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HIV Testing Program Activities and Challenges in Four U.S. Urban Areas. 美国四个城市地区的 HIV 检测项目活动与挑战。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.99
James W Carey, Cari Courtenay-Quirk, Neal Carnes, Aisha L Wilkes, Alisú Schoua-Glusberg, Casey Tesfaye, Valerie Betley, Sarah Pedersen, Laura A Randall, Paula M Frew

The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.

国家 "结束艾滋病毒流行:美国计划 "支持在艾滋病负担过重的辖区和群体中扩大检测范围。公共卫生规划者可以从了解 HIV 检测服务(HTS)的优势、挑战和创新中获益。我们对来自德克萨斯州休斯顿、佛罗里达州迈阿密、路易斯安那州新奥尔良和华盛顿特区当地卫生部门、社区组织和社区成员的 120 名 HTS 工作人员进行了半结构式访谈。我们采用定性方法对访谈记录进行了编码,以确定主题。项目的优势包括将 HIV 检测与其他客户服务相结合;优先检测和量身定制的激励措施;多种广告宣传方法;以及 HTS 提供者之间的合作关系。挑战包括污名化、恐惧和差异;造成服务提供者之间竞争的资金要求;以及服务的可及性、不必要的重复检测和创新不足。四个辖区应对了其中的一些挑战,但并非全部。跨辖区合作、州和联邦合作伙伴以及计划数据可能有助于确定加强半边天计划的其他策略。
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引用次数: 0
HIV Prevention During the COVID-19 Pandemic: Sexual Activity and PrEP Use Among Black Same-Gender-Loving Men and Black Cisgender Women. COVID-19大流行期间的艾滋病毒预防:黑人同性男性和黑人顺性女性的性活动和PrEP使用
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.142
A. Corneli, B. Perry, Jamilah Taylor, J. Beckford, N. Molokwu, S. Reif, Johnny Wilson, Chelsea Gulden, Jacquelyn Bickham, J. Siren, Wesley Thompson, M. Clement
Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender women-to explore the impact of the initial phase of the COVID-19 pandemic on sexual activities and PrEP use. Almost all participants reduced the frequency of sex and number of partners. Women described little interest in sex, whereas men began to connect with some sexual partners after stay-at-home orders were lifted. Both populations were concerned about contracting COVID-19 through sexual partners, and men described selecting partners based on perceived COVID-19 risk. Participants valued PrEP and could access it, although several men who were not having sex stopped taking it. Risk of acquiring HIV during this time was likely limited. Future qualitative research is needed to understand how sexual behaviors and PrEP use changed as the pandemic continued.
由于长期的不平等,美国南部的黑人人口受到艾滋病毒和COVID-19的影响不成比例。我们进行了20次深度访谈,其中12次访谈对象是热爱同性的黑人男性,8次访谈对象是黑人顺性女性,以探讨COVID-19大流行初期对性活动和PrEP使用的影响。几乎所有的参与者都减少了性生活的频率和伴侣的数量。女性对性几乎没有兴趣,而男性在解除居家令后开始与一些性伴侣建立联系。这两个人群都担心通过性伴侣感染COVID-19,男性描述了根据感知的COVID-19风险选择伴侣。参与者重视PrEP,并且可以获得它,尽管一些没有性生活的男性停止服用它。在此期间感染艾滋病毒的风险可能有限。未来需要进行定性研究,以了解随着大流行的持续,性行为和预防措施的使用是如何变化的。
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引用次数: 2
Transforming Latinx HIV Care: Mixed-Methods Evaluation of a Patient-Centered HIV Practice Transformation. 拉丁艾滋病护理转型:以患者为中心的艾滋病实践转型的混合方法评价。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.131
Jesus Felizzola, Veronica Pinho, D. Funk, Ana María del Río-González, M. C. Zea, Catalina Sol, Suyanna L. Barker
We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and patient-centered care for Latinxs living with HIV. Quantitative and qualitative data were simultaneously collected to capture the complex interactions among care providers, staff, and patients as well as to monitor practice changes that occurred as a result of the project implementation. The practice transformation intervention consisted of core competency workforce training, workflow redesign, and data-driven quality improvement strategies utilized to guide the intervention and to gather data from providers and patients. The mixed-methods approach facilitated meaningful change within the clinic that resulted in improved patient outcomes, patient experiences of care, and increases in staff's perceived level of knowledge of patient-centered care and improved efficiencies in HIV health care service delivery.
我们对华盛顿特区的艾滋病毒初级保健实践转型项目进行了一项混合方法纵向评估。该项目旨在提高组织能力,为拉丁裔艾滋病毒感染者提供文化上合适的、以患者为中心的护理。同时收集了定量和定性数据,以捕捉护理提供者、工作人员和患者之间复杂的相互作用,并监测由于项目实施而发生的实践变化。实践转化干预包括核心能力劳动力培训、工作流程重新设计和数据驱动的质量改进策略,用于指导干预并从提供者和患者那里收集数据。混合方法促进了诊所内有意义的变革,从而改善了患者的治疗结果和患者的护理体验,提高了工作人员对以患者为中心的护理的认知水平,并提高了艾滋病毒保健服务提供的效率。
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引用次数: 1
Characterizing Problematic Drug Use Among Transgender Women and Cisgender Men During the Emerging HIV Crisis in the Philippines: Implications for Policy Research. 在菲律宾新出现的艾滋病毒危机期间,变性女性和同性性别男性有问题药物使用的特征:对政策研究的启示》。
IF 1.6 4区 医学 Q2 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.116
Arjee J Restar, Ma Irene N Quilantang, Anthony Surace, Adedotun Ogunbajo, Randolph Chan, Alexander Adia, Susan Cu-Uvin, Don Operario

Drug use and HIV are key issues for public health interventions in the Philippines. We examined associations of problematic drug use among 320 Filipinx transgender women (trans-WSM) and cisgender men who have sex with men (cis-MSM). The prevalence of exhibited problematic drug use in this sample was 29.38%. Greater odds of problematic drug use were observed among Filipinx participants who recently engaged in sex work (adjusted OR [aOR] = 2.79, 95% CI [1.08, 7.18]), reported having HIV positive and unknown status vs. negative status (aOR = 3.61, 95% CI [1.39, 9.39], and aOR = 13.99, 95% CI [2.04, 29.69], respectively), exhibited low HIV knowledge (aOR = 4.15, 95% CI [1.82, 9.44]), and displayed hazardous drinking (aOR = 2.77, 95% CI [1.21, 6.33]). Given its correlates of HIV-related indicators, integration of HIV and harm reduction services as a public health intervention could potentially decrease problematic drug use.

吸毒和艾滋病是菲律宾公共卫生干预的关键问题。我们研究了 320 名菲律宾变性女性(trans-WSM)和男男性行为者(cis-MSM)中问题药物使用的相关性。在这一样本中,表现出问题药物使用的流行率为 29.38%。在最近从事性工作(调整后 OR [aOR] = 2.79,95% CI [1.08,7.18])、报告 HIV 阳性和未知状态与报告 HIV 阴性和未知状态(调整后 OR = 3.79,95% CI [1.08,7.18])的菲律宾裔参与者中,发现问题药物使用的几率更大。aOR = 3.61,95% CI [1.39,9.39] 和 aOR = 13.99,95% CI [2.04,29.69]),HIV 知识水平低(aOR = 4.15,95% CI [1.82,9.44]),以及酗酒(aOR = 2.77,95% CI [1.21,6.33])。考虑到艾滋病相关指标的相关性,将艾滋病防治与减低危害服务相结合作为一项公共卫生干预措施可能会减少问题药物的使用。
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引用次数: 0
Family Conflict Non-negotiation and HIV Disclosure Associated With ART Adherence in a Disadvantaged Population. 家庭冲突、不谈判和艾滋病毒披露与弱势群体抗逆转录病毒治疗依从性相关。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.158
M. Mitchell, Tuo-Yen Tseng, Dulce M. Cruz-Oliver, Zachary Catanzarite, Eric D. Hansen, A. Knowlton
Adherence to antiretroviral therapy (ART) is vital for reducing racial and gender disparities in morbidity and mortality among people living with HIV/AIDS (PLWH). Little research attention has been given to aspects of family functioning affecting ART adherence among PLWH vulnerable to disparities. Data were from n = 313 participants (93% African American) in the BEACON study, which recruited injection-drug-using PLWH on ART. Using factor analysis and longitudinal structural equation modeling, we found that current substance use and negative family conflict tactics (i.e., non-negotiation) predicted PLWH's lower probability of ART adherence at 12-month follow-up; and greater HIV disclosure to support network members predicted a higher probability of adherence. These findings suggest the importance of family and other support network members in this vulnerable population's ART adherence. Social network-focused interventions promoting prosocial response to conflict and negotiation skills are important for improving vulnerable PLWH's HIV outcomes and reducing health disparities.
坚持抗逆转录病毒治疗(ART)对于减少艾滋病毒/艾滋病感染者发病率和死亡率方面的种族和性别差异至关重要。很少有研究关注家庭功能方面影响抗逆转录病毒治疗依从性易受差异影响的PLWH。数据来自BEACON研究的n = 313名参与者(93%是非裔美国人),该研究招募了接受抗逆转录病毒治疗的使用注射药物的PLWH。通过因子分析和纵向结构方程模型,我们发现当前的物质使用和消极的家庭冲突策略(即不谈判)预测了PLWH在12个月随访时较低的抗逆转录病毒治疗依从性;向支持网络成员披露更多的艾滋病毒信息预示着更大的坚持可能性。这些发现表明,家庭和其他支持网络成员在这一弱势群体坚持抗逆转录病毒治疗方面的重要性。以社会网络为重点的干预措施,促进对冲突的亲社会反应和谈判技巧,对于改善弱势PLWH的艾滋病毒结果和缩小健康差距非常重要。
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引用次数: 0
HIV PrEP Clinician Communication Preferences Among Black Sexual Minority Men. HIV PrEP临床医生在黑人性少数男性中的沟通偏好
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.1521/aeap.2022.34.2.168
Derek T. Dangerfield, Alexander Lipson, Janeane N. Anderson
Black sexual minority men (BSMM) are substantially less likely than White SMM to accept a clinician's recommendation to initiate HIV pre-exposure prophylaxis (PrEP). The purpose of this study is to identify PrEP messaging preferences among BSMM. Data were obtained from 12 focus groups and one in-depth interview among BSMM in Baltimore, MD (N = 39). Focus groups were stratified (18-24, 25-34, and 35 and older), and facilitators probed on ways clinicians could discuss PrEP with BSMM. An adapted pile sorting approach was used to identify themes. Most identified as homosexual, gay, or same-gender-loving (68%), were employed (69%), and single (66%). Thematic analysis revealed that BSMM wanted clinicians to explain PrEP efficacy and side effects, tailor messaging, provide prevention messaging with care, and disclose PrEP use. Clinicians could increase uptake and adherence among BSMM by implementing PrEP communication preferences. Discussing PrEP efficacy and safety is also necessary. When possible, clinicians should disclose PrEP use history to build trust.
黑人性少数男性(BSMM)比白人性少数男性(BSMM)更不可能接受临床医生的建议,开始进行HIV暴露前预防(PrEP)。本研究的目的是确定PrEP短信在BSMM之间的偏好。数据来自马里兰州巴尔的摩市BSMM的12个焦点小组和1个深度访谈(N = 39)。对焦点群体进行分层(18-24岁、25-34岁和35岁及以上),主持人探讨临床医生如何与BSMM讨论PrEP。采用一种适应性的堆分类方法来识别主题。大多数被认定为同性恋、同性恋或同性恋者(68%),有工作(69%),单身(66%)。专题分析显示,BSMM希望临床医生解释PrEP的疗效和副作用,量身定制信息,提供预防信息,并披露PrEP的使用情况。临床医生可以通过实施PrEP沟通偏好来增加BSMM的吸收和依从性。讨论PrEP的有效性和安全性也是必要的。在可能的情况下,临床医生应披露PrEP的使用历史,以建立信任。
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引用次数: 2
Familism and HIV Risk Among Men Who Have Sex With Men in Taiwan: The Mediating Roles of Stressful Life Events and Coping Strategies. 台湾男男性行为者的家庭主义与HIV风险:压力生活事件与应对策略的中介作用。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-02-01 DOI: 10.1521/aeap.2022.34.1.1
Deng-Min Chuang, Peter A Newman, Lin Fang, Meng-Chuan Lai

Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., adverse childhood experiences, intimate partner violence, and sexuality-related discriminatory experiences), and coping strategies to condomless anal sex (CAS) among Taiwanese MSM. Participants were 1,000 MSM (mean age = 28.5 years) recruited through five community-based organizations. Structural equation modeling using bootstrapping with 3,000 iterations evaluated the mediating effects of 14 coping strategies. We found a pathway from familism to CAS through stressful life events and substance use coping. The protective effects of familism on stressful life events and CAS suggest that integrating components of family support and family connection into HIV prevention and education programs may increase the effectiveness of these programs in reducing HIV risk behaviors and dysfunctional coping strategies among MSM in Taiwan.

家庭主义可能在生活在集体主义文化中的男男性行为者(MSM)的艾滋病毒风险行为中起重要作用。本研究探讨台湾男男性接触者无套肛交发生的假设路径,包括家庭主义、生活压力事件(如不良童年经历、亲密伴侣暴力、性相关歧视经历)、应对策略等。参与者是通过五个社区组织招募的1,000名男男性行为者(平均年龄= 28.5岁)。采用3000次迭代自举的结构方程模型评估了14种应对策略的中介效应。我们发现了从家庭主义到CAS的途径,通过压力生活事件和物质使用应对。家庭主义对压力性生活事件的保护作用,提示将家庭支持和家庭联系纳入HIV预防和教育计划,可能会提高这些计划在减少台湾男同性恋者HIV风险行为和功能失调应对策略方面的有效性。
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引用次数: 0
Emotive Media as a Counterbalance to AIDS Messaging Fatigue in South Africa: Responses to an HIV/AIDS Awareness Music Video. 情感媒体作为平衡艾滋病信息疲劳在南非:对艾滋病毒/艾滋病意识音乐视频的反应。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-02-01 DOI: 10.1521/aeap.2022.34.1.17
Gavin Robert Walker

South Africa recorded and estimated 230,000 new infections in 2020, and low levels of AIDS risk awareness remain prevalent among the nation's youth. While public health awareness initiatives continue to be necessary, the large quantity of AIDS-related content that has permeated the media landscape since the start of the epidemic has resulted in increasing indifference to health messaging. Drawing from the concept of referent emotional responses, this article analyzes the reception of "Sing," an HIV/AIDS awareness music video characterized by emotive visual representations of AIDS. The data highlight ongoing fatigue towards HIV/AIDS messaging and the potential of highly emotive media to engage target audiences in a climate of indifference to AIDS awareness. The article recommends that future awareness and prevention campaigns consider the role of emotive content in effective AIDS-related health promotion in South Africa.

南非在2020年记录并估计有23万新感染病例,该国年轻人对艾滋病风险的认识水平仍然很低。虽然提高公众健康意识的举措仍然是必要的,但自从艾滋病开始流行以来,媒体上充斥着大量与艾滋病有关的内容,导致人们越来越不重视健康信息。本文从指涉情感反应的概念出发,分析了《歌唱》这首以情感视觉呈现艾滋病为特征的艾滋病宣传音乐视频的接受情况。这些数据突出表明,目前人们对艾滋病毒/艾滋病的信息传递感到厌倦,而且高度情绪化的媒体有可能在对艾滋病认识漠不关心的气氛中吸引目标受众。这篇文章建议,今后的提高认识和预防运动应考虑到情感内容在南非有效促进与艾滋病有关的健康方面的作用。
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引用次数: 3
Trends in HIV Stigma Experienced by People Living With HIV in the Netherlands: A Comparison of Cross-Sectional Surveys Over Time. 荷兰艾滋病毒感染者所经历的艾滋病毒污名趋势:长期横断面调查的比较。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-02-01 DOI: 10.1521/aeap.2022.34.1.33
Sarah E Stutterheim, Kyran J R Kuijpers, Moon I Waldén, Renee N N Finkenflügel, Pieter A R Brokx, Arjan E R Bos

We investigated whether HIV stigma has changed in recent years. We compared data on stigma settings and manifestations from 2007 (n = 667) and, specifically for health care, 2009 (n = 262), to data acquired in 2019/2020 (n = 258). Results showed reductions in stigma from friends, family, acquaintances, at work, in the financial services sector, and in media, but stigmatizing messages in media remained highly prevalent. Stigma in the LGBTQI+ community, with sexual partners, and while partying also remained prevalent and, disconcertingly, relatively unchanged. Stigma in health care increased. HIV stigma was positively related to psychological distress, and negatively related to social support and medication adherence. Further, most participants were familiar with U=U and PrEP, but 13.3% questioned the accuracy of U=U. Stigma reduction efforts should focus on reducing stigma in media, in the LGBTQI+ community and while dating, and in health care, with U=U as a key message.

我们调查了近年来艾滋病耻辱感是否发生了变化。我们比较了2007年(n = 667)和2009年(n = 262)的病耻感设置和表现数据,特别是在医疗保健方面(n = 262)与2019/2020年获得的数据(n = 258)。结果显示,来自朋友、家人、熟人、工作场所、金融服务部门和媒体的污名化有所减少,但媒体上的污名化信息仍然非常普遍。在LGBTQI+群体中,与性伴侣的耻辱,以及聚会的耻辱也仍然普遍存在,令人不安的是,相对没有变化。医疗保健方面的耻辱现象增加。HIV污名与心理困扰呈正相关,与社会支持和药物依从性呈负相关。此外,大多数参与者熟悉U=U和PrEP,但13.3%的人质疑U=U的准确性。减少耻辱感的工作应侧重于减少媒体、LGBTQI+社区、约会时和医疗保健中的耻辱感,并将U=U作为关键信息。
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引用次数: 4
Crowdsourced PrEP Promotion Messages for an HIV High-Burden Area: A Framework-Based Content Analysis. 针对艾滋病高发区的众包 PrEP 推广信息:基于框架的内容分析。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-02-01 DOI: 10.1521/aeap.2022.34.1.69
Evan L Eschliman, Mudia Uzzi, Jordan J White, Allison Mathews, Marcus Henry, Meghan B Moran, Kathleen Page, Carl A Latkin, Joseph D Tucker, Cui Yang

Pre-exposure prophylaxis (PrEP) is an important and highly effective HIV prevention strategy, but its uptake remains low, particularly among marginalized populations at high risk of HIV. Innovative and community-driven promotion strategies, such as open contests, are needed to address disparities. This directed content analysis uses a PrEP-specific adaptation of the Information-Motivation-Behavioral Skills (IMB) model to identify themes related to PrEP use reflected in community-generated submissions (n = 73) from an open contest conducted to elicit crowdsourced health promotion messages on PrEP in Baltimore, Maryland. In addition to identifying eight of the themes from the adapted IMB model, this analysis also identified two novel salient themes in the motivation category: self-worth/self-love and self-care practice. Findings from this analysis can inform PrEP promotion efforts by pointing to salient themes identified from a community-driven approach that are less well represented in existing research.

暴露前预防疗法(PrEP)是一项重要而高效的艾滋病预防策略,但其使用率仍然很低,尤其是在艾滋病高危边缘人群中。需要创新的、社区驱动的推广策略(如公开竞赛)来解决差异问题。本指导性内容分析使用了针对 PrEP 的信息-动机-行为技能(IMB)模型,以确定与 PrEP 使用相关的主题,这些主题反映在马里兰州巴尔的摩市为征求有关 PrEP 的众包健康推广信息而举办的公开竞赛中,由社区提交的参赛作品(n = 73)中。除了从改编的 IMB 模型中识别出八个主题外,该分析还在动机类别中识别出两个新的突出主题:自我价值/自爱和自我保健实践。这项分析的结果可以为 PrEP 的推广工作提供参考,因为它指出了从社区驱动方法中发现的、在现有研究中体现较少的突出主题。
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引用次数: 0
期刊
Aids Education and Prevention
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