Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention

George Ayala, Keletso Makofane, Glenn-Milo Santos, Jack Beck, Tri D Do, Pato Hebert, Patrick A Wilson, Thomas Pyun, Sonya Arreola, George Ayala, Keletso Makofane, Glenn-Milo Santos, Jack Beck, Tri D Do, Pato Hebert, Patrick A Wilson, Thomas Pyun, Sonya Arreola

Abstract

Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.

Figures

Figure 1
Figure 1
Percent of respondents who reported easy access to services.

References

    1. Beyrer C., Baral S. D., van Griensven F., et al. The global epidemiology of HIV infection among men who have sex with men. The Lancet. 2012;380(9839):367–377. doi: 10.1016/S0140-6736(12)60821-6.
    1. Baral S., Sifakis F., Cleghorn F., Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Medicine. 2007;4(12, article e339) doi: 10.1371/journal.pmed.0040339.
    1. Sullivan P. S., Hamouda O., Delpech V., et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Annals of Epidemiology. 2009;19(6):423–431. doi: 10.1016/j.annepidem.2009.03.004.
    1. Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. Morbidity and Mortality Weekly Report. 2010;59:1201–1207.
    1. Beyrer C., Wirtz A., Walker D., Johns B., Sifakis F., Baral S. The Global HIV Epidemics Among Men Who Have Sex with Men. Washington, DC, USA: The World Bank; 2011.
    1. Ayala G., Hebert P., Keatley J., Sundararaj M. An Analysis of Major HIV Donor Investments Targeting Men Who Have Sex with Men and Transgender People. Oakland, Calif, USA: The Global Forum on MSM & HIV, (MSMGF); 2011.
    1. Grant R. M., Lama J. R., Anderson P. L., et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. The New England Journal of Medicine. 2010;363(27):2587–2599. doi: 10.1056/NEJMoa1011205.
    1. Cohen M. S., Chen Y. Q., McCauley M., et al. Prevention of HIV-1 infection with early antiretroviral therapy. The New England Journal of Medicine. 2011;365(6):493–505. doi: 10.1056/NEJMoa1105243.
    1. Das M., Chu P. L., Santos G., et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PloS ONE. 2010;5(6) doi: 10.1371/journal.pone.0011068.e11068
    1. Anglemyer A., Rutherford G. W., Egger M., Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database of Systematic Reviews. 2011;(5) doi: 10.1002/14651858.CD009153.CD009153
    1. UNAIDS. Combination HIV Prevention: Tailoring and Coordinating Biomedical, Behavioral and Structural Strategies to Reduce New HIV Infections: A Discussion Paper. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2010.
    1. Gupta G. R., Parkhurst J. O., Ogden J. A., Aggleton P., Mahal A. Structural approaches to HIV prevention. The Lancet. 2008;372(9640):764–775. doi: 10.1016/S0140-6736(08)60887-9.
    1. Johnson W. D., Diaz R. M., Flanders W. D., et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database of Systematic Reviews. 2008;(3)CD001230
    1. Waldo C. R., Coates T. J. Multiple levels of analysis and intervention in HIV prevention science: exemplars and directions for new research. AIDS. 2000;14(2):S18–S26.
    1. Mantell J. E., Myer L., Carballo-Diéguez A., et al. Microbicide acceptability research: current approaches and future directions. Social Science and Medicine. 2005;60(2):319–330. doi: 10.1016/j.socscimed.2004.05.011.
    1. World Bank. World Bank Country and Lending Groups, 2012, .
    1. Su C. T., Parham L. D. Generating a valid questionnaire translation for cross-cultural use. The American Journal of Occupational Therapy. 2002;56(5):581–585.
    1. Nevo B. Face validity re-visited. Journal of Educational Measurement. 2005;22(4):287–293.
    1. Carrière I., Bouyer J. Choosing marginal or random-effects models for longitudinal binary responses: application to self-reported disability among older persons. BMC Medical Research Methodology. 2002;2(1, article 15) doi: 10.1186/1471-2288-2-15.
    1. Song Y., Li X., Zhang L., et al. HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China. AIDS Care. 2011;23(2):179–186. doi: 10.1080/09540121.2010.487088.
    1. Ayala G., Hebert P., Lauer K., Sundararaj M. HIV Prevention with MSM: Balancing Evidence with Rights based Principles of Practice. Global Forum on MSM and HIV website, 2010, .
    1. Knox J., Sandfort T., Yi H., Reddy V., Maimane S. Social vulnerability and HIV testing among South African men who have sex with men. International Journal of STD and AIDS. 2011;22(12):709–713. doi: 10.1258/ijsa.2011.010350.
    1. Arreola S., Hebert P., Makofane K., Beck J., Ayala G. Access to HIV Prevention and Treatment for Men Who Have Sex with Men: Finding from the 2012 Global Men’s Health and Rights Survey (GMHR) Oakland, Calif, USA: The Global Forum on MSM & HIV, (MSMGF); 2012.
    1. Ayala G., Bingham T., Kim J., Wheeler D., Millet G. Modeling the impact of social discrimination and financial hardship on the sexual risk for HIV among Latino and Black men who have sex with men. The American Journal of Public Health. 2012;102(2):S242–S249. doi: 10.2105/AJPH.2011.300641.
    1. Mizuno Y., Borkowf C., Millett G. A., Bingham T., Ayala G., Stueve A. Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS and Behavior. 2012;16(3):724–735. doi: 10.1007/s10461-011-9967-1.
    1. Wilson P. A., Yoshikawa H. Experiences of and responses to social discrimination among Asian and Pacific Islander gay men: their relationship to HIV risk. AIDS Education and Prevention. 2004;16(1):68–83. doi: 10.1521/aeap.16.1.68.27724.
    1. Díaz R. M., Ayala G., Bein E., Henne J., Marin B. V. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. The American Journal of Public Health. 2001;91(6):927–932.
    1. Stall R., Frieden M., Catania J. An update on syndemic theory among urban gay men. Proceedings of the American Public Health Association Conference; 2007; Washington, DC, USA.
    1. Shoptaw S., Weiss R. E., Munjas B., et al. Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health. 2009;86(supplement 1):S77–S92. doi: 10.1007/s11524-009-9372-5.
    1. Wong C. F., Weiss G., Ayala G., Kipke M. D. Harassment, discrimination, violence, and illicit drug use among young men who have sex with men. AIDS Education and Prevention. 2010;22(4):286–298. doi: 10.1521/aeap.2010.22.4.286.
    1. McDermott E., Roen K., Scourfield J. Avoiding shame: young LGBT people, homophobia and self-destructive behaviours. Culture, Health and Sexuality. 2008;10(8):815–829. doi: 10.1080/13691050802380974.
    1. Stall R., Hoff C., Coates T. J., et al. Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men: Implications for secondary prevention efforts. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1996;11(2):151–160.
    1. Meyer I. H. Minority stress and mental health in gay men. Journal of Health and Social Behavior. 1995;36(1):38–56.
    1. Arreola S., Ayala G., Banos O., Beck J., Keatley J., Sundararaj M. In Our Own Words: Preferences, Values and Perspectives on HIV Prevention and Treatment—A Civil Society Consultation with MSM and Transgender People. Oakland, Calif, USA: The Global Forum on MSM & HIV, (MSMGF); 2010.
    1. Jackson T., Huang A., Chen H., Gao X., Zhong X., Zhang Y. Cognitive, psychosocial, and sociodemographic predictors of willingness to use HIV pre-exposure prophylaxis among chinese men who have sex with men. AIDS and Behavior. 2012;16(7):1853–1861. doi: 10.1007/s10461-012-0188-z.
    1. Poynten I. M., Jin F., Prestage G. P., Kaldor J. M., Imrie J., Grulich A. E. Attitudes towards new HIV biomedical prevention technologies among a cohort of HIV-negative gay men in Sydney, Australia. HIV Medicine. 2010;11(4):282–288. doi: 10.1111/j.1468-1293.2009.00777.x.
    1. Galea J. T., Kinsler J. J., Salazar X., et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk peruvian populations. International Journal of STD and AIDS. 2011;22(5):256–262. doi: 10.1258/ijsa.2009.009255.
    1. Brooks R. A., Landovitz R. J., Kaplan R. L., Lieber E., Lee S., Barkley T. W. Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care and STDs. 2012;26(2):87–94. doi: 10.1089/apc.2011.0283.
    1. Kelesidis T., Landovitz R. J. Preexposure prophylaxis for HIV prevention. Current HIV/AIDS Reports. 2011;8(2):94–103. doi: 10.1007/s11904-011-0078-4.
    1. Majid A., Redfield R. R., Gilliam B. L. The use of preexposure treatments for HIV prophylaxis. HIV/AIDS—Research and Palliative Care. 2012;4:17–28.
    1. Talley A. E., Bettencourt B. A. The moderator roles of coping style and identity disclosure in the relationship between perceived sexual stigma and psychological distress. Journal of Applied Social Psychology. 2011;41(12):2883–2903. doi: 10.1111/j.1559-1816.2011.00863.x.
    1. Balsam K. F., Mohr J. J. Adaptation to sexual orientation stigma: a comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology. 2007;54(3):306–319. doi: 10.1037/0022-0167.54.3.306.
    1. Detrie P. M., Lease S. H. The relation of social support, connectedness, and collective self-esteem to the psychological well-being of lesbian, gay, and bisexual youth. Journal of Homosexuality. 2007;53(4):173–199. doi: 10.1080/00918360802103449.
    1. Golombok S., Harding R., Sheldon J. An evaluation of a thicker versus a standard condom with gay men. AIDS. 2001;15(2):245–250. doi: 10.1097/00002030-200101260-00015.
    1. Center for Disease Control and Prevention. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. Morbidity and Mortality Weekly Report. 2011;60(3):65–68.
    1. Rothman K. J. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–46.
    1. Schwartländer B., Stover J., Hallett T., et al. Towards an improved investment approach for an effective response to HIV/AIDS. The Lancet. 2011;377(9782):2031–2041. doi: 10.1016/S0140-6736(11)60702-2.
    1. Trapence G., Collins C., Avrett S., et al. For personal survival to public health: community leadership by men who have sex with me in the response to HIV. The Lancet. 2012;380(9839):400–410. doi: 10.1016/S0140-6736(12)60834-4.

Source: PubMed

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