In July 2023, clade IIb-associated mpox reemerged in Germany at low levels, mainly affecting men who have sex with men. We report a representative case and phylogeny of available genome sequences. Our findings underscore the need for standardized surveillance and indication-based vaccination to limit transmission and help prevent endemicity.


Assuntos
Filogenia , Alemanha/epidemiologia , Humanos , Masculino , Doenças Transmissíveis Emergentes/epidemiologia , Pessoa de Meia-Idade , Homossexualidade Masculina , Adulto , Feminino
16.
Emerg Infect Dis ; 30(7): 1475-1477, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38916800

RESUMO

Pasteurella bettyae is a gram-negative bacillus sporadically involved in human infections; its main reservoirs are cats and dogs. A recent publication suggests the possibility of sexual transmission leading to genital infections in men who have sex with men. We report 9 cases in France of genital infection among this population.


Assuntos
Homossexualidade Masculina , Infecções por Pasteurella , Pasteurella , Humanos , Masculino , França/epidemiologia , Adulto , Infecções por Pasteurella/transmissão , Infecções por Pasteurella/microbiologia , Pasteurella/isolamento & purificação , Pasteurella/genética , Pasteurella/classificação , Pessoa de Meia-Idade , Adulto Jovem
17.
Arch Sex Behav ; 53(7): 2795-2806, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38849704

RESUMO

Cabotegravir (CAB-LA), the first long-acting injectable pre-exposure prophylaxis (PrEP), has been approved for use in the USA and is not currently on the market in China. However, willingness to use CAB-LA and associated factors among men who have sex with men (MSM) have not yet been evaluated in China. A cross-sectional study was conducted in Guangxi, China, in 2022 recruiting 1,006 MSM. Their mean age was 30.2 years, 74.2% had college or above education, and 48.6% had a monthly income between 3,000 and 5,999 Chinese yuan (CNY). Most (73.4%) had previously heard of PrEP while few (8.3%) had ever used this type of preventative medication. Willingness to use CAB-LA was 79.8% and was positively associated with eight variables: younger age, being married to a woman, having a low monthly income, having six or more male partners in the past six months, having only regular male partners in the past month, having a high perceived risk of HIV infection, and history of using PrEP. Ten other variables were not significantly associated with willingness to use CAB-LA. Among 894 participants who were willing to use or did not definitely reject using CAB-LA, the main concerns about CAB-LA were its side effects (90.2%), efficacy (63.6%), and high cost (58.2%). Only 14.7% were willing to pay more than 1,200 CNY (~US$180) every two months to use CAB-LA. The preferred injection places were centers for disease control facilities, hospitals, and social organizations. Many (89.0%) said that they would recommend CAB-LA to their male sexual partners. We conclude that willingness to use CAB-LA was high among MSM in Guangxi. However, implementation of CAB-LA faces tough challenges due to its high cost and the low use of PrEP. Peer education may play a large role in the implementation of CAB-LA in China.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Profilaxia Pré-Exposição , Piridonas , Humanos , Masculino , China , Adulto , Estudos Transversais , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/estatística & dados numéricos , Piridonas/administração & dosagem , Piridonas/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Parceiros Sexuais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto Jovem , Pessoa de Meia-Idade , Dicetopiperazinas
18.
AIDS Patient Care STDS ; 38(6): 267-274, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38864761

RESUMO

Human immunodeficiency virus (HIV) is a public health concern among young sexual minority men (YSMM), ages 17 to 24, in the United States. Biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP), can help reduce the risk of HIV transmission among this population. However, there is limited awareness and use of nPEP by YSMM. This study aims to explore the perceptions of YSMM regarding the nPEP care continuum, which consists of three areas of focus: awareness, uptake, and linkage to other HIV prevention services. This study draws on synchronous online focus groups with a sample of 41 YSMM in the United States. Transcripts from the focus groups were analyzed using reflexive thematic analysis. Participants reported limited nPEP awareness and prior use, a process of personal appraisal of nPEP need based on HIV risk and costs, and a preference for PrEP over PEP for long-term HIV prevention. Interventions should be tailored to increase awareness of nPEP among YSMM and reduce addressable barriers to nPEP use for YSMM, including cost and confidentiality concerns, in situations where nPEP is warranted. Finally, more research is needed on how nPEP use can act as a bridge to PrEP initiation for this population.


Assuntos
Fármacos Anti-HIV , Continuidade da Assistência ao Paciente , Grupos Focais , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Profilaxia Pós-Exposição , Minorias Sexuais e de Gênero , Humanos , Masculino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Adolescente , Adulto Jovem , Estados Unidos , Minorias Sexuais e de Gênero/psicologia , Fármacos Anti-HIV/uso terapêutico , Pesquisa Qualitativa , Acessibilidade aos Serviços de Saúde , Profilaxia Pré-Exposição , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção
19.
Cien Saude Colet ; 29(6): e10752023, 2024 Jun.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-38896677

RESUMO

The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management.


El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo.


Assuntos
Homossexualidade Masculina , Entrevistas como Assunto , Gestão de Riscos , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Homossexualidade Masculina/psicologia , Gestão de Riscos/métodos , Minorias Sexuais e de Gênero/psicologia , Pesquisa Qualitativa , Infecções por HIV/prevenção & controle , Assunção de Riscos , Adulto , Espanha , Tomada de Decisões , Comportamento Sexual , Pessoa de Meia-Idade
20.
BMC Public Health ; 24(1): 1638, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38898512

RESUMO

BACKGROUND: Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS: Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS: Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS: The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.


Assuntos
Surtos de Doenças , Promoção da Saúde , Minorias Sexuais e de Gênero , Estigma Social , Confiança , Humanos , Masculino , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Surtos de Doenças/prevenção & controle , Reino Unido/epidemiologia , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Pesquisa Qualitativa
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