Multiple Determinants, Common Vulnerabilities, and Creative Responses

Mayer, Kenneth H.; Pape, Jean William; Wilson, Phill; Diallo, Dázon Dixon; Saavedra, Jorge; Mimiaga, Matthew J.; Koenig, Serena P.; Farmer, Paul

doi:10.1097/qai.0b013e31825c16d9

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…From a policy perspective, findings suggest extending the understanding of health inequities to revise and develop policies that facilitate a better context for the well-being of this population by reducing social exclusion. Issues such as marriage equity, protection from violence, attention to stigma and homophobia as well as protection from discrimination in the worksite have been documented as appropriate tools to reduce health inequities among gay men and other MSM (Campbell, 2013; Gonzales, 2014; Halkitis, 2012; Logie, 2012; Molina & Ramirez-Valles, 2013) and the impact of the HIV epidemic on these groups (Mayer et al, 2012; Phillips et al, 2013; Rodriguez-Diaz et al, in press). …”

Section: Discussionmentioning

confidence: 99%

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

et al. 2015

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Most of the research among HIV-positive populations has been approached from behavioral risk models. This is particularly true for those otherwise socially vulnerable groups like men who have sex with men (MSM). As a response to this pattern, we examined data from an ongoing health promotion research being conducted in Puerto Rico (PR). The study is limited to HIV-positive MSM and consists of the participation in a survey interview that includes domains used to assess indicators of socio-economic-related factors (age, educational level, employment, religion, and partnership status) and sexual health (sexual satisfaction, condom use, and sexual health knowledge (SHK)). Participants reported a relatively high level(75 %) of sexual satisfaction and inconsistent condom use (50.9 % reported always using a condom). A deficient (61 %) SHK was also reported. In multivariate analyses, a higher educational level was associated with higher sexual satisfaction (aβ = 3.223; 95 % CI 0.291–6.156) and higher levels of SHK (aβ=1.328; 95 % CI 0.358–2.297), while unemployment was associated with less condom use (aOR 0.314; 95 % CI 0.122–0.810). Not having a primary sexual partner was associated with less sexual satisfaction (aβ= −3.871; 95 % CI −7.534–0.208) and more condom use (aOR 4.292; 95 % CI 1.310–14.068). Findings support the notion that men of a disadvantaged socioeconomic position may have a poorer sexual health status; with a lower level of education and unemployment leading this disparity. Findings also evidence that partnership status may have a role in the sexual health of HIV-positive MSM. To our knowledge, this is the first comprehensive analysis of sexual health and socio-economic indicators among Hispanic/Latino HIV-positive MSM in PR and in the Caribbean. Findings provide valuable information to address the sexual health needs of an underserved population.

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Section: Discussionmentioning

confidence: 99%

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

et al. 2015

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“…In order to improve the delivery and uptake of HIV testing moving forward, identifying geographic areas in which confidential MSM-sensitive HIV testing is not available, and expanding access to affordable, confidential and MSM-friendly HCT sites, which provide linkage to affordable and appropriate HIV care, treatment and related services, may be useful in reducing the number of undiagnosed MSM and in disrupting HIV transmission among MSM in Cameroon [ 6 , 23 , 42 ]. Evaluating the feasibility of couples-based testing, partner-notification services, and rapid testing may also facilitate HIV testing uptake among MSM [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Correlates of prior HIV testing among men who have sex with men in Cameroon: a cross-sectional analysis

et al. 2014

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BackgroundRegular HIV testing is vital for timely linkage to the HIV care continuum and ensuring the success of behavioral and biomedical interventions to prevent HIV acquisition. Men who have sex with men (MSM) are a key population for HIV prevention, treatment, and care efforts globally. This study measures the factors associated with prior HIV testing among MSM in Cameroon.MethodsIn 2011, 272 and 239 MSM aged ≥ 18 were recruited from Douala and Yaoundé respectively using respondent-driven sampling (RDS) for a cross-sectional surveillance study. Participants completed a structured socio-behavioral survey and were offered HIV and syphilis testing and counseling.ResultsThe majority of men self-reported ever testing for HIV (81.6%; 413/506) and receiving their last HIV test result (95.4%; 394/413). Testing in the last 12 months was more prevalent in Douala (63.3%; 169/267) compared to Yaoundé (55.9%; 132/236). Median frequency of testing was every 18 months in Douala and every two years in Yaoundé. In multivariate RDS-weighted analysis, correlates of ever testing for HIV in Douala were: having higher than secondary education compared to having secondary education or less (aOR = 3.51, 95% CI: 1.32-9.34), ever accessing a community-based HIV service for MSM (aOR = 3.37, 95% CI: 1.57-7.24) and having ≥4 male oral or anal sexual partners in the past 12 months (aOR = 2.49, 1.08-5.74). In Yaoundé, having higher than secondary education (aOR = 7.96, 95% CI: 1.31-48.41) was associated with ever testing for HIV.ConclusionsSupporting regular HIV testing and linkage to care is important in a context of high HIV prevalence and limited use of condoms and condom-compatible lubricants. Building the capacity of MSM organizations and mainstream health services to deliver affordable, integrated, confidential, and MSM-sensitive HIV testing may assist in effectively engaging more MSM in the HIV treatment cascade. Giving specific attention to MSM who are younger, of lower socioeconomic status and less connected to community-based MSM organizations may increase HIV testing uptake. Given the levels of HIV testing and high HIV prevalence among MSM in Cameroon, optimizing the safe and effective provision and uptake of antiretroviral-based prevention and treatment approaches is paramount in changing the trajectory of the HIV epidemic among these men and within their sexual networks.

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“…Although this process can lead to re-alignment of resources for improved cost-effectiveness, a recent analysis of HIV prevention spending in 69 low- and middle-income countries with a variety of epidemic types revealed that spending patterns did not consistently reflect either current evidence or the HIV-specific context of each country [43•]. Recognition of the culture-specific aspects of microepidemics in a country is an important first step toward development of community-based organizations that can foster locally effective HIV responses [44]. In fact, bold and collaborative leadership in local scale-up of HIV prevention and treatment has been shown to underpin success in countries as varied as Brazil, Botswana, Nigeria, and India [45].…”

Section: National Responses and Trendsmentioning

confidence: 99%

Overview of the Current State of the Epidemic

Hankins

2013

Curr HIV/AIDS Rep

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At the end of 2011, about half of the 34.0 million [31.4–35.9 million] people living with HIV infection knew their HIV status. With large regional variations, an estimated 0.8 % of all adults aged 15 to 49 years have HIV infection and HIV subtype diversity is increasing. Although HIV incidence has declined in 39 countries, it is stable or increasing in others. HIV prevalence continues to rise as antiretroviral treatment scale-up results in fewer HIV-related deaths while new infections continue to occur. Increased treatment uptake is likely reducing HIV transmission in countries with large mortality declines. Key populations, including sex workers, men who have sex with men, transgender people, people who inject drugs and young women in high prevalence settings require effective prevention programs urgently. Correcting mismatches in resource allocation and reducing community viral load will accelerate incidence declines and affect future epidemic trends, if concerted action is taken now.

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Multiple Determinants, Common Vulnerabilities, and Creative Responses

Cited by 10 publications

References 16 publications

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

Sexual Health and Socioeconomic-Related Factors Among HIV-Positive Men Who Have Sex with Men in Puerto Rico

Correlates of prior HIV testing among men who have sex with men in Cameroon: a cross-sectional analysis

Overview of the Current State of the Epidemic

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