RESUMO
The DESIRE Study (MTN-035) explored product preference among three placebo rectal microbicide (RM) formulations, a rectal douche (RD), a suppository, and an insert, among 210 sexually active transgender people and men who have sex with men in five counties: the United States, Peru, Thailand, South Africa, and Malawi. Participants used each product prior to receptive anal sex (RAS) for 1 month, following a randomly assigned sequence, then selected their preferred product via computer assisted self-interview. In-depth interviews examined reasons for preference. We compared product preference and prior product use by country to explore whether geographic location and experience with the similar products impacted preference. A majority in the United States (56%) and Peru (58%) and nearly half in South Africa (48%) preferred the douche. Most in Malawi (59%) preferred the suppository, while half in Thailand (50%) and nearly half in South Africa (47%) preferred the insert. Participants who preferred the douche described it as quick and easy, already routinized, and serving a dual purpose of cleansing and protecting. Those who preferred the insert found it small, portable, discreet, with quick dissolution. Those who preferred the suppository found the size and shape acceptable and liked the added lubrication it provided. Experience with product use varied by country. Participants with RD experience were significantly more likely to prefer the douche (p = 0.03). Diversifying availability of multiple RM dosage forms can increase uptake and improve HIV prevention efforts globally.
RESUMEN: El estudio DESIRE (MTN-035) exploró la preferencia de producto entre tres formulaciones de microbicida rectal (MR) de placebo, una ducha rectal, un supositorio y un inserto, entre 210 personas transgénero y hombres que tienen sexo con hombres en cinco países: los Estados Unidos, Perú., Tailandia, Sudáfrica y Malawi. Los participantes utilizaron cada producto antes del sexo anal receptive (SAR) durante un mes, siguiendo una secuencia asignada al azar, luego seleccionaron su producto preferido mediante una autoentrevista asistida por computadora. Las entrevistas en profundidad examinaron los motivos de preferencia. Comparamos la preferencia de producto y el uso previo del producto por país para explorar si la ubicación geográfica y la experiencia con la forma farmacéutica impactaron la preferencia. Una mayoría en los Estados Unidos (56%) y Perú (58%) y casi la mitad en Sudáfrica (48%) prefirieron la ducha rectal. La mayoría en Malawi (59%) prefirió el supositorio, mientras que la mitad en Tailandia (50%) y casi la mitad en Sudáfrica (47%) prefirió el inserto. Los participantes que prefirieron la ducha rectal la describieron como rápida y fácil, ya parte de su rutina y que tenía el doble propósito de limpiar y proteger. Los que prefirieron el inserto lo consideraron pequeño, portátil, discreto y de rápida disolución. Los que prefirieron el supositorio encontraron que tenía un tamaño y forma aceptables y proveía lubricación adicional. La experiencia con el uso del producto varió según el país. Los participantes con experiencia con duchas rectales tenían significativamente más probabilidades de preferir la ducha rectal (p = 0,03). Diversificar la disponibilidad de múltiples formas farmacéuticas de MR puede aumentar la aceptación y mejorar los esfuerzos de prevención del VIH a nivel mundial.
Assuntos
Administração Retal , Infecções por HIV , Homossexualidade Masculina , Minorias Sexuais e de Gênero , Humanos , Masculino , Tailândia , Infecções por HIV/prevenção & controle , Malaui , Minorias Sexuais e de Gênero/psicologia , Estados Unidos , Adulto , Feminino , Adulto Jovem , África do Sul , Homossexualidade Masculina/psicologia , Supositórios , Adolescente , Peru , Preferência do Paciente , Comportamento Sexual , Pessoas Transgênero/psicologia , Anti-Infecciosos/administração & dosagem , Placebos/administração & dosagem , Formas de DosagemRESUMO
BACKGROUND: Strengthening HIV prevention services is a key priority of the Ending the HIV Epidemic plan. Informed by the Consolidated Framework for Implementation Research, we examined HIV testers' perceived barriers and facilitators to implementing HIV prevention services, including testers' strengths and weaknesses; enabling factors within the inner and outer settings; and willingness to adopt potential implementation strategies. METHODS: In 2019, the Penn Center for AIDS Research (CFAR) partnered with the Philadelphia Department of Public Health (PDPH) to examine system-level challenges and opportunities experienced by PDPH-funded HIV testers (individuals conducting HIV testing) in Philadelphia. We recruited HIV testers to complete 2 web surveys (n ≈ 40 each) and in-depth interviews (n = 11). RESULTS: Testers self-reported high HIV testing self-efficacy and competence, despite identifying gaps in their knowledge of STI testing, reporting moderate willingness to recommend pre-exposure prophylaxis, and having insufficient cultural competency when working with priority populations. Testers indicated that educational materials and policies within their agencies might require realignment to affirm sexual and gender minority clients. In qualitative interviews, testers noted challenges to implementing PDPH priorities because limited funding fueled competition between local agencies, deterred interagency partnerships, and limited their ability to serve key populations locally. DISCUSSION: HIV testers are critical partners in addressing agency-level barriers to HIV prevention service provision through multilevel implementation strategies. In partnership with PDPH, we will create and implement a train-the-trainers program consisting of skill-building activities, technical assistance, and capacity-building for all agency personnel to address missed opportunities in HIV prevention. These activities will reinforce scalability and sustainability of PDPH-supported HIV prevention programs.
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Profilaxia Pré-Exposição , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Ciência da Implementação , PhiladelphiaRESUMO
The Undetectable = Untransmittable (U=U) campaign was launched in 2016 to simultaneously reduce human immunodeficiency virus (HIV) stigma and raise awareness about treatment as prevention. This research note assesses HIV-negative young men who have sex with men's U=U awareness and perceived accuracy to inform this population's combination HIV prevention strategies.
Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Infecções por HIV/psicologia , Promoção da Saúde/métodos , Humanos , Masculino , Mid-Atlantic Region , Comportamento Sexual/estatística & dados numéricos , Estigma Social , Adulto JovemRESUMO
BACKGROUND: The United States Centers for Disease Control and Prevention promote HIV testing every 6 months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services' quality. Using a novel mystery shopper methodology, we assessed YMSM's testing experiences in 3 cities and recommend service delivery improvements. METHODS: We assessed YMSM's experiences at HIV testing sites in Philadelphia (n = 30), Atlanta (n = 17), and Houston (n = 19). YMSM (18-24) were trained as mystery shoppers and each site was visited twice. After each visit, shoppers completed a quality assurance survey to evaluate their experience. Data were pooled across sites, normed as percentages, and compared across cities. RESULTS: Across cites, visits averaged 30 minutes (SD = 25.5) and were perceived as welcoming and friendly (70.9%). YMSM perceived most sites respected their privacy and confidentiality (84.3%). YMSM noted deficiencies in providers' competencies with sexual minorities (63.4%) and comfort during the visit (65.7%). Sites underperformed on Lesbian, Gay, Bisexual, Transgender visibility (49.6%) and medical forms inclusivity (57.95%). Sites on average did not discuss YMSM's relationship context (49.8%) nor provide risk reduction counseling (56.8%) or safer sex education (24.3%). Sites delivered pre-exposure prophylaxis information and counseling inconsistently (58.8%). CONCLUSIONS: Testing sites' variable performance underscores the importance of improving HIV testing services for YMSM. Strategies are recommended for testing sites to promote cultural sensitivity: funding staff trainings, creating systems to assess adherence to testing guidelines and best practices, and implementing new service delivery models.
Assuntos
Infecções por HIV/diagnóstico , Disparidades em Assistência à Saúde/estatística & dados numéricos , Homossexualidade Masculina , Serviços Preventivos de Saúde/organização & administração , Adulto , Aconselhamento , Assistência à Saúde Culturalmente Competente , Infecções por HIV/prevenção & controle , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Programas de Rastreamento , Serviços Preventivos de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde , Estados Unidos/epidemiologiaRESUMO
Youth living with HIV (YLH) experience multiple disease-related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual- and neighborhood-level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood-specific data were compiled from the 2010 U.S. Census Bureau and matched with individual-level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non-Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross-level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV , Pobreza , Características de Residência , Apoio Social , Adolescente , Adulto , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
This study examined how acceptability of placebo gel with receptive anal intercourse (RAI) and likelihood of future rectal microbicide use varied across partner types. Because no rectal microbicide is available yet, use of placebo permitted the study of gel use behavior in real-life circumstances. A total of 87 men who have sex with men (MSM) aged 18 to 30 years inserted placebo gel rectally before RAI during 12 weeks. Using mixed-methods design, participants completed a behavioral questionnaire and in-depth interview. In all, 62 men (71.3%) reported gel use with a lover (i.e., spouse equivalent, boyfriend), 32 (36.8%) with a one-night stand (i.e., man with whom you had sex once), and 29 (33.3%) with an "other" male partner. While gel acceptability was high across partner types, use with lovers was facilitated by trust and familiarity; yet trust made participants believe protection was less necessary. Conversely, participants expressed high likelihood of using gel with one-night stands, whom they perceived as riskier; yet they felt less comfortable discussing gel with them, often resorting to covert use or forgoing gel. A successful microbicide will be positioned as a sexual pleasure enhancer so that men can present it to their lovers and other partners as a gel that improves sex and secondarily prevents human immunodeficiency virus (HIV).
Assuntos
Anti-Infecciosos/uso terapêutico , Homossexualidade Masculina/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Géis , Humanos , Masculino , Placebos , Porto Rico , Estados Unidos , Adulto JovemRESUMO
This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Atenção , Transtornos Cognitivos/psicologia , Logro , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/etnologia , Criança , Escolaridade , Feminino , Humanos , Hipercinese/psicologia , Comportamento Impulsivo/psicologia , Inteligência , Relações Interpessoais , Masculino , Memória de Curto Prazo , Mães , Testes Neuropsicológicos , Resolução de Problemas , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor , Porto Rico , EnsinoRESUMO
OBJECTIVE: This study examined the impact of inattention, hyperactivity, and oppositional defiant disorder (ODD) behaviors and gender on family life. METHOD: We created scales for the Family Experiences Inventory (FEI) in a nonclinical sample of Spaniard families with children ages 6 to 12 years (N = 369) and analyzed the perceived impact of these three behavior dimensions on family experiences. RESULTS: Multiple regression analyses indicated that ODD behaviors were uniquely correlated with Total FEI and its dimensions. Inattention was also uniquely related to higher negative Impact on School Relations and lower Positive Impact on Parents scales. Finally, gender-hyperactivity interactions indicated that boys with higher hyperactivity scores were more likely to score higher on the FEI Total, School Relations, and Siblings scales, and more likely to score lower on the Positive Impact on Parents scale than girls. CONCLUSIONS: These findings suggested that parents perceive greater child-related impact and place greater burden from having a male child with hyperactivity. Inattention, hyperactivity, and oppositional defiant behaviors are associated with global parent-child interactive stress but the pattern of associations will vary depending upon the behavior, child gender, and context of family life examined.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Família/psicologia , Hipercinese/psicologia , Criança , Comportamento Infantil/psicologia , Análise Fatorial , Feminino , Hispânico ou Latino/psicologia , Humanos , Modelos Lineares , Masculino , Percepção , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
CONTEXT: Gender has been recognized as a significant influence on sexual health behaviors. Labor migration presents an important context of vulnerability for sexual health. To understand how the context of migration affects risk-related practices, both cultural and social aspects of gender need to be explored. METHODS: In the quantitative part of a mixed-methods study conducted in 1999 in Atlanta, 187 Mexican migrant men were asked about their demographic characteristics; sexual history; migration motivations; substance use; social support; leisure-time activities; and ideas about masculinity, sexuality and marriage. Multivariate regression analyses were conducted to test the association between these domains and men's number of partners since their arrival in Atlanta. RESULTS: Number of partners was positively associated with owning a home in Mexico; number of trips back to Mexico; social network size; having had a sex worker as a partner; and going out dancing and to strip clubs on weekends (coefficients, 0.3-4.1). It was negatively associated with age, education, contact with social network members and feeling that sex is tied to emotional intimacy (-0.4 to -1.0). CONCLUSIONS: Programs must acknowledge and target migrant men's social networks and the spaces in which they may encounter risky sexual situations. Multilevel strategies, such as the development of more health-enhancing community spaces and the promotion of safer sexual practices should form part of comprehensive efforts to reduce sexual risk among migrant men.
Assuntos
Atitude Frente a Saúde/etnologia , Relações Extramatrimoniais/etnologia , Casamento/etnologia , Sexo Seguro/etnologia , Adulto , Georgia/epidemiologia , Humanos , Acontecimentos que Mudam a Vida , Masculino , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , Parceiros Sexuais/psicologia , Percepção Social , Inquéritos e Questionários , Saúde da Mulher , Adulto JovemRESUMO
AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children's attitudes toward PWA using drawings (n=65) and stories (n=45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children's fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children's attitudes through creative data collection procedures.