PURPOSE: To examine factors associated with completing enrollment milestones in the Together 5,000 cohort of at-risk men (n = 8661), transmen (n = 53), and transwomen (n = 63) who have sex with men. METHODS: Between 2017-2018, participants completed an online enrollment survey and were offered opportunities to complete an incentivized secondary online survey as well as selfadministered at-home HIV testing (OraSure HIV-1 Oral specimen collection device). We explored factors associated with completing each study component. RESULTS: In total, 8,777 individuals completed our enrollment survey, 6,166 (70.3%) completed the secondary survey, and 5,010 returned the at-home HIV test kit that was mailed to them (81.3% of those mailed a kit). Consistent with other researchers, in our multivariable models, those who were White, with more years of education, were more likely to complete study components, although the magnitude of these associations was small. For example, 50.9% of those enrolled, 47.9% of those completing the secondary survey, and 46.8% of those completing HIV testing were persons of color-a statistically significant, but meaningfully insignificant decline. CONCLUSIONS: These findings highlight the ongoing need for researchers to identify barriers that may prevent persons of color and younger individuals from participating in research studies.
BackgroundGay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years.ObjectiveThe Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs.MethodsWe used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment.ResultsThe study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years.ConclusionsA large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions.International Registered Report Identifier (IRRID)RR1-10.2196/13715
Cultural categories related to sexuality and gender vary considerably cross-culturally. While Western cultures categorize people primarily in terms of sexual attractions (i.e., gay, straight, bisexual), many cultures distinguish between groups based on additional issues such as gender role presentation and position preference in anal sex (i.e., insertive/receptive). The current study gathered data on three categories of natal males in Mumbai, India-hijra, kothi, and panthi (N = 93). Hijra are androphilic (sexually attracted to adult men), typically sexually receptive, transgender, sometimes castrated, and live in fictive kinship networks that are hierarchically organized. Kothi are also androphilic, typically sexual receptive and relatively feminine but less so than hijra; unlike hijra, kothi are never castrated. Hijra and kothi were understood by some participants to be mutually compatible, and so three groups were identified-those endorsing hijra only (n = 11), kothi only (n = 22), and both hijra and kothi (n = 22). Panthi (n = 38) are the masculine insertive partners of hijra and kothi. Measures employed were self-report and viewing time measures of sexual attraction, sexual behavior and position preference, self-described masculinity/femininity, recalled childhood gender atypicality, gendered occupational preferences, and gender presentation milestones (i.e., wearing female clothes, castration). All hijra and kothi groups were found to be exclusively androphilic in viewing time and self-reported sexual attractions, and to be gender-atypical on all measures. Panthi were found to be relatively male-typical and to have a bisexual pattern of viewing time and self-reported sexual attractions. Kothi were found to be less extreme in their female typicality and to report less female gender presentation milestones than hijra or hijra/kothi. Most hijra and hijra/kothi and all kothi said that they were not castrated. Contrary to the manner in which they are socially defined, a third of panthi report having been receptive in anal sex, and a third of all hijra and kothi groups report having been insertive at some time.
Improving HIV testing rates and increasing early detection among men who have sex with men (MSM) are critical strategies for enhancing overall health and decreasing HIV transmission. Remote testing and phone delivery of HIV test results may reduce barriers such as geographic isolation or HIV-related stigma. In 2018-19, 50 MSM completed qualitative interviews about their experience receiving a positive HIV test result via phone through their participation in a research study that included remote HIV testing. Interview topics included the acceptability of, and concerns about, phone delivery of HIV results, as well as suggestions for improvement. Interviews were transcribed, coded, and analysed using an inductive thematic approach. Overall, participants reported high acceptability of phone delivery of HIV-positive results. Participants praised the support and information provided by study staff. Benefits identified included increased convenience compared to in-person medical visits, allowing participants to emotionally process their test results privately, as well as receiving the results from supportive and responsive staff members. A few participants indicated drawbacks to phone-based HIV test result delivery, such as logistical concerns about receiving a phone call during the day (e.g., while at work), reduced confidentiality, and the lack of in-person emotional support. Overall, participants described phone delivery of positive HIV-results as acceptable. At-home testing with phone delivery has the potential to increase HIV testing access, especially to geographically isolated or medically underserved patients.
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