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1.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190003, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576979

RESUMO

INTRODUCTION: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). OBJECTIVES: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). METHODS: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile's Successive Sampling estimator. RESULTS: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: "very high", "high", "moderate" and "low", with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. CONCLUSION: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Homossexualidade Masculina/etnologia , Humanos , Análise de Classes Latentes , Masculino , Autorrelato , Sexismo/etnologia , Fatores Socioeconômicos
2.
MMWR Morb Mortal Wkly Rep ; 68(40): 873-879, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600183

RESUMO

Correct and consistent condom use and human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) are protective against sexual transmission of HIV (1,2). The incidence of HIV infection among Hispanic/Latino men who have sex with men (MSM) in the United States is increasing (3). HIV risk among Hispanic/Latino MSM differs based on their place of birth and years of U.S. residence (4). Data from CDC's National HIV Behavioral Surveillance (NHBS)* for 2011-2017 were analyzed to assess changes in sexual risk behaviors among Hispanic/Latino MSM by place of birth and years of U.S. residence. Overall, condomless anal sex during the previous 12 months increased from 63% in 2011 to 74% in 2017, and PrEP use during the previous 12 months increased from 3% in 2014 to 24% in 2017. Regardless of place of birth, nearly 75% of Hispanic/Latino MSM reported condomless anal sex during 2017. However, because of PrEP use, <60% of non-U.S.-born Hispanic/Latino MSM and <50% of U.S.-born Hispanic/Latino MSM reported unprotected anal sex (condomless anal sex and no PrEP use) during 2017. Results indicate that PrEP can be a vital tool for reducing HIV transmission among Hispanic/Latino MSM, especially those who have condomless anal sex. Interventions to prevent HIV acquisition, including increasing PrEP uptake, could address cultural and linguistic needs of Hispanic/Latino MSM, as well as other barriers to prevention of HIV infection typically faced by all MSM.


Assuntos
Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Assunção de Riscos , Sexo sem Proteção/etnologia , Adolescente , Adulto , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
3.
AIDS Educ Prev ; 31(5): 479-490, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31550192

RESUMO

Contextual factors, such as cultures of collectivism versus individualism, shape HIV coping strategies; despite this, little research regarding collective coping strategies applied to HIV exists. This may be important for the growing HIV epidemic in the Philippines, which has a collectivistic culture and where men who have sex with men (MSM) account for a majority of the cases. Fifteen semistructured, in-depth interviews with HIV-positive MSM and 6 interviews with community-based organization workers were conducted between June and August 2017. Data were analyzed using thematic framework analysis. Three strategies were identified: peer support, spirituality, and support from existing relationships. Each form of collective coping had unique mechanisms and benefits for dealing with HIV. Overall, helping MSM with HIV find a collective identity after an HIV diagnosis enables management of HIV-related challenges. Policies and research interventions that improve access to collective identities for MSM with HIV may improve management of HIV-related challenges.


Assuntos
Adaptação Psicológica , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Grupo Associado , Apoio Social , Espiritualidade , Adulto , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Homossexualidade Masculina/etnologia , Humanos , Entrevistas como Assunto , Masculino , Filipinas/epidemiologia , Pesquisa Qualitativa
4.
AIDS Educ Prev ; 31(5): 407-420, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31550198

RESUMO

Mobile technology-based interventions show promise for conveying HIV prevention information to Latino men who have sex with men (LMSM) and Latina transgender women (LTGW); however, implementing such interventions can pose serious challenges. To understand how to adapt existing interventions for these populations, we conducted nine focus groups (N = 91 participants, 52 LMSM, 39 LTGW) in Los Angeles, California. We used a rapid assessment process to create narrative reports that we examined using thematic analysis to explore differences across sites and between LMSM and LTGW. Lessons learned: requiring smartphone use could diminish participation of poor participants; sending personalized messages on the same days and times can help participants anticipate receiving study information; working with community partners is essential for building trust; recognizing different language literacies and diverse countries of origin can improve the cultural competency of intervention materials. Addressing these challenges may enhance efforts to address the HIV prevention needs of these communities.


Assuntos
Telefone Celular , Assistência à Saúde Culturalmente Competente , Infecções por HIV/prevenção & controle , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Mensagem de Texto , Pessoas Transgênero , Adulto , Características Culturais , Feminino , Grupos Focais , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Humanos , Entrevistas como Assunto , Los Angeles , Masculino , Pesquisa Qualitativa
5.
MMWR Morb Mortal Wkly Rep ; 68(37): 801-806, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31536484

RESUMO

In 2017, preliminary data show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of human immunodeficiency virus (HIV) infection, that MSM who inject drugs accounted for an additional 3%, and that African American/black (black) and Hispanic/Latino (Hispanic) MSM were disproportionately affected (1). During 2010-2015, racial/ethnic disparities in HIV incidence increased among MSM; in 2015, rates among black and Hispanic MSM were 10.5 and 4.9 times as high, respectively, as the rate among white MSM (compared with 9.2 and 3.8 times as high, respectively, in 2010) (2). Increased use of preexposure prophylaxis (PrEP), which reduces the risk for sexual acquisition of HIV infection by approximately 99% when taken daily as prescribed,* would help to reduce these disparities and support the Ending the HIV Epidemic: A Plan for America initiative† (3). Although PrEP use has increased among all MSM since 2014 (4), racial/ethnic disparities in PrEP use could increase existing disparities in HIV incidence among MSM (5). To understand racial/ethnic disparities in PrEP awareness, discussion with a health care provider, and use (steps in the HIV PrEP continuum of care) (6), CDC analyzed 2017 National HIV Behavioral Surveillance (NHBS) data. Black and Hispanic MSM were significantly less likely than were white MSM to be aware of PrEP, to have discussed PrEP with a health care provider, or to have used PrEP within the past year. Among those who had discussed PrEP with a health care provider within the past year, 68% of white MSM, 62% of Hispanic MSM, and 55% of black MSM, reported PrEP use. Prevention efforts need to increase PrEP use among all MSM and target eliminating racial/ethnic disparities in PrEP use.§.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
6.
AIDS Behav ; 23(Suppl 3): 331-339, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31541391

RESUMO

Black men who have sex with men (MSM) in the South have the highest rates of HIV diagnosis in the country adding to the persistent racial disparities in HIV experienced by this population. The current HIV prevention and care landscape is heavily driven by individual-level clinical and biomedical approaches that have shown progress in reducing HIV diagnoses, but yield less than adequate results in reducing the HIV racial disparities for Black MSM in the South. In efforts to enhance focus on reducing the racial HIV disparities and more completely address the needs of Black MSM in the South, we offer insight on comprehensive approaches that can complement our current HIV prevention and care portfolio. There are five domains we discuss which include: (1) leveraging and integrating resources; (2) building upon existing program models designed to reduce disparities; (3) workforce development and cultural sensitivity; (4) social determinants of health data utilization; and 5) policy considerations. We urge public health practitioners and healthcare providers to consider and incorporate the outlined approaches to improve HIV outcomes along the continuum of care and ultimately reduce disparities in HIV affecting the quality of life of Black MSM living in the South.


Assuntos
Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Determinantes Sociais da Saúde/etnologia , Adulto , Fortalecimento Institucional , Assistência à Saúde Culturalmente Competente , Infecções por HIV/etnologia , Disparidades nos Níveis de Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Qualidade de Vida , Estigma Social
7.
AIDS Behav ; 23(10): 2803-2815, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407211

RESUMO

Although young Black men who have sex with men (YBMSM) are disproportionately affected by HIV, they may be more heterogeneous as a group than is typically appreciated. Thus, the present study used a person-centered data-analytic approach to determine profiles of HIV-related risk among YBMSM and whether these profiles could be distinguished by age, HIV status, and socioeconomic risk (i.e., socioeconomic distress). YBMSM (N = 1808) aged 18 to 29 years completed a survey of sociodemographic characteristics, HIV status, and HIV-related behavioral and attitudinal factors (i.e., safer-sex self-efficacy, negative condom attitudes, being in difficult sexual situations, being in difficult sexual relationships, HIV treatment optimism, perceived HIV stigma). Latent profile analysis was used to identify HIV risk profiles and whether age, HIV status, and socioeconomic distress were associated with these profiles. Four profiles emerged: low-, medium-, and high-risk profiles, respectively, and a mixed profile characterized by a tendency to be in difficult sexual situations and relationships while also reporting high safer-sex self-efficacy and low negative attitudes toward condom use. Difficult sexual situations emerged as the key defining indicator of whether a profile reflected higher or lower risk. Younger age, being HIV-positive, and socioeconomic distress were associated with having a higher-risk profile. Given that unique risk profiles emerged that were differentially predicted by sociodemographic characteristics and HIV status, these findings have implications for tailoring interventions to the needs of different subgroups of YBMSM. Also, disempowering or risky sexual situations and relationships among YBMSM must be addressed.


Assuntos
Afro-Americanos/etnologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/etnologia , Assistência Centrada no Paciente , Profilaxia Pré-Exposição , Autoeficácia , Comportamento Sexual/estatística & dados numéricos , Estigma Social , Adolescente , Adulto , Afro-Americanos/psicologia , Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Fatores de Risco , Sexo Seguro , Inquéritos e Questionários , Texas , Adulto Jovem
8.
AIDS Behav ; 23(10): 2654-2673, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31463711

RESUMO

Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclusion criteria and were categorized into the PrEP care continuum: (1) awareness (n = 16), (2) uptake (n = 9), and (3) adherence (n = 12). Only 26 of the studies presented analytical findings by race/ethnicity. Key barrier themes included cost, HIV-related stigma, and fear of potential side effects. A key facilitator theme identified by black MSM included gaining PrEP awareness from social and sexual networks. There are significant gaps in research on black MSM and PrEP utilization, especially regarding PrEP uptake and adherence. These data are needed to inform interventions to address current inequities in PrEP services, to help improve care outcomes for black MSM.


Assuntos
Afro-Americanos/psicologia , Fármacos Anti-HIV/administração & dosagem , Continuidade da Assistência ao Paciente , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Conscientização , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Retenção nos Cuidados , Comportamento Sexual , Estigma Social
9.
AIDS Behav ; 23(Suppl 3): 266-275, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31463712

RESUMO

Minority stress theory posits that homonegativity-whether experienced, anticipated, or internalized-adversely impacts health. We conducted qualitative interviews with 28 YB-GBMSM living with HIV to explore manifestations of homonegativity over the life course. Thematic analysis identified patterns in the ways that homonegativity was discussed at different points in participants' lives. Stifling, and sometimes traumatic, familial and religious environments led to experienced homonegativity early in life. These experiences led to anticipated and internalized homonegativity, which in turn shaped sexual identity formation processes in adolescence and into young adulthood. Ultimately, many participants distanced themselves from home environments, seeking and often finding extrafamilial support. Most participants eventually reached self-acceptance of both their sexuality and HIV status. In conclusion, experienced, anticipated and internalized homonegativity were pervasive as YB-GBMSM navigated family and religious environments over the life course. Future interventions should work with youth, families, and churches to prevent these harmful experiences.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Africano/psicologia , Bissexualidade/etnologia , Infecções por HIV/diagnóstico , Homossexualidade Masculina/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Bissexualidade/psicologia , Georgia/epidemiologia , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Entrevistas como Assunto , Masculino , Grupos Minoritários , Pesquisa Qualitativa , Comportamento Sexual , Minorias Sexuais e de Gênero/psicologia , Adulto Jovem
10.
AIDS Behav ; 23(Suppl 3): 304-312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456198

RESUMO

Client-level data from two Tennessee-based PrEP navigation demonstration projects reported to the Tennessee Department of Health from January to December 2017 were evaluated to determine the proportion of clients who accepted, were linked to, and were prescribed PrEP. Disparities by age, race, transmission risk, and geographic region as well as trends over time were examined via bivariate and multivariable modified Poisson regression models accounting for potential confounders. Among 1385 PrEP-eligible individuals, 50.5% accepted, 33.4% were linked, and 27.3% were prescribed PrEP. PrEP uptake varied by age, race, and HIV transmission risk, and most disparities persisted across Tennessee throughout evaluation period. Multivariable regression models revealed significant independent associations between age, race/ethnicity, transmission risk, and region and PrEP acceptance and linkage. While differences in PrEP acceptance by race narrowed over time, success among black MSM was limited, underscoring a significant need to improve upstream PrEP continuum outcomes for this important population.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Distribuição por Sexo , Tennessee
11.
AIDS Behav ; 23(11): 3044-3051, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31456200

RESUMO

Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12 months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6 months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Habitação/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adulto , Cidades , Continuidade da Assistência ao Paciente , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , Populações Vulneráveis , Adulto Jovem
12.
MMWR Morb Mortal Wkly Rep ; 68(27): 597-603, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31298662

RESUMO

In February 2019, the U.S. Department of Health and Human Services proposed a strategic initiative to end the human immunodeficiency (HIV) epidemic in the United States by reducing new HIV infections by 90% during 2020-2030* (1). Phase 1 of the Ending the HIV Epidemic initiative focuses on Washington, DC; San Juan, Puerto Rico; and 48 counties where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and on seven states with a disproportionate occurrence of HIV in rural areas relative to other states.† One of the four pillars in the initiative is protecting persons at risk for HIV infection using proven, comprehensive prevention approaches and treatments, such as HIV preexposure prophylaxis (PrEP), which is the use of antiretroviral medications that have proven effective at preventing infection among persons at risk for acquiring HIV. In 2014, CDC released clinical PrEP guidelines to health care providers (2) and intensified efforts to raise awareness and increase the use of PrEP among persons at risk for infection, including gay, bisexual, and other men who have sex with men (MSM), a group that accounted for an estimated 68% of new HIV infections in 2016 (3). Data from CDC's National HIV Behavioral Surveillance (NHBS) were collected in 20 U.S. urban areas in 2014 and 2017, covering 26 of the geographic areas included in Phase I of the Ending the HIV Epidemic initiative, and were compared to assess changes in PrEP awareness and use among MSM. From 2014 to 2017, PrEP awareness increased by 50% overall, with >80% of MSM in 17 of the 20 urban areas reporting PrEP awareness in 2017. Among MSM with likely indications for PrEP (e.g., sexual risk behaviors or recent bacterial sexually transmitted infection [STI]), use of PrEP increased by approximately 500% from 6% to 35%, with significant increases observed in all urban areas and in almost all demographic subgroups. Despite this progress, PrEP use among MSM, especially among black and Hispanic MSM, remains low. Continued efforts to improve coverage are needed to reach the goal of 90% reduction in HIV incidence by 2030. In addition to developing new ways of connecting black and Hispanic MSM to health care providers through demonstration projects, CDC has developed resources and tools such as the Prescribe HIV Prevention program to enable health care providers to integrate PrEP into their clinical care.§ By routinely testing their patients for HIV, assessing HIV-negative patients for risk behaviors, and prescribing PrEP as needed, health care providers can play a critical role in this effort.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , População Urbana , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
Aust N Z J Public Health ; 43(5): 424-428, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287941

RESUMO

OBJECTIVES: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. METHODS: A retrospective, cross-sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. RESULTS: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01-AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). CONCLUSIONS: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/diagnóstico , Homossexualidade Masculina/etnologia , Comportamento Sexual/etnologia , Doenças Sexualmente Transmissíveis/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Austrália/epidemiologia , Estudos Transversais , Infecções por HIV/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Assunção de Riscos , Parceiros Sexuais , Adulto Jovem
14.
AIDS Educ Prev ; 31(4): 306-324, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361514

RESUMO

Some Black/African American and Hispanic/Latino men who have sex with men (MSM) living with HIV do not take antiretroviral therapy (ART). We conducted semistructured interviews with 84 adult, Black/African American and Hispanic/Latino MSM with HIV to understand ART barriers and facilitators. We used chi-square statistics to identify factors associated with ART use (p ≤ .05), and selected illustrative quotes. Over half (51.2%) said they followed their doctor's instructions; however, only 27.4% reported consistently taking ART. Some men delayed ART until overcoming diagnosis denial or becoming very sick. ART use was facilitated by encouragement from others, treatment plans, side effect management, lab test improvements, pill-taking reminders, and convenient care facilities that provide "one-stop shop" services. Men were more likely to take ART when having providers who communicated effectively and were perceived to treat them with respect. Healthcare personnel can use our findings to strengthen services for MSM of color.


Assuntos
Afro-Americanos/psicologia , Terapia Antirretroviral de Alta Atividade/psicologia , Infecções por HIV/tratamento farmacológico , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Adesão à Medicação/psicologia , Adulto , Afro-Americanos/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Atitude do Pessoal de Saúde , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Pessoal de Saúde , Acesso aos Serviços de Saúde , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Estados Unidos , População Urbana
15.
AIDS Educ Prev ; 31(4): 325-343, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361519

RESUMO

Sexual minority individuals experience barriers to receiving equitable health care. Research also indicates that young men who have sex with men (YMSM), particularly young men of color, have limited engagement in the HIV care continuum and there are significant disparities across the continuum. This study aims to uncover how providers can engage YMSM of color in all forms of care, including primary care and HIV prevention through an HIV prevention continuum. This qualitative study reports data from the Healthy Young Men's Cohort Study; a total of 49 YMSM participated in the eight focus groups. This study provides a description of YMSM's overall health concerns, experiences with health care, and under what circumstances YMSM seek care. We then present a model describing the salient characteristics of a HIV prevention continuum for YMSM of color and provide clear areas for education, intervention, and policy change to support better overall health for YMSM of color.


Assuntos
Afro-Americanos/psicologia , Continuidade da Assistência ao Paciente , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/psicologia , Homossexualidade Masculina/psicologia , Adolescente , Afro-Americanos/estatística & dados numéricos , Estudos de Coortes , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Alfabetização em Saúde , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Humanos , Entrevistas como Assunto , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Estados Unidos/epidemiologia , Adulto Jovem
16.
AIDS Behav ; 23(Suppl 3): 251-265, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31102108

RESUMO

Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Hispano-Americanos/psicologia , Programas de Rastreamento/métodos , Parceiros Sexuais/psicologia , Apoio Social , Adulto , Bissexualidade/etnologia , Bissexualidade/psicologia , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , North Carolina , Assunção de Riscos , Testes Sorológicos , Comportamento Sexual , Rede Social , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-31067679

RESUMO

Pre-exposure prophylaxis (PrEP) effectively reduces human immunodeficiency virus (HIV) transmission. We aimed to estimate the impact of different PrEP prioritization strategies among Black and Latino men who have sex with men (MSM) in the United States, populations most disproportionately affected by HIV. We developed an agent-based simulation to model the HIV epidemic among MSM. Individuals were assigned an HIV incidence risk index (HIRI-MSM) based on their sexual behavior. Prioritization strategies included PrEP use for individuals with HIRI-MSM ≥10 among all MSM, all Black MSM, young (≤25 years) Black MSM, Latino MSM, and young Latino MSM. We estimated the number needed to treat (NNT) to prevent one HIV infection, reductions in prevalence and incidence, and subsequent infections in non-PrEP users avoided under these strategies over 5 years (2016-2020). Young Black MSM eligible for PrEP had the lowest NNT (NNT = 10) followed by all Black MSM (NNT = 33) and young Latino MSM (NNT = 35). All Latino MSM and all MSM had NNT values of 63 and 70, respectively. Secondary infection reduction with PrEP was the highest among young Latino MSM (53.2%) followed by young Black MSM (37.8%). Targeting all MSM had the greatest reduction in prevalence (14.7% versus 2.9%-3.9% in other strategies) and incidence (49.4% versus 9.4%-13.9% in other groups). Using data representative of the United States MSM population, we found that a strategy of universal PrEP use by MSM was most effective in reducing HIV prevalence and incidence of MSM. Targeted use of PrEP by Black and Latino MSM, however, especially those ≤25 years, had the greatest impact on HIV prevention.


Assuntos
Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Adolescente , Adulto , Afro-Americanos , Infecções por HIV/etnologia , Hispano-Americanos , Homossexualidade Masculina/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Sexo Seguro , Estados Unidos , Adulto Jovem
18.
AIDS Behav ; 23(9): 2361-2374, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31016504

RESUMO

In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4 years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.


Assuntos
Afro-Americanos/psicologia , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Comportamento de Redução do Risco , Estigma Social , Adolescente , Adulto , Estudos Transversais , HIV , Infecções por HIV/psicologia , Promoção da Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Assunção de Riscos , Sexo Seguro , Autoeficácia , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero , Adulto Jovem
19.
AIDS Behav ; 23(10): 2719-2729, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30993479

RESUMO

We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.


Assuntos
Afro-Americanos/psicologia , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Adesão à Medicação/etnologia , Profilaxia Pré-Exposição/métodos , Pessoas Transgênero/psicologia , Afro-Americanos/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/psicologia , Philadelphia , Pesquisa Qualitativa , Assunção de Riscos , Minorias Sexuais e de Gênero , Estigma Social , Apoio Social , Tenofovir/administração & dosagem , Tenofovir/uso terapêutico , Pessoas Transgênero/estatística & dados numéricos , Adulto Jovem
20.
Sex., salud soc. (Rio J.) ; (31): 57-80, enero-abr. 2019.
Artigo em Português | LILACS | ID: biblio-1004713

RESUMO

Resumo Este artigo se ocupa da trajetória da Turma OK, grupo fundado em 1961, dedicado a promover a sociabilidade entre homens homossexuais no Rio de Janeiro. Procuro compreender a história desse grupo à luz das tensões entre diferentes processos sociais, identidades e classificações sexuais construídas e reconstruídas pelas turmas de "bichas" nas décadas de 1960 e 1970. Busco compreender também como essa associação passa de um grupo de sociabilidade de "homens homossexuais" da Zona Sul do Rio de Janeiro que fazem reuniões fechadas em apartamentos para um espaço de shows e encontros que pretende se afirmar como um "patrimônio da Lapa". O trabalho de pesquisa foi fundamentado em observação participante, pesquisa documental e entrevistas em profundidade.


Abstract This article analyzes the trajectory of the Turma OK group, founded in 1961 to promote sociability among homosexual men in Rio de Janeiro. The history of this group is understood in light of the tensions between different social processes, identities and sexual classifications constructed and reconstructed by the groups of "bichas" (or "queers") in the decades of 1960 and 1970. The passage of this association from a group of sociability for "homosexual men" from affluent areas of Rio de Janeiro who held closed meetings in apartments to a space of shows and meetings claiming to be a bohemian "Lapa heritage". The research is based on participant observation, document analysis and in-depth interviews.


Resumen Este artículo se ocupa de la trayectoria de la Turma OK. Buscamos comprender la historia de ese grupo a la luz de las tensiones entre diferentes procesos sociales, identidades y clasificaciones sexuales construidas y reconstruidas por las clases de "bichas" en las décadas de 1960 y 1970. Buscamos comprender también cómo esa asociación pasa de un grupo de sociabilidad de "hombres homosexuales" de la Zona Sur de Río de Janeiro que hacen reuniones cerradas en apartamentos para un espacio de shows y encuentros que pretende afirmarse como un "patrimonio de Lapa". El trabajo de investigación fue fundamentado en observación participante, investigación documental y entrevistas en profundidad.


Assuntos
Humanos , Brasil/etnologia , Homossexualidade Masculina/etnologia , Características Culturais , Pesquisa Qualitativa , Minorias Sexuais e de Gênero , Identidade de Gênero
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