HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities

Hickson, Ford; Melendez‐Torres, G. J.; Reid, David; Weatherburn, Peter

doi:10.1136/sextrans-2016-052800

Cited by 18 publications

(16 citation statements)

References 15 publications

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“…In addition to being more likely to be PrEP users, pro remote testers were more likely to be people who had never previously tested for HIV and people who self-identified as being of non-white ethnicity. These results are consistent with the existing evidence [35] and further suggest that remote testing options could be effective methods of reaching people at high risk of infection who are facing particularly elevated barriers to testing [37]. This includes black African MSM, who are a priority group for intervention because they have a significantly higher HIV prevalence and incidence than other groups [9].…”

Section: Discussionsupporting

confidence: 87%

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

et al. 2019

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Background In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. Methods and findings Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather...

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Section: Discussionsupporting

confidence: 87%

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

et al. 2019

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“…Mental health inequalities along ethnic gradients seen in heterosexual men are preserved in MSM,20 and also found in these data. However, associations between ethnicity and HIV, being on ART, or use of PEP, widely reported in the literature are not found in this analysis 17 19 21…”

Section: Discussionmentioning

confidence: 57%

Chemsex-related drug use and its association with health outcomes in men who have sex with men: a cross-sectional analysis of Antidote clinic service data

Stevens

Moncrieff²,

Gafos

2019

Sex Transm Infect

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PurposeChemsex-related drug use (CDU) is an escalating public health issue among men who have sex with men (MSM), associated with significant physical, biomedical and psychosocial harm. Few interventions exist to help MSM engaging in chemsex and little data exist on which to build. This cross-sectional analysis, using data from Antidote, the UK’s only lesbian, gay, bisexual, and transgender specialist drug service, aims to remedy this paucity of data.MethodsModified Poisson regression was used to assess associations between CDU and a range of health outcomes; CDU+ subanalysis disaggregated MSM by primary chemsex drug of concern; and HIV+ subanalysis investigated whether CDU was associated with self-reported treatment adherence, HIV seroconversion and other HIV-specific issues.FindingsCompared with CDU− MSM, MSM presenting for CDU were more likely to be HIV+, current or previous injectors, to have used postexposure prophylaxis in the last year, and have had ≥6 sexual partners in the last 90 days, though less likely to be hazardous alcohol consumers or to have experienced previous suicidal ideation (all p<0.0005). CDU+ subanalysis revealed health outcome differences—those selecting mephedrone were less likely to be hepatitis C+, HIV+, current or previous injectors, or to have experienced previous suicidal ideation (all p<0.0005), whereas those selecting methamphetamine were more likely (all p<0.0005, except suicidal ideation p=0.009).ImplicationsThis analysis shows MSM presenting for CDU are a heterogeneous high-risk population with unmet health needs. There is a need for standardised chemsex surveillance and for improved intersectorial working between sexual health and drug treatment services. Future research should investigate typological differences between MSM presenting for CDU.Originality/valueTo date, this is the world’s largest analysis of MSM seeking treatment for CDU. Further, the publication of ‘real-world’ service data is a valuable addition to the literature alongside surveys and recruited studies.

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“…HIV incidence in an English national cohort of clinic attending BMSM was 3.2 per 100 person-years, compared with 2.0 for all MSM 3. In a cross-sectional study, 2.8% of BMSM were diagnosed with HIV in the preceding 12 months compared with 1.1% of MSM overall 4. Although long a priority group in the USA, intensive and focused HIV prevention interventions for UK BMSM, who make up 5% of clinic attending MSM,6 have not been a reality.…”

Section: Introductionmentioning

confidence: 92%

What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18–45 in London? Results from a qualitative study

2019

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BackgroundBlack men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared with other men who have sex with men, despite similar risk profiles. New prevention technologies, including pre-exposure prophylaxis (PrEP), may be effective in responding to these inequalities, provided they are appropriately targeted and acceptable to their intended beneficiaries. This study aims to understand the motivations and barriers of BMSM aged 18–45 to PrEP uptake.MethodsTwenty-five BMSM recruited through geolocation social networking apps took part in in-depth interviews between April and August 2016. Intersectionality theory was used as an organising principle. Interviews were transcribed verbatim and analysed using a thematic framework analysis.ResultsFor BMSM with heterogeneous social groups, discussions about sexual health were challenging because of the intersection of ethnic background, family history and religion. This limited conversations about PrEP to gay male friends who often held stigmatising views of condomless anal intercourse. BMSM reported exclusion from gay male spaces (online and offline) which could serve to restrict exposure to PrEP messages. Stereotypes of BMSM intersected with negative conceptions of PrEP users, limiting acknowledgement of PrEP candidacy. For those who had attempted to or successfully accessed it, PrEP was framed as a strategy to mitigate risk and to guard against further stigma associated with HIV infection.DiscussionBMSM operate within a complex set of circumstances related to the intersection of their sexual, ethnic, cultural and religious identities, which shape PrEP acceptability. Interventions which seek to facilitate uptake in this group must be attentive to these. Health promotion and clinical services could seek to facilitate nuanced discussions about the merits of PrEP for those at frequent risk, perhaps while also providing publicly visible PrEP role models for BMSM and other marginalised groups.

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HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities

Abstract: Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences.

Cited by 18 publications

References 15 publications

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

Chemsex-related drug use and its association with health outcomes in men who have sex with men: a cross-sectional analysis of Antidote clinic service data

What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18–45 in London? Results from a qualitative study

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