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HIV prevalence among transgender women (TW) in Tijuana, Mexico is estimated at 22%. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by > 90%, though uptake in Tijuana has been low due to limited availability. The interplay between PrEP and gender stigmas may also serve as a barrier to PrEP uptake among TW in Tijuana. Experiences of gender- and PrEP- stigmas were assessed quantitatively (Quan) among 110 HIV-negative TW and qualitatively (Qual) among 17 TW through semi-structured interviews guide by the Health Stigma and Discrimination Framework. Qual findings were triangulated with Quant data to identify factors that may support gender affirmation and reduce PrEP stigma in an explanatory sequential Quan â Qual fashion. Most participants were < 40 years of age (80%), while approximately half had at least a high school education (48.2%) and were accessing gender-affirming hormone therapy (56.4%). Mean expectations of gender stigma were greatest for endorsing negative future expectations from others (M = 17.69; possible range 0-36). PrEP stigma was prominent among those who associated negative stereotypes with PrEP users, such as poor judgment (M = 45.91; possible range 14-70) and high personal risk attributes (M = 28.61; possible range 12-60). While PrEP knowledge was low among the qualitative sample, participants identified gender-, PrEP-, and intersectional- stigmas as potential barriers to PrEP uptake. Participants suggested that resilience strategies used to combat gender stigma could also mitigate PrEP stigma. Enhancing resilience skills at the intersection of gender and PrEP stigma may reduce these barriers, facilitating greater PrEP uptake as it becomes more available in Mexico.
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BACKGROUND: Little is known about awareness and willingness to use or purchase HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Mexico. METHODS: MSM in Mexico were recruited via advertisements on online social venues to participate in Encuesta de Sexo Entre Hombres, an online behavioral survey. Awareness of PrEP, willingness to take PrEP if available for free, willingness to purchase PrEP, awareness of post-exposure prophylaxis (PEP), and ever PEP use were assessed in descriptive and multivariate analyses. RESULTS: Overall, 54.8% (4588/8376) of participants were aware of PrEP. Of those aware, 77.6% were willing to use PrEP if free and 52.6% were willing to purchase PrEP, generally at a maximum monthly cost of $500MXP. Both awareness of and willingness to use PrEP if free or for purchase were significantly greater among MSM who were younger, and varied by demographic, recent healthcare use, and behavioral risk factors. Only 8.2% had ever used PEP, which was highly associated with healthcare utilization. CONCLUSIONS: About half of Mexican MSM were aware of PrEP. The majority of those aware were willing to use PrEP if available for free and many were willing to purchase PrEP at low cost. Leveraging demographic, recent healthcare use, and behavioral risk characteristics associated with awareness and willingness to use PrEP could be useful in designing future PrEP programs for MSM in Mexico. Expanding healthcare settings in which PEP is available may also support identifying candidates for PrEP and scaling up PrEP implementation.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Humanos , Masculino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , México , Adulto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Adulto Jovem , Pessoa de Meia-Idade , Inquéritos e Questionários , Adolescente , Assunção de RiscosRESUMO
Restricted movement among populations decreases genetic variation, which may be the case for the Montezuma quail (Cyrtonyx montezumae), a small game bird that rarely flies long distances. In the northern limit of its distribution, it inhabits oak-juniper-pine savannas of Arizona, New Mexico, and Texas. Understanding genetic structure can provide information about the demographic history of populations that is also important for conservation and management. The objective of this study was to determine patterns of genetic variation in Montezuma quail populations using nine DNA microsatellite loci. We genotyped 119 individuals from four study populations: Arizona, Western New Mexico, Central New Mexico, and West Texas. Compared to other quail, heterozygosity was low (H¯0 = 0.22 ± 0.04) and there were fewer alleles per locus (A = 2.41 ± 0.27). The global population genetic differentiation index RST = 0.045 suggests little genetic structure, even though a Bayesian allocation analysis suggested three genetic clusters (K = 3). This analysis also suggested admixture between clusters. Nevertheless, an isolation-by-distance analysis indicates a strong correlation (r = 0.937) and moderate evidence (P = 0.032) of non-independence between geographical and genetic distances. Climate change projections indicate an increase in aridity for this region, especially in temperate ecosystems where the species occurs. In this scenario, corridors between the populations may disappear, thus causing their complete isolation.
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Ecossistema , Variação Genética , Humanos , Animais , Variação Genética/genética , Teorema de Bayes , Genética Populacional , CodornizRESUMO
We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.
RESUMEN: Analizamos los datos de 15,233 hombres mexicanos que tienen sexo con hombres (HSH) recopilados entre mayo y julio de 2017 por el estudio Encuesta de Sexo Entre Hombres para examinar las diferencias en el continuo de la atención del VIH. Los datos se estratificaron en seis regiones geográficas. Se utilizaron razones de prevalencia para evaluar las asociaciones entre la región y los resultados de la atención. Entre los participantes sin prueba de VIH positiva (n = 13 583), el 66.1% se había hecho la prueba alguna vez en su vida y el 43.0% en el último año. Entre las personas que refirieron pruebas de VIH positivas (n = 1 650), el 83.9% informó asesoramiento post-diagnóstico, el 61.9% vinculación oportuna a la atención, el 42.4% resultados oportunos de CD4/carga viral, el 38.2% acceso oportuno a la terapia antirretroviral (TAR) y el 87.7% continuaba en TAR. La región de la Ciudad de México/Estado de México tuvo resultados del continuo de la atención significativamente superiores en pruebas de VIH pasadas y recientes, vinculación con la atención, resultados de carga viral/CD4 y uso actual de TAR. Comprender las variaciones geográficas de la atención del VIH en HSH en México es un paso importante para informar los esfuerzos para poner fin a la epidemia de HIV/Sida para 2030 en Latinoamérica.
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Infecções por HIV , Minorias Sexuais e de Gênero , Masculino , Humanos , Homossexualidade Masculina/psicologia , Infecções por HIV/epidemiologia , México , Antirretrovirais/uso terapêutico , Continuidade da Assistência ao PacienteRESUMO
OBJETIVO: Describir el diseño, implementación y el perfil de los participantes de la Encuesta de Sexo Entre Hombres (ES Entre Hombres). Material y métodos. ES Entre Hombres es una encuesta en línea no probabilística aplicada a nivel nacional a hombres de 18 años o más, que tienen sexo con hombres (HSH) y que usan internet. La población de estudio se reclutó a través de publicidad en diversos sitios de encuentro en línea y los cuestionarios se autoaplicaron con SurveyGizmo. RESULTADOS: Durante 11 semanas se registró un total de 15 875 autoaplicaciones elegibles y completas de las 32 entidades del país. La mayoría de los participantes fueron jóvenes (<29 años; 65.7%) y personas que acceden a internet diariamente (94.3%). Conclusión. Las encuestas realizadas por internet para poblaciones como los HSH representan un método costoefectivo de estudio poblacional, ya que tienen el potencial de ahorrar recursos y alcanzar muestras grandes, lo que a la vez facilita la cobertura geográfica a un bajo costo.
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Homossexualidade Masculina , Minorias Sexuais e de Gênero , Humanos , Internet , Masculino , México , Estudos RetrospectivosRESUMO
Many men who have sex with men (MSM) do not disclose their sexuality to their healthcare provider, despite potential health benefits. Data from the 2017 Encuesta de Sexo Entre Hombres online survey of 13,277 HIV-negative or unknown status MSM in Mexico were used to explore MSM patients' sexuality disclosure experience on sexual health outcomes using multivariable Poisson models with robust variance estimation to estimate adjusted prevalence ratios (aPR). Sexual health outcomes included Hepatitis B (HepB) and human papillomavirus (HPV) vaccination, and lifetime and past year HIV testing. Overall, 53.9% (n/N) disclosed their sexuality to their healthcare provider, and of those 6.4%, 62.9%, and 30.7% reported a negative, neutral, or positive disclosure experience, respectively. In comparison to no disclosure, neutral and positive disclosure experiences were associated with HepB vaccination (aPR[95% Confidence Interval (95% CI)] = 1.17[1.09, 1.25], p < 0.001; aPR[95% CI] = 1.35[1.25, 1.46], p < 0.001, respectively) and positive disclosure experiences were associated with HPV vaccination (aPR[95% CI] = 1.46[1.24, 1.71], p < 0.001). Those who disclosed their sexual behavior were more likely than those who did not disclose their sexual behavior to have received an HIV test in their lifetime (negative: aPR[95% CI] = 1.51[1.43, 1.60], p < 0.001; neutral: aPR[95% CI] = 1.61[1.56, 1.66], p < 0.001; positive: aPR[95% CI] = 1.64[1.58, 1.69], p < 0.001) and an HIV test in the past year (negative: aPR[95% CI] = 1.89[1.70, 2.10], p < 0.001; neutral: aPR[95% CI] = 2.09[1.98, 2.20], p < 0.001; positive: aPR[95% CI] = 2.24[2.12, 2.37], p < 0.001). There is a need to implement trainings for healthcare providers that focus on sexual health risk assessments and creating a space that encourages MSM patients and healthcare providers to discuss sexual health.
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Infecções por HIV , Infecções por Papillomavirus , Minorias Sexuais e de Gênero , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , México , Avaliação de Resultados em Cuidados de Saúde , Comportamento SexualRESUMO
Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.
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Infecções por HIV , Minorias Sexuais e de Gênero , Benchmarking , Análise Fatorial , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , México/epidemiologia , Comportamento Sexual , Estigma SocialRESUMO
Resumen: Objetivo: Describir el diseño, implementación y el perfil de los participantes de la Encuesta de Sexo Entre Hombres (ES Entre Hombres). Material y métodos: ES Entre Hombres es una encuesta en línea no probabilística aplicada a nivel nacional a hombres de 18 años o más, que tienen sexo con hombres (HSH) y que usan internet. La población de estudio se reclutó a través de publicidad en diversos sitios de encuentro en línea y los cuestionarios se autoaplicaron con SurveyGizmo. Resultados: Durante 11 semanas se registró un total de 15 875 autoaplicaciones elegibles y completas de las 32 entidades del país. La mayoría de los participantes fueron jóvenes (<29 años; 65.7%) y personas que acceden a internet diariamente (94.3%). Conclusión: Las encuestas realizadas por internet para poblaciones como los HSH representan un método costoefectivo de estudio poblacional, ya que tienen el potencial de ahorrar recursos y alcanzar muestras grandes, lo que a la vez facilita la cobertura geográfica a un bajo costo.
Abstract: Objective: To describe the design, implementation and profile of participants in the Sex Between Men Survey (ES entre Hombres). Materials and methods: ES entre Hombres is an online non-probabilistic survey applied at a national level to men 18 years of age or older, who have sex with men (MSM) and who use the internet. The target population was recruited through advertising on various online meeting sites and the questionnaires were self-administered using SurveyGizmo. Results: During 11 weeks a total of 15 875 eligible participants completed a self-applied questionnaire in 32 Mexican states. Most of the participants were young people (<29 years old; 65.7%) and people who access the internet daily (94.3%). Conclusion: Internet surveys for populations such as MSM represent a cost-effective method for population-based studies, since they have the potential to save resources and reach large samples sizes, providing geographic coverage at a low cost.
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BACKGROUND: While the genetic contribution to obesity is well established, few studies have examined how genetic variants influence standardized body mass index Z-score (BMIz) in Hispanics/Latinos, especially across childhood and adolescence. OBJECTIVES: We estimated the effect of established BMIz loci in Chilean children of the Santiago Longitudinal Study (SLS). METHODS: We examined associations with BMIz at age 10 for 15 loci previously identified in European children. For significant loci, we performed association analyses at ages 5 and 16 years, for which we have smaller sample sizes. We tested associations of unweighted genetic risk scores (GRSs) for previously identified tag variants (GRS_EUR) and from the most significant variants in SLS at each locus (GRS_SLS). RESULTS: We generalized five variants at age 10 (P < 0.05 and directionally consistent), including rs543874 that reached Bonferroni-corrected significance. The effect on BMIz was greatest at age 10 for all significant loci, except FTO, which exhibited an increase in effect from ages 5 to 16. Both GRSs were associated with BMIz (P < 0.0001), but GRS_SLS explained a much greater proportion of the variation (13.63%). CONCLUSION: Our results underscore the importance of conducting genetic investigations across life stages and selecting ancestry appropriate tag variants in future studies for disease prediction and clinical evaluation.
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Índice de Massa Corporal , Obesidade Infantil/genética , Adolescente , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Chile , Estudos de Coortes , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Estudos Longitudinais , Masculino , Polimorfismo de Nucleotídeo Único , Fatores de RiscoRESUMO
Resumen Los probióticos y prebióticos actualmente se postulan como una alternativa potencial de reemplazo a los antibióticos utilizados como subterapéuticos, a modo de promotores de crecimiento. Su ventaja es que no dejan residuos en el huevo ni en la carne del ave, y no generan riesgo de resistencia antibiótica en la microbiota humana. El uso de los microorganismos probióticos, principalmente bacterias productoras de ácido láctico en la alimentación de las aves, contribuye al mantenimiento de la integridad y estabilidad de la flora intestinal. Esto dificulta la proliferación de microorganismos perjudiciales, lo cual ayuda a prevenir la aparición de enfermedades y a mejorar el rendimiento productivo. Sin embargo, en cuanto a su efecto como promotor de crecimiento, los resultados son contradictorios, en gran medida debido a la variedad de microorganismos y dosis que se pueden suministrar, al tipo de aves utilizadas, a los métodos de administración, a la composición de las dietas de alimentación de las aves y a las condiciones ambientales en que se realizan los bioensayos. Por lo tanto, y debido a la necesidad de prescindir de los antibióticos como promotores de crecimiento, es indispensable continuar investigando y ampliando el conocimiento de estos aditivos, mediante la realización de bioensayos que permitan determinar las cepas bacterianas y los métodos de administración más idóneos en los linajes de aves modernas bajo producción intensiva. El objetivo de esta revisión es presentar un análisis de las condiciones en las que estas sustancias actúan, y explicar por qué a veces sus efectos son insignificantes.
Abstract Probiotics and prebiotics are currently postulated as a potential replacement alternative to sub-therapeutic antibiotics as growth promoters. The advantage is that these agents do not leave residues in the egg or meat of the poultry, and do not cause risk of developing antibiotic resistance in human microbiota. The use of probiotic microorganisms, mainly lactic acid-producing bacteria in poultry feeding, contributes to maintaining the integrity and stability of the intestinal flora. This hampers the proliferation of harmful microorganisms, which helps to prevent the onset of disease and improves productive performance. Nevertheless, regarding their effect as growth promoters, results are contradictory, largely because of the variety of microorganisms and doses that can be administered, the type of poultry used, methods of administration, diet compositions, and environmental conditions in which bioassays are performed. Therefore, given the need to eliminate antibiotics as growth promoters, it is essential to continue researching and expanding our knowledge of these additives, by conducting bioassays to determine bacterial strains and the most suitable methods of administration in modern poultry lineages under intensive production. The objective of this review is to present an analysis of the conditions under which these substances work, and to explain why their effects are sometimes insignificant.
Resumo Os probióticos e prebióticos atualmente se postulam como uma alternativa potencial de substituição aos antibióticos utilizados como subterapêuticos, a modo de promotores de crescimento. Têm como vantagem que estes agentes não deixam resíduos no ovo nem na carne da ave, e não geram risco de resistência antibiótica na microbiota humana. O uso dos micro-organismos probióticos, principalmente bactérias produtoras de ácido láctico na alimentação das aves, contribui para a manutenção da integridade e estabilidade da flora intestinal. Isto dificulta a proliferação de micro-organismos prejudiciais, fator que ajuda a prevenir a aparição de doenças e a melhorar o rendimento produtivo. No entanto, em relação ao seu efeito como promotor de crescimento, os resultados são contraditórios, em grande medida devido à variedade de micro-organismos e doses que podem ser administradas, ao tipo de aves utilizadas, aos métodos de administração, à composição das dietas de alimentação das aves e às condições ambientais em que se realizam os bioensaios. Portanto, e devido à necessidade de prescindir dos antibióticos como promotores de crescimento, é indispensável continuar pesquisando e ampliando o conhecimento destes aditivos, mediante a realização de bioensaios que permitam determinar as cepas bacterianas e os métodos de administração mais idôneos nas linhagens de aves modernas sob produção intensiva. O objetivo desta revisão é apresentar uma análise das condições nas que estas substâncias atuam, e explicar por que às vezes os seus efeitos são insignificantes.