Self-Administered Screening for Syndemic Mental Health Problems Should be Routinely Implemented Among MSM PrEP Users

Tan, Darrell H. S.; Leon-Carlyle, Marisa; Mills, Rosanne Mt; Moses, Erin; Carvalhal, Adriana

doi:10.1080/19359705.2015.1105765

Cited by 22 publications

(18 citation statements)

References 8 publications

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“…Our findings mirror the high levels of syndemic conditions we have observed in MSM using or considering HIV pre-exposure prophylaxis (PrEP),[ 32 ] and are in stark contrast to rates in the general population. For example, the Canadian Community Health Survey-Mental Health reports that only 4.7%, 3.2% and 0.7% of Canadians meet criteria for depression, alcohol dependence/abuse, and drug abuse during the previous 12 months, respectively, albeit using different assessment instruments.…”

Section: Discussionsupporting

confidence: 86%

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

et al. 2018

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IntroductionThe standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or ‘syndemic’ psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk.MethodsBetween 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models.ResultsThe 186 MSM included in the analysis had median age 31 (IQR = 26–36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models.ConclusionsThe prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV.

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Section: Discussionsupporting

confidence: 86%

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

et al. 2018

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“…depressive symptoms, post-traumatic stress disorder, alcohol dependence, tobacco use, and hard-drug use)–compared to experience none or one psychosocial health problem–was significantly associated with increasing number of male sexual partners among Nigerian GBMSM [20]. Previous research has highlighted the need to screen for mental health problems among GBMSM PrEP users, as it may lead to suboptimal PrEP adherence [21] and overall health [22].…”

Section: Discussionmentioning

confidence: 99%

Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria

Ogunbajo

Iwuagwu²,

Williams³

et al. 2019

PLoS ONE

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BackgroundNigerian gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, with an estimated prevalence of between 11–35%. Pre-exposure prophylaxis (PrEP) has the potential to significantly decrease incident HIV infections among Nigerian GBMSM. Understanding the relationship between socio-demographic, sexual risk behavior, and psychosocial factors with PrEP awareness, willingness to use, and history of use among this group is pivotal to maximizing PrEP uptake.MethodsBetween March and June 2019, 419 participants completed an interviewer-administered survey assessing PrEP awareness, willingness to use, and history of use; socio-demographics; sexual risk behavior; and psychosocial factors. Bivariate and multivariable logistic regression were used to examine factors associated with PrEP awareness, willingness to use, and history of use.Results53.6% were aware of PrEP; 80.1% were willing to use PrEP; and 29.7% had previously used PrEP. In multivariable analysis, factors associated with an increased odds of PrEP awareness include residing in Abuja [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI): 2.13 to 11.83] and Lagos (aOR 12.30; 95% CI: 4.92 to 30.67) vs. residing in Plateau, living with HIV (aOR 2.56; 95% CI: 1.54 to 4.72), using location-based apps for seeking sexual partners (aOR 4.06; 95% CI: 2.28 to 7.24), having health insurance (aOR 2.31; 95% CI: 1.08 to 4.40), history of suicidal thoughts (aOR 2.05; 95% CI: 1.02 to 4.10), and history of PrEP use (aOR 45.5; 95% CI: 5.60 to 370.04). Decreasing clinically significant depressive symptoms was associated with lower willingness to use PrEP (aOR 0.96; 95% CI: 0.92 to 0.99). Lastly, factors associated with increased odds of having a history of PrEP use were those reporting 6 or more insertive anal sex acts in the last 30 days compared to those with none (aOR 5.76; 95% CI: 1.58 to 20.98) and being aware of PrEP (aOR 29.6; 95% CI: 3.78 to 231.84).DiscussionNearly half of the Nigerian GBMSM in this study had no prior awareness of PrEP, but after being informed about its potential benefits, the majority were willing to use it. However, PrEP uptake among Nigerian GBMSM remains low. Findings suggest that educational messages are necessary to ensure appropriate PrEP scale-up, especially tailored towards Nigerian GBMSM.

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“…This high prevalence is consistent with data showing that syndemic health problems concentrate in urban gbMSM and synergize to produce high HIV risk [ 15 , 16 , 34 ], and also highlights the potential to use PrEP programs as a gateway to other health services [ 35 ]. Another study from our group identified a similarly high burden of syndemic problems among patients accessing nPEP [ 18 ], and we have elsewhere argued for the routine implementation of screening strategies for such syndemics in all PrEP programs [ 17 ]. Multiple drug use in our study was similar to the baseline prevalence among gbMSM enrolled in the US PrEP Demonstration Project, where 20.1% reported use of 3 or more of poppers, ketamine, ecstasy, gamma-hydroxybutyrate, cocaine, methamphetamine, or erectile dysfunction drugs in the past 3 months [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Further, the HIRI-MSM only includes items on sexual and drug-taking behaviors, and does not include items for mental health problems and other more distal HIV risk factors, despite their objective connection to HIV risk. We have previously observed a high prevalence of syndemic problems among gay men seeking both PrEP [ 17 ] and nPEP (non-occupational post-exposure prophylaxis) [ 18 ], but these analyses were not stratified by referral type. In this study, we hypothesized that provider-referred men would have a higher HIV risk profile (as determined by their HIRI-MSM score and number of syndemic problems) than men who self-referred.…”

Section: Introductionmentioning

confidence: 99%

High HIV risk and syndemic burden regardless of referral source among MSM screening for a PrEP demonstration project in Toronto, Canada

et al. 2018

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BackgroundTo maximize public health impact and cost-effectiveness, HIV pre-exposure prophylaxis (PrEP) must reach individuals at high HIV risk. Referrals for PrEP can be self- or provider-initiated, but there are several challenges to both. We assessed whether HIV risk differed by referral source among gay, bisexual and other men who have sex (gbMSM) screening for an HIV PrEP demonstration project.MethodsPREPARATORY-5 was an open-label PrEP demonstration project enrolling gbMSM at high risk of HIV acquisition in Toronto, Canada. Study eligibility criteria related to high risk was defined as scoring ≥10 on the HIV Incidence Risk Index for MSM (HIRI-MSM) and engaging in at least 1 act of condomless receptive anal sex within the past 6 months. Recruitment was promoted through self-referrals (ads in a sexual networking app and gay newspaper/website) and provider-referrals (10 community-based organizations, CBOs). HIV risk score (HIRI-MSM) and syndemic health burden were measured among gbMSM screened for study participation and compared according to referral source.ResultsBetween October 16 and December 30, 2014, online ads generated 1518 click-throughs and CBOs referred 115 individuals. Overall, 165 men inquired about the trial, of which 86 underwent screening. The majority of screened men were self-referrals (60.5%), scored ≥10 on HIRI-MSM (96.5%), and reported condomless receptive anal sex in the past 6 months (74.2%). Self- and provider-referrals had similarly high HIV risk profiles, with a median (IQR) HIRI-MSM score of 26.0 (19.0–32.5) and 28.5 (20.0–34.0) (p = 0.3), and 75.0% and 73.5% reporting condomless receptive anal sex (p = 0.9), respectively. The overall burden of syndemic health problems was also high, with approximately one-third overall identified as having depressive symptoms (39.5%), alcohol-related problems (39.5%), multiple drug use (31.4%), or sexual compulsivity (31.4%). There were no significant differences in syndemic health problems by referral source.ConclusionsHIV risk and syndemic burden were high among gbMSM presenting for this PrEP demonstration project regardless of referral source. Self-referral may be a useful and efficient strategy for identifying individuals suitable for PrEP use. Online strategies and CBOs working in gay men’s health may play important roles in connecting individuals at high HIV risk to PrEP services.Trial registrationClinicalTrials.gov NCT02149888. Registered May 12th 2014.

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Self-Administered Screening for Syndemic Mental Health Problems Should be Routinely Implemented Among MSM PrEP Users

Cited by 22 publications

References 8 publications

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV

Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria

High HIV risk and syndemic burden regardless of referral source among MSM screening for a PrEP demonstration project in Toronto, Canada

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