How Substance Use Health Insurance And Social Determinants Of Health Affect The Hiv Prevention Continuum In Los Angeles Ca Focus On Pre Exposure Prophylaxis Prep And Treatment As Prevention PDF Download

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How Substance Use, Health Insurance, and Social Determinants of Health Affect the HIV Prevention Continuum in Los Angeles, CA: Focus on Pre-Exposure Prophylaxis (PrEP) and Treatment as Prevention

How Substance Use, Health Insurance, and Social Determinants of Health Affect the HIV Prevention Continuum in Los Angeles, CA: Focus on Pre-Exposure Prophylaxis (PrEP) and Treatment as Prevention
Author: Chelsea Leigh Shover
Publisher:
Total Pages: 91
Release: 2018
Genre:
ISBN:
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BACKGROUND: Recent advances in biomedical HIV prevention - including pre-exposure prophylaxis (PrEP) and treatment as prevention (TAsP) - are key to ending the HIV epidemic. The analysis examined how social factors that are strongly related to HIV incidence and treatment outcomes (e.g., substance use, access to healthcare, age, race/ethnicity, gender, and geographic location) may affect the HIV prevention continuum. METHODS: Chapters 2 and 3 use data collected as part of clinical care at the Los Angeles LGBT Center. In Chapter 2, a cross-sectional study of HIV-negative men who have sex with men (MSM) and transgender people who have sex with men (TGSM) who visited the Center between August 2015 and April 2017 examined how sexual history, substance use, and demographic factors were associated with initiating PrEP. In Chapter 3, records-based longitudinal study of patients prescribed PrEP at the Center evaluated discontinuation, HIV incidence, and loss to follow-up. Chapter 4 uses data from the mStudy to analyze the relationship between methamphetamine use (urine drug screen and self-reported frequency) patterns and viremia among HIV positive MSM of color. RESULTS: Use of sex drugs, but not alcohol use, was associated with PrEP initiation among MSM and TGSM. Key demographic risks were associated with lower odds of PrEP initiation (Black or Latino race/ethnicity, younger age). About half of patients who started PrEP at the Center discontinued or were lost to follow-up. HIV incidence among those who discontinued was 1.4%, compared to 0.3% among those who were actively attending follow-up appointments. Persistence was highest for those receiving PrEP through a low-cost program, and lowest for younger people. Longitudinal patterns of frequent and/or recent methamphetamine use were associated with a detectable pattern of viremia. CONCLUSION: Because younger people had lower PrEP initiation and more discontinuation compared to older people, strategies to support youth are key to PrEP's success for HIV prevention. The findings that methamphetamine was an obstacle to secondary HIV prevention but not necessarily to PrEP use highlight how facilitating PrEP use among people who use methamphetamine and other substances may be key to HIV prevention.

Sexually Transmitted Infections

Sexually Transmitted Infections
Author: National Academies of Sciences, Engineering, and Medicine
Publisher:
Total Pages: 750
Release: 2021-12-24
Genre: Medical
ISBN: 9780309683951
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One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research.

Pre-Exposure Prophylaxis Care Continuum Among Men Who Have Sex with Men in Vietnam

Pre-Exposure Prophylaxis Care Continuum Among Men Who Have Sex with Men in Vietnam
Author: Quang Loc Pham
Publisher:
Total Pages: 132
Release: 2020
Genre:
ISBN:
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BackgroundPre-exposure Prophylaxis (PrEP) is effective in preventing HIV acquisition and therefore is a key priority to ending the HIV/AIDS epidemic. Men who have sex with men (MSM) can largely benefit from the program because they are disproportionately affected by the epidemic. There is a paucity of studies conducted in Vietnam investigating barriers of PrEP uptake as well as the PrEP care continuum. The study aims to identify the challenges of PrEP implementation from the perspective of MSM and from the perspective of service providers working in antiretroviral therapy (ART) clinics, and to inform interventions to improve PrEP implementation. Methods A mixed-method design was used in the study. Sub-study 1 utilized the existing data of a cohort study of MSM and the ongoing PrEP-program data of an MSM-focused clinic in Hanoi, Vietnam to identify factors associated with PrEP initiation. Sub-study 2 was in-depth interviews of 30 discontinued MSM to explore multi-level challenges related to PrEP discontinuation. Sub-study 3 was a cross-sectional survey of service providers working in ART clinics in Hanoi, Ho Chi Minh, and Hai Phong Cities in Vietnam to investigate the association between service providers' acceptability of the PrEP program and concern about PrEP use. Results Study 1 found that 43% of HIV-negative MSM initiating PrEP. Four factors associated with increased PrEP initiation were revealed, that were, reported gender identity, no ATS use in the past three months or never, having more than two sexual partners in the last month, and ever tested for HIV in the last 12 months. Study 2 reported the challenges related to PrEP discontinuation in three levels: 1) Individual-level challenges were risk behaviors and risk perception, pill burden, side effects, and lack of motivation to treatment, 2) Institutional-level challenges were PrEP accessibility and logistical difficulties, 3) Structural-level challenges included cost due to the medication, stigma toward PrEP use, and the impact of the COVID-19 pandemic. Additionally, the study found that long-acting injectable PrEP was highly acceptable among discontinued MSM and that side effects and pain due to intramuscular injection were two major challenges related to injectable PrEP. Study 3 presented the high acceptability of PrEP implementation among ART service providers. The association between PrEP acceptability and concern about PrEP use was not observed, however, higher awareness of PrEP-related information, lower stigma toward MSM, and higher job satisfaction were correlated with increased PrEP acceptability. Conclusion MSM faces multi-level challenges to initiate PrEP and to remain in the PrEP program. Interventions targeting the multi-level challenges should be developed and need to be delivered in a comprehensive package.

Understanding the Well-Being of LGBTQI+ Populations

Understanding the Well-Being of LGBTQI+ Populations
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 437
Release: 2021-01-23
Genre: Social Science
ISBN: 0309680816
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The increase in prevalence and visibility of sexually gender diverse (SGD) populations illuminates the need for greater understanding of the ways in which current laws, systems, and programs affect their well-being. Individuals who identify as lesbian, gay, bisexual, asexual, transgender, non-binary, queer, or intersex, as well as those who express same-sex or -gender attractions or behaviors, will have experiences across their life course that differ from those of cisgender and heterosexual individuals. Characteristics such as age, race and ethnicity, and geographic location intersect to play a distinct role in the challenges and opportunities SGD people face. Understanding the Well-Being of LGBTQI+ Populations reviews the available evidence and identifies future research needs related to the well-being of SDG populations across the life course. This report focuses on eight domains of well-being; the effects of various laws and the legal system on SGD populations; the effects of various public policies and structural stigma; community and civic engagement; families and social relationships; education, including school climate and level of attainment; economic experiences (e.g., employment, compensation, and housing); physical and mental health; and health care access and gender-affirming interventions. The recommendations of Understanding the Well-Being of LGBTQI+ Populations aim to identify opportunities to advance understanding of how individuals experience sexuality and gender and how sexual orientation, gender identity, and intersex status affect SGD people over the life course.

AIDS, Sex, and Culture

AIDS, Sex, and Culture
Author: Ida Susser
Publisher: John Wiley & Sons
Total Pages: 380
Release: 2011-09-09
Genre: Social Science
ISBN: 144435910X
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AIDS, Sex, and Culture is a revealing examination of the impact the AIDS epidemic in Africa has had on women, based on the author's own extensive ethnographic research. based on the author's own story growing up in South Africa looks at the impact of social conservatism in the US on AIDS prevention programs discussion of the experiences of women in areas ranging from Durban in KwaZulu Natal to rural settlements in Namibia and Botswana includes a chapter written by Sibongile Mkhize at the University of KwaZulu Natal who tells the story of her own family’s struggle with AIDS

Disease Control Priorities, Third Edition (Volume 6)

Disease Control Priorities, Third Edition (Volume 6)
Author: King K. Holmes
Publisher: World Bank Publications
Total Pages: 1027
Release: 2017-11-06
Genre: Medical
ISBN: 1464805253
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Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

The Impact of Partnership Factors on Adherence to HIV Pre-Exposure Prophylaxis and Antiretroviral Therapy

The Impact of Partnership Factors on Adherence to HIV Pre-Exposure Prophylaxis and Antiretroviral Therapy
Author: Zoe Gabriele Baker
Publisher:
Total Pages: 122
Release: 2018
Genre:
ISBN:
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Adherence to medications for HIV prevention and treatment is essential to reducing HIV transmission risk and improving health outcomes. Adherence to these medications remain insufficient in several key populations, however. Understanding how partnership types and dynamics may encourage or hinder HIV medication adherence is necessary to improving adherence rates among important sub-groups, including young men who have sex with men (YMSM), serodiscordant couples, and adolescent girls. My first paper identified the partnership and housing factors associated with adherence to oral PrEP among YMSM. PrEP adherence was relatively low in the study, declining from 46% at baseline to 39% at study conclusion. PrEP adherence was significantly associated with increasing age (OR=1.35; 95% CI: 1.14, 1.60), and race (African-Americans vs. other OR=0.37, 95% CI: 0.21, 0.66). Relationship type, length, and depth, number of partners, and partner's HIV status were not significantly associated with adherence. PrEP adherence was associated with housing insecurity, including ever being kicked out of the home (AOR=0.43; 95% CI: 0.18, 1.04), and the Housing Insecurity Index (AOR=0.64; 95% CI: 0.44, 0.93). PrEP adherence was also associated with privacy, including number of people living in the residence (AOR=0.82; 95% CI: 0.71, 0.95), sleeping in a private bedroom (AOR=2.10, 95% CI: 1.01, 4.40), and the Lack of Privacy Index (AOR=0.82; 95% CI: 0.71, 0.95). YMSM did not modify their PrEP-taking depending on relationship risk. Housing insecurity and lack of privacy may hinder PrEP adherence among YMSM. My second paper determined whether HIV viral suppression was associated with partnership status and partnership support among HIV-positive individuals and serodiscordant couples in Brazil. Viral suppression did not significantly differ between HIV-positive partnered (79% virally suppressed) and unpartnered (76% virally suppressed) individuals. Among individuals in partnerships, viral load suppression was significantly associated with having partners who attended monthly visits (AOR=2.99; 95% CI: 1.00, 8.93); among women in partnerships, viral load suppression was significantly associated with having a partner who actively reminded them to take ART (AOR=2.67; 95% CI: 1.04, 6.88). Practical measures of social support, including attending monthly visits and reminding a partner to take ART, may improve viral suppression among HIV-positive individuals in serodiscordant partnerships. My third paper assessed the product, relationship, and sex factors that affect acceptability of a vaginal ring (VR) for HIV prevention among adolescent girls aged 15 to 17 years. Product factors were most frequently mentioned as barriers to VR acceptability. Many participants reported concerns about the large size of the VR upon first impression, and some reported pain with VR insertion. Several participants reported concerns regarding cleanliness of the VR, particularly during menstruation. Relationship factors rarely appeared to act as barriers to VR acceptability; the majority of participants disclosed VR use to their sexual partners, and positive reactions from sexual partners regarding the VR were common. Emotional and/or physical discomfort surrounding VR use during sex was mentioned occasionally as a potentially barrier to VR acceptability. Relationship factors appear to be important in several populations for adherence to HIV-related medications. YMSM in high-risk sexual relationships may not modify PrEP-taking, leaving them at risk for HIV acquisition. Among serodiscordant couples, practical measures of partnership support may improve ART adherence and promote viral suppression. While adolescent girls most often reported that product-related factors inhibited VR acceptability, lack of partnership disclosure, negative partner reactions, and discomfort during sex may hinder VR acceptability among some girls.

Care Barriers to HIV Prevention Tools Among Key Populations

Care Barriers to HIV Prevention Tools Among Key Populations
Author: Myriam Dergham
Publisher:
Total Pages: 0
Release: 2023
Genre:
ISBN:
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Background : HIV prevalence is higher in some populations: men who have sex with men, sex workers, people who inject drugs, transgender people, and migrants. Many HIV (human immunodeficiency virus) prevention tools have been developed: condoms, voluntary medical male circumcision (VMMC), needle exchange programs, pre-exposure prophylaxis (PreP) (oral, long-acting injection, local microbicides), post exposure prophylaxis (PEP), treatment as prevention (TasP). This article identifies and reviews the barriers to their optimal use among this populations. Methods: In November 2022, a systematic literature search was conducted to select available information according to the PRISMA-ScR methodology, in Medline and Scopus databases. We included populations of any age and gender. Preferences of people living with HIV were included if the target intervention was prevention, but we excluded people on anti-retroviral therapy with no aim to TaSP. We also excluded mother to child transmission prevention, and condom only us for contraception. Results : We screened 4564 titles and abstracts, reviewed 674 full texts and included 224 studies, that were conducted in 55 countries, from 2018 to 2023. Our study highlighted several barriers at different level. Some structural barriers are common between all populations, such as insurance barriers, poverty and homelessness, police issues, healthcare discriminations. Besides, the criminalization of same-sex relationship, transidentity, but also the criminalization of substance use and sex work are major barriers to the sue of prevention tools, as well as the undocumented migrants status. It also highlighted common sociocultural barriers, such as low HIV literacy and low perceived risk. HIV vulnerability is fueled by social stigma (HIV stigma and internalized stigma) which influence their behaviors and health outcomes. Key populations are particularly exposed to violence, forced sex, but also substance use and sex work. The intersection between multiple stigmatized identifies can severely intensify the negative health conséquences, at structural and sociocultural levels. At an individual level, the fear of having a positive result to an HIV test remains a huge barrier. The lack of access to condoms (especially without stigmatization), the cost, and sometimes the wrong beliefs imped their utilization, but it is above all the refusal by the partner, the low negotiation power, and the stealthy removal that jeopardize its good use. Syringe exchange programs are a trustworthy harm reduction intervention; however, geographic coverage remains limited, and many jurisdictions continue to have laws and policies that limit or forbid syringe service programs. Concerning PrEP, the low awareness, the cost, and the fear of side effects are major obstacles. Even if PrEP is a promising mean, the PrEP stigma and the fear of being perceived as an HIV positive person taking ARV and the resulting HIV stigma is an impediment. Besides, the oral galenic is not adapted for all, especially SW and PWUD: LAI PrEP, implant, or eventually a vaccine could be more convenient. Conclusion :This scoping review can help researchers, policy makers, program implementers, and health economists to better understand the barriers from using HIV prevention tools to reduce HIV widespread.

Pre-exposure Prophylaxis for the Prevention of HIV Infection

Pre-exposure Prophylaxis for the Prevention of HIV Infection
Author: Roger Chou
Publisher:
Total Pages: 220
Release: 2019
Genre:
ISBN:
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BACKGROUND: Effective prevention strategies for HIV infection are an important public health priority. Pre-exposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) regularly (e.g., daily) or before and after HIV exposure events to decrease the risk of acquiring HIV infection. PURPOSE: To synthesize evidence for the U.S. Preventive Services Task Force (USPSTF) on effects of PrEP on risk of HIV acquisition, mortality, harms, and other clinical outcomes; effects of adherence on PrEP-associated outcomes; and accuracy of methods for identifying potential candidates for PrEP. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, and Embase from inception to June 2018 and manually reviewed reference lists; additional surveillance for new literature was conducted through January 25, 2019. STUDY SELECTION: Randomized, controlled trials on the benefits and harms of PrEP versus placebo or no PrEP in adults without HIV infection at high risk of becoming infected; studies on the diagnostic accuracy of instruments for predicting incident HIV infection; studies on effects of adherence to PrEP on risk of HIV infection; and studies on rates of adherence to PrEP in U.S. populations. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): In populations at higher risk of acquiring HIV infection, PrEP was associated with decreased risk of HIV infection versus placebo or no PrEP (11 trials; relative risk [RR], 0.46 [95% confidence interval (CI), 0.33 to 0.66; I2=67%; absolute risk reduction, −2.0% [95% CI, −2.8% to −1.2%] after 4 months to 4 years). Effects were consistent across HIV risk categories and for PrEP with tenofovir disoproxil fumarate plus emtricitabine or tenofovir alone. There was a strong association between higher adherence and greater efficacy (adherence ≥70%: 6 trials; RR, 0.27 [95% CI, 0.19 to 0.39]; I2=0%; adherence >40% to

The Health of Sexual Minorities

The Health of Sexual Minorities
Author: Ilan H. Meyer
Publisher: Springer Science & Business Media
Total Pages: 740
Release: 2007-03-12
Genre: Medical
ISBN: 0387313346
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This is the first concise handbook on Lesbian, Gay, Bisexual and Transgender (LGBT) health in the past few years. It breaks the myths, breaks the silence, and breaks new ground on this subject. This resource offers a multidimensional picture of LGBT health across clinical and social disciplines to give readers a full and nuanced understanding of these diverse populations. It contains real-world matters of definition and self-definition, meticulous analyses of stressor and health outcomes, a extensive coverage of research methodology concerns, and critical insights into the sociopolitical context of LGBT individuals’ health and lives.