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Decision-making errors such as present bias (PB) can have important consequences for health behaviors, but have been largely studied in the financial domain. We conducted a mixed-method study on PB in the context of ART adherence among clinic-enrolled adults in Uganda (n = 39). Specifically, we quantified PB by asking about preferences between medication available sooner to minimize headaches versus available later to cure headaches. We describe demographic similarities among PB participants and qualitatively explored how participants reflected on their PB (or absence thereof) in the context of health. Participants reporting PB were predominantly male, single/unmarried, older, had higher levels of education and income and more advanced HIV progression. Three common reasons for more present-biased choices provided were: (1) wanting to avoid pain, (2) wanting to return to work, and (3) fear of one's health worsening if s/he did not address their illness immediately. While PB in the financial domain often suggests that poorer individuals are more likely to prefer immediate rewards over their wealthier counterparts, our results suggest poor health is potentially a driving factor of PB. Further research is needed to build on these finding and inform how programs can frame key messages regarding ART adherence to patients displaying PB.Trial registration: ClinicalTrials.gov identifier: NCT03494777.

Background Behavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases—present bias, information salience, overoptimism, and loss aversion—relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants’ perceptions of these biases. Methods 43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. Results 56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one’s plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one’s own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan. Conclusion Mixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.

We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).

The health and economic threats posed by the COVID-19 pandemic can be sources of great distress among people living with HIV, which in turn can impact the management of their HIV disease. We examined change in depression from pre- to post-lockdown restrictions and correlates of elevated depressive symptoms, including antiretroviral therapy (ART) adherence. Participants enrolled in a randomized controlled trial of an ART adherence intervention in Uganda. The month-12 follow-up assessment was fully administered just prior to the start of the pandemic-related lockdown in March 2020; at the conclusion of the lockdown three months later, we administered a mixed-methods phone-based assessment. ART adherence was electronically monitored throughout the study period, including during and after the lockdown. Depression was assessed with the 8-item Patient health questionnaire (PHQ-8), on which scores > 9 signify a positive screen for elevated depressive symptoms. A sample of 280 participants completed both the month-12 and post-lockdown assessments. Rates of elevated depressive symptoms nearly tripled from month 12 (n = 17, 6.1%) to the post-lockdown assessment (n = 50, 17.9%; McNemar test

Background The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil. Methods The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression. Results The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV. Conclusion We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.

Medicare beneficiaries dually eligible for Medicaid are a low-income group who are often in poor health. Little research has examined sex differences in patient experience by dual/low-income subsidy (LIS) status.Cross-sectional comparison by sex and low-income status.We used linear regression to compare 6 case mix-adjusted patient experience measures (on a 0-100 scale) by sex within non-dual/LIS and dual/LIS beneficiary groups among 549,603 respondents 65 years and older to the 2016-2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys of beneficiary experience with Medicare (mail with telephone follow-up of nonrespondents, 42% response rate).Dual/LIS male beneficiaries reported worse patient experiences on all 6 measures than female beneficiaries, with scores 1 to 2 percentage points lower for 3 measures and less than 1 percentage point lower for the other 3 measures. For 4 of the 6 measures, sex differences among dual/LIS beneficiaries were significantly larger than those among non-dual/LIS beneficiaries. In all 4 instances, the gaps between men and women among dual/LIS beneficiaries favored women; P .05 for all differences discussed.Low-income male Medicare beneficiaries are more likely to report poor patient experiences, possibly because of lower health literacy, less patient activation, and smaller social networks, along with provider responses to these characteristics. Efforts to address these patient-level factors should happen in parallel with structural-level approaches to train and prepare providers to ensure attentive, respectful patient-centered care for all patients. Additionally, targeted use of ombudsmen and interventions may help reduce inequities.

To investigate whether rural-urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males.Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban-rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through evaluation of statistical interactions).Across all 7 categories of measures, scores for rural residents were worse than scores for urban residents. For 4 categories-care for patients with (suspected) chronic obstructive pulmonary disease, avoiding prescription misuse, behavioral health, and diabetes care-the average difference across measures in the category was greater than 3 percentage points. Across all 34 measures, there were 15 statistically significant rural-by-sex interactions that exceeded 1 percentage point. In 11 of those cases, the deficit associated with living in a rural area was greater for males than for females. In 3 cases, the deficit associated with living in a rural area was larger for females than for males. In 1 case involving Follow-up After Hospitalization for Mental Illness, rural residents had an advantage, and it was larger for males than for females.Interventions may help address patient- (eg, health literacy and patient activation), provider- (eg, workforce recruitment and retention), and structural-level issues contributing to these disparities, especially for rural males.

Medicare beneficiaries annually select fee-for-service Medicare or a private Medicare insurance (managed care) plan; information about plan performance on quality measures can inform their decisions. Although there is drill-down information available regarding quality variation by race and ethnicity, there remains a dearth of evidence regarding the extent to which care varies by other key beneficiary characteristics, such as gender. We measured gender differences for six patient experience measures and how gender gaps differ across Medicare plans.We used data from 300,979 respondents to the 2015-2016 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems surveys. We fit case mix-adjusted linear mixed-effects models to estimate gender differences and evaluate heterogeneity in differences across health plans.Nationally, women's experiences were better than men's (p .05) by 1 percentage point on measures involving interactions with administrative staff (+1.6 percentage point for customer service) and timely access to care (+1.1 percentage point for getting care quickly), but worse on a measure that may involve negotiation with physicians (getting needed care). Gender gaps varied across plans, particularly for getting care quickly and getting needed care, where plan-level differences of up to 5 to 6 percentage points were observed.Although the average national differences in patient experience by gender were generally small, gender gaps were larger in some health plans and for specific measures. This finding indicates opportunities for health plans with larger gender gaps to implement quality improvement efforts.

Discrimination is thought to be a key driver of health disparities that affect people with multiple intersecting devalued identities, such as HIV-positive Latino sexual minority men (SMM). Ineffective coping with the stress of discrimination (e.g., rumination, substance use) may lead to worse long-term mental and physical health. Within the context of a community partnership, we developed a nine-session, community-based, cognitive behavior therapy group intervention to address coping with discrimination among HIV-positive Latino immigrant SMM. In Study 1, we assessed anticipated intervention acceptability via semi-structured interviews with 28 HIV-positive Latino SMM and ten social service providers and administrators; we used interview data to develop the manualized intervention. In Study 2, we assessed acceptability, feasibility, and preliminary effects in a pre-post, non-randomized intervention evaluation with two intervention groups of HIV-positive Latino SMM (n = 30, average age = 48.5, SD = 10.3). In semi-structured interviews, key stakeholders were enthusiastic about the proposed intervention. In the non-randomized evaluation, feasibility was evidenced by moderate levels of intervention attendance (five sessions on average); reasons for missed sessions (e.g., illness, scheduling conflict with work) were unrelated to the intervention. Linear regressions showed preliminary effects for decreased negative emotional coping responses to discrimination pre-to-post intervention (i.e., feeling less anger, sadness, powerlessness, helplessness, and shame on two subscales; b (SE) = −0.23 (0.10), p = .03; b (SE) = −0.25 (0.11), p = .03). Our intervention holds promise for reducing disparities by empowering Latino SMM to leverage innate resilience resources to improve their health in the face of discrimination.

Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.

Psilocybin-facilitated psychotherapy shows potential transdiagnostic efficacy for a range of mental health conditions. Though vulnerable populations bear disproportionate mental health burden, they have been largely neglected in the clinical psilocybin literature. However, if the field is to best respond to the diverse needs of individuals from vulnerable populations, care must be taken to ensure these individuals are represented in the empirical research. This report calls attention to this concern by detailing the challenges and opportunities associated with evaluating psilocybin-facilitated psychotherapy in vulnerable populations. First, we show how working with vulnerable populations must be considered in the context of an often-problematic past and differential exposure to and experience with classic psychedelics. We then provide actionable recommendations for future research testing psilocybin-facilitated psychotherapy in vulnerable populations, including an emphasis on recruitment strategies, the appropriate communication and assessment of subjective effects, building therapeutic alliance, multicultural competence, and flexible study designs. On these premises we call for future work in this area, underscoring that there is vast room for improvement and expansion in this rapidly advancing field of study.

Background General population surveys are increasingly offering broader response options for questions on sexual orientation-for example, not only gay or lesbian, but also "something else" (SE) and "don't know" (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories. Objectives Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare 3 increasingly inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority. Materials and methods We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013-2014 National Health Interview Survey to generate predicted probabilities of identifying as a sexual minority adult. Results About 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and health care disparity estimates. Conclusions Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult.

Evidence suggests that simple text messaging interventions may not suffice to improve ART adherence among youth in low-resource settings. To address this shortcoming, we developed an intervention that shared weekly real-time adherence feedback to youth in Uganda using short message services (SMS), based on information tracked by an electronic device (Wisepill). We present results from 7 formative and 6 exit focus groups (FGs) in Mulago and Entebbe, Uganda with youth ages 15-24, providers, and Community Advisory Board members. Participants consistently conveyed positive impressions of Wisepill, noting that it helped store their medications, facilitated travel, served as a reminder, and motivated adherence. Participants raised phone-related issues before the study; most were addressed but some remained (e.g., limited network access, electricity for powering phones). Further, they highlighted the importance of carefully crafting text messages (e.g., use slang rather than potentially stigmatizing words) and viewed personalizing messages favorably but were divided on the desirability of including their name in study-related texts. Exit FGs confirmed that sharing group adherence levels with participants tapped into the competitive spirit common among youth. Our results suggest future mobile technology-based interventions can be improved by providing messages that go beyond simple reminders to provide individual and group-level adherence feedback.

Latino men who have sex with men (LMSM) and Latina transgender women (LTGW) often lack access to HIV prevention information and strategies such as pre-exposure prophylaxis (PrEP). We explored knowledge gaps and culturally sensitive messaging about PrEP among HIV-negative LMSM and LTGW in Los Angeles. We recruited participants from a Latinx LGBT community-based organization. We conducted nine focus groups (n = 91 participants) with 52 LMSM and 39 LTGW. We used a rapid assessment process to create narrative reports that we analyzed using thematic analysis. Key quotes were transcribed verbatim; they were reviewed by the team, then uploaded to Dedoose to identify themes across sites and between groups. Three themes emerged for both LMSM and LTGW: knowledge gaps regarding PrEP remain; people who have knowledge about PrEP often served as its champions; highlighting positive aspects of culture could help improve PreP’s uptake and sustained use. Only LMSM worried that PrEP could impact condom use. Some issues were more pronounced among LTGW (e.g., more limited access to PrEP); others were unique to LTGW (e.g., worry about drug-hormones interactions). Collaborative research, programs, and policies, informed by LMSM and LTGW themselves, are needed to narrow existing knowledge gaps and promote PrEP uptake and sustained utilization.

Discrimination negatively impacts the health of HIV-positive Latino sexual minority men (LSMM+). A growing literature on LSMM+ chronicles associations based on multiple devalued identities and mental health symptoms, HIV medication nonadherence, and sexual behaviors with the potential to transmit HIV. To gain additional insights on identity-based discrimination—as well as the associated coping responses—we conducted 30 qualitative interviews with LSMM+. Participants were probed regarding recent discrimination events (context, details, perpetrator, type) based on their intersecting identities (Latinx ethnicity, residency status, sexual minority orientation, HIV-positive serostatus) and their coping responses. We transcribed and translated the interviews and conducted a content analysis. Participants reported inter-group (i.e., between majority and minority group members) and intraminority-group (i.e., within minority group members) experiences as common. Participants described their intraminority-group experiences with discrimination based on being a Latinx sexual minority person in their families and home communities. Participants reported a range of coping responses to discrimination experiences. However, participants reported only functional (and no dysfunctional) coping strategies, and they endorsed using similar strategies in response to inter-group and intraminority-group discrimination. Coping strategies included strategic avoidance, social support, self-advocacy, and external attribution. Additional coping strategies (spirituality and positive reframing) emerged more strongly in response to inter-group experiences with discrimination. Our results underscore the need to address both inter-group and intraminority-group discrimination experiences. Future interventions can focus on strengthening the effective coping skills that LSMM+ currently employ as potential levers to address LSMM+ health disparities.

Study Objective: As recent efforts to improve culturally competent clinical care (CCCC) have largely overlooked older LGB adults, we conducted a scoping review of position statements, empirical, and non-empirical research and suggest action steps. Methods: We followed PRISMA Extension for Scoping Reviews Guidelines and searched for articles 1/1/11-3/14/19 (n = 1210) and other resources (n = 52), deduplicating, dually screening abstracts (n = 1,156), reviewing full-text (n = 107), and conducted a content analysis to identify distinct and cross-cutting domains (n = 44). Main Findings: Most research was based on simple pre/post-training differences in provider knowledge. A majority of sources were non-empirical. We identified three distinct domains (education & staffing, physical environment, and inclusive language & communication) and three cross-cutting domains (subgroup differences, research, and policy). Principal Conclusions: Sparse empirical data that specify best approaches to improve CCCC exist; nevertheless, providers, in collaboration with researchers and policy makers, can initiate improved practices aimed at increasing CCCC for older LGB patients.

Background We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention’s acceptability and feasibility. Methods We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen’s Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys). Results Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn’t fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys. Conclusions Our theoretically-grounded assessment shows the intervention is both acceptable and feasible. Trial registration The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [NCT03144336].

OBJECTIVE: To determine how weekly text messages and small incentives impact HIV knowledge and frequency of HIV testing among Latinx sexual minority men (LSMM) and transgender women (LTGW). DESIGN: Prospectively randomized participants into 2 intervention arms compared with a nonrandomized comparison group. SETTING: Bienestar, a primarily Latinx focused HIV service provider located across Los Angeles County. SUBJECTS, PARTICIPANTS: Two hundred eighteen participants self-identifying as LSMM or LTGW, HIV negative, having regular mobile phone access, ≥18 years, and fluent in English or Spanish. INTERVENTION: The “information only” (IO) group received text messages with HIV prevention information. The “information plus” (IP) group additionally could win incentives by answering weekly quiz questions correctly and testing for HIV once every 3 months. We followed participants for 12 months. MAIN OUTCOME MEASURE(S): HIV knowledge and frequency of HIV testing. RESULTS: We found no effect on HIV knowledge in the IO group but a statistically significant improvement in the IP group (79.2%–88.1%; P = 0.007). The frequency of HIV testing was higher in both intervention groups relative to the comparison group: On average, 22.0% of IO participants and 24.9% of IP participants tested at a Bienestar site within a given 3-month period, compared with 13.0% in the comparison group. This represents unadjusted relative risk ratios of 1.69 for the IO group (95% CI: 1.25 to 2.1; P < 0.01) and 1.91 for the IP group (95% CI: 1.51 to 2.31; P < 0.01), respectively. CONCLUSIONS: This study demonstrates that a simple, low-cost intervention may help increase HIV testing frequency among LSMM and LTGW, 2 groups at high HIV risk.

Purpose: Sexual minority adults experience considerable mental and physical health disparities compared to their heterosexual counterparts, but changes in these disparities over time may, in part, ...

Background Despite initial high motivation, individuals receiving antiretroviral therapy (ART) for several years may experience incomplete adherence over time, increasing their risk of HIV-related morbidity and mortality. Habits, defined as automatic and regular practices, do not rely on conscious effort, and may therefore support high long-term ART adherence. Methods This qualitative study contributes to the evidence on how clients with adherence problems remember and form habits to take ART medications. Free-listing and unstructured interviewing were used among 42 clinic-enrolled adults in Kampala, Uganda who were receiving ART and participating in a randomized clinical trial for treatment adherence (clinicaltrials.gov: NCT03494777). Data were coded and analyzed using inductive content analysis. Results Findings indicated that clients’ most routine habits (eating, bathing, sleeping) did not always occur at the same time or place, making it difficult to reliably link to pill-taking times. Efforts to improve ART habits included having a relative to ask about pill-taking, re-packaging medications, leaving medications in view, using alarms, carrying water, or linking pill-taking to radio/prayer schedules. Reported challenges were adhering to ART schedules during changing employment hours, social activities, and travel. Conclusion While habit-forming interventions have the potential to improve ART adherence, targeting treatment-mature clients’ existing routines may be crucial in this population.

This is a cross-sectional study examining highly effective contraceptive (HEC) use among HIV-positive women in Salvador, Brazil. We used multivariate logistic regression to look for predictors of alternative contraceptive choices among women who discontinued HEC after HIV diagnosis. Of 914 participants surveyed, 38.5% of participants used HEC before but not after diagnosis. Of these, 65.9% used condoms alone; 19.3% used no protection; and 14.8% reported abstinence. Use of condoms alone was associated with a history of other sexually transmitted infections (AOR 2.18, 95% CI 1.09-4.66, p = 0.029). Abstinence was associated with recent diagnosis (AOR 8.48, 95% CI 2.20-32.64, p = 0.002). Using no method was associated with age below 25 (AOR 5.13, 95% CI 1.46-18.00, p = 0.011); income below minimum wage (AOR 2.54, 95% CI 1.31-4.92, p = 0.006); HIV-positive partner status (AOR 2.69, 95% CI 1.03-7.02, p = 0.043); and unknown partner status (AOR 2.90, 95% CI 1.04-8.05, p = 0.042). Improved contraceptive counseling is needed after HIV diagnosis. Continuation of HEC should be encouraged for women wishing to prevent pregnancy, and may increase contraceptive coverage among HIV-positive women.

INTRODUCTION: Youth in Uganda are disproportionately impacted by HIV and report significant barriers to ART adherence. We asked participants how fixed versus flexible adherence target setting for incentive interventions, in combination with other support systems, could help HIV-positive youth in Uganda reach medication adherence targets. METHODS: Four focus groups conducted in Luganda were audiotaped, transcribed, and translated into English; the transcriptions were then coded using Dedoose software. Two members of the research team read the text and identified the basic topics covered. A codebook was developed that detailed inclusion and exclusion criteria for each topic area, as well as typical entries for each code. A directed content analysis was used to identify key themes. RESULTS: Several themes were common across groups. Participants consistently maintained that they preferred to set their own adherence targets. But regardless of how adherence targets were assigned, participants noted that missing their target was disappointing. They commented positively on the use of Medication Event Monitoring System (MEMS) caps, noting that knowing their adherence information was being tracked often encouraged them to take their medications. Participants reported that receiving text messages further motivated them to take their medications; however, on occasions when they reported not doing well, they wanted intensive follow-up by staff. Participants said that the prize drawing alone did not motivate their ART adherence and that receiving ‘zero’ in the drawing was disheartening. CONCLUSION: We found that participants preferred to set their own adherence targets and that doing so increased a sense of ownership in achieving them. All participants enjoyed using MEMS caps and expressed disappointment at needing to return the device at the study’s completion. Participants noted that text message reminders may be a useful way to help patients stay motivated between clinic visits; however, ongoing engagement and support are needed from providers and counselors. Finally, our participants stressed the importance of including incentives with a small, positive value rather than 0 when designing the lowest prize.

Background Studies report serious adherence problems among youth (individuals age 15 to 24 years of age) in Uganda. Recent growth in mobile phone ownership among Ugandan youth has highlighted the potential of using text-based interventions to improve ART adherence. We therefore developed and conducted a randomized controlled trial and examined the acceptability, feasibility, and preliminary impact of a pilot intervention providing weekly real-time antiretroviral adherence feedback, based on information from a smart pill box, to HIV-positive Ugandan youth. Methods We randomized participants to a control group, or to receive messages with information on either their own adherence levels (Treatment 1 - T1), or their own adherence and peer adherence levels (Treatment 2 – T2). We conducted six focus groups with providers and youth ages 15-24, double coded interviews, and achieved a Cohen’s Kappa of 0.79. Result The quantitative and qualitative data show that the intervention was deemed acceptable and feasible. The direction and magnitude of the treatment effects for T2 are promising. Adherence in the control group decreased from 80% to 70% by the end of the study. In the T2 group, adherence increased initially and remained between 80% and 85% for the duration of the study. Regression models estimate a 3 percentage point increase in adherence in the initial 9 weeks of the study in the T2 group relative to the control, which grows to a 9 percentage point increase by the last 9 weeks of the study. The T1 intervention shows no signs of impact; adherence in the T1 group decreased from 84% to 74%. This pilot study was not powered to detect statistical differences. Conclusions Improving youth’s adherence by supplementing information about their adherence with information about adherence of peers is a promising new strategy that should be further evaluated in a fully-powered study. Providing one’s own adherence information alone appears to have less potential.

Brazil has recently integrated HIV Pre-exposure Prophylaxis (PrEP) into its public health system and offered to key populations such as transgender women (TGW). This study investigates factors associated with PrEP refusal among TGW living in one of the largest and poorest cities of Brazil. We recruited 127 TGW using Respondent Driven Sampling (RDS) in Salvador, Brazil. Latent class analysis (LCA) was used to define acceptability of PrEP. Two latent classes were identified: “high acceptability of PrEP” (91.3%) and “PrEP refusal” (8.7%). PrEP was less acceptable among white TGW and among those age 25 or older, with income above minimum wage (≥ US$252.87), and reporting unprotected receptive anal intercourse with (URAI) causal partners. The findings highlight how nuanced strategies that takes into consideration unique characteristics are needed to effectively address the acceptability of PrEP.

In this short communication, we discuss some key behavioral economic (BE) biases that likely minimize HIV prevention efforts, explore why certain key populations such as men who have sex with men or transgender women-may be more likely to succumb to these biases, and suggest how incentives informed by BE can support these populations in their effort to remain HIV-negative. Based on our formative work in an ongoing study, we discuss two important insights regarding the use of incentives to inform future HIV prevention efforts. First, participants often expressed more excitement for prizes that were viewed as fun (e.g., movie gift cards) or luxurious (e.g., cosmetics gift cards) rather than necessities (e.g., grocery store gift cards) of the same financial value and suggests that including an element of fun can be a powerful tool for incentivizing safe HIV-related behavior. Second, participants preferred not to be "paid" to display health behaviors, indicating the way incentives are given out (and perceived) is central to their success. Going forward, a BE perspective can help improve the impact of incentives - and increase their cost-effectiveness by carefully adapting them to the preferences of their recipients.

The extent to which disparities affect all sexual minority women (SMW) versus specific subgroups of lesbian, bisexual, or other women remains unclear, in part due to inconsistent analysis of available data. We propose an integrated approach that aggregates subgroups to maximize power to detect broadly applicable disparities, then tests for subgroup heterogeneity, exercising caution with disaggregation when there is no direct evidence of heterogeneity.Multivariate analyses of 2014-2015 National Health Interview Survey data examined six barriers to care. We compared heterosexual women (n = 36,474) with SMW (n = 1048) overall and tested for heterogeneous outcomes among subgroups of SMW compared with heterosexual women and with each other.Controlling for sociodemographics and health status, aggregated analyses showed that SMW were more likely than heterosexual peers to have trouble finding a provider (adjusted percentages 5.1% vs. 3.2%, p 0.01) and no optimal usual place of care (14.5% vs. 11.2%, p 0.01). There was no evidence of subgroup heterogeneity for either barrier, suggesting uniform disparities for SMW. In contrast, only lesbian/gay women were more likely than heterosexual women to be told their health insurance was not accepted (p = 0.03); this was the only outcome for which the adjusted difference between bisexual and lesbian/gay women was significant (2.8% vs. 6.3%, p = 0.02).Analyses that only disaggregated data would have understated overall sexual minority disparities and perhaps overstated subgroup differences; an integrated approach can more accurately characterize disparities experienced by all SMW versus those specific to certain subgroups. Large national surveys should include sexual orientation questions to support adequately powered comparisons.

OBJECTIVES While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults. DESIGN Nationally representative cross-sectional survey. SETTING United States. PARTICIPANTS A total of 1 252 705 adults, aged 65 years and older, responding to 2013 to 2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys. MEASUREMENTS The dependent variable was Healthcare Effectiveness Data and Information Set self-reported influenza immunization. The primary predictor was sex. Covariates included general health status, education, race/ethnicity, and Medicare Advantage (MA; managed care) vs Fee-for-Service (FFS) coverage. RESULTS After adjusting for health status and other sociodemographic factors, women's immunization was 2% lower than men's immunization in MA, with no significant overall sex difference in FFS. Women were immunized less often than men in 95% of MA health plans, with the largest gaps in low-immunizing plans. Further analyses revealed variation in sex differences by health status, education, and race/ethnicity in both MA and FFS. Notably in MA, women in poor health were immunized less often than men in similar health (-4%; P

Mobile Technology and Incentives (MOTIVES) is a randomized pilot study of a mobile technology-based and behavioral economics-supported HIV prevention intervention. Behavioral economics (BE) uses financial incentives in a way that departs from the traditional focus on large monetary payments. Instead, BE suggests that relatively small “nudges” can effectively initiate and sustain behavior change. This pilot study examines the feasibility and acceptability of an HIV prevention intervention that uses text messages in combination with BE incentives to improve retention of HIV prevention information and increase frequency of HIV testing among Latino/a men who have sex with men (MSM) and transgender women (TGW). The pilot will also estimate mission-critical design parameters with point and confidence interval estimates of the intervention to inform a future, fully powered effectiveness study. The project will be conducted in collaboration with Bienestar Human Services, Inc. (Bienestar), a non-profit community-based service organization. The intervention is being tested in a small, randomized controlled trial to pilot the intervention’s feasibility and acceptability among 200 Latino/a MSM and TGW from Bienestar’s HIV testing sites. Information on feasibility will include recruitment, refusal, and retention rates as well as message sending success rates; acceptability will include perceived appropriateness based on responses to the intervention. Participants will be randomized into either the “information only” control group (e.g. receiving text messages with HIV prevention information) or the “information plus” intervention group (e.g. additionally receiving quiz questions that provide the possibility of winning prizes). Participants will be followed for 12 months from enrollment. In addition to using data abstracted from Bienestar’s routine data collection mechanisms, we will also collect survey data (blinded outcome assessment) from participants at 0, 6, and 12 months to provide an initial assessment of whether incentives affect their level of HIV knowledge and testing frequency. If shown to be acceptable, feasible, and resource-efficient, MOTIVES will provide an innovative way to communicate the latest HIV prevention information and support trimestral HIV screening among Latino/a MSM and TGW. ClinicalTrials.gov, NCT03144336 . Registered on 5 May 2017.

This cross-sectional study assessed sexually transmitted infection (STI) prevalence, socio-demographic characteristics, substance use, sexual behaviors, and sexual network profiles among African American sexual minorities in Jackson, Mississippi. Bivariate chi-square tests and generalized estimating equation (GEE) models explored individual and partner-related factors. Compared to their heterosexual counterparts, male African American sexual minorities reported fewer sex partners (odds ratios [OR] 0.33, 95% confidence intervals [CI] 0.16-0.65) and lower concurrency levels (OR 0.42, 95%CI 0.24-0.72). African American sexual minority women reported greater substance abuse, more sex partners (OR 2.54, 95%CI 1.47-4.38), higher concurrency levels (OR 1.81, 95%CI 1.24-2.64), and more transactional sex (OR 2.52, 95%CI 1.25-5.11). These results highlight the need for nuanced STI interventions tailored to African American sexual minorities in Mississippi.

Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.

Objective Many national HIV guidelines recommend that health care providers encourage patients to identify a treatment partner from their social network to support antiretroviral therapy adherence. This study examined associations of patient and treatment partner characteristics with patient viral suppression in Botswana. Design One hundred thirty-one patients [67 (51.1%) virally suppressed and 64 (48.9%) not suppressed] and their treatment partners were recruited for cross-sectional interviews from one HIV clinic. Methods Participants completed surveys assessing social network, sociodemographic, and psychosocial characteristics. Open-ended questions explored treatment partner relationship quality. Results Multivariate logistic regressions indicated a higher likelihood of viral suppression among patients who reported greater average emotional closeness to their network members [odds ratio (95% confidence interval) = 3.8 (1.3 to 11.5), P = 0.02] and whose treatment partners were spouses/partners [odds ratio (95% confidence interval) = 2.6 (1.0 to 6.7), P = 0.04]. Qualitative analyses indicated that treatment partners of suppressed patients provided both medical and nonmedical support, whereas treatment partners of unsuppressed patients focused mainly on adherence reminders and appointment accompaniment. Treatment partners, especially of unsuppressed patients, requested ongoing training and counseling skills. Conclusions Additional research is needed to further explore effective characteristics of treatment partners to inform HIV treatment guidelines. Standard training for treatment partners could include medical-related information and counseling education.

HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60-90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants' primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care.

Transgender populations are heavily burdened by HIV and other sexually transmissible infections (STIs). However, data on co-infection with HIV and STIs among transgender people are limited. A systematic review was conducted of peer-reviewed articles and conference abstracts between January 2010 and November 2015 that focussed on HIV and STI infections among transgender populations globally. The literature was synthesised and opportunities for improving health research were commented on. Few studies reported HIV–STI co-infection (n = 4), while the majority of studies reported HIV and STI infections separately (n = 23). Most studies were conducted outside of the USA (n = 19), and all but one of these studies reported data on transgender women only. Among USA-based studies (n = 8), several reported data on both transgender men and transgender women (n = 3), whereas other studies reported exclusively on transgender men (n = 1) or transgender women (n = 4). Understanding HIV and STIs among transgender people requires research that simultaneously considers multilevel drivers of vulnerabilities. More data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations. Leveraging the knowledge of transgender-specific determinants of HIV and STIs should guide the content and approaches to future HIV and STI prevention and treatment efforts.

Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4350 cells/mm(3). Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.

Studies have demonstrated that an early HIV diagnosis is a critical first step towards continued engagement in care. We examined HIV testing experiences in Salvador, Brazil, to understand how a focus on quality services can inform service provision more generally in the post-2015 global health agenda. Seventeen semi-structured interviews were conducted with HIV-positive pregnant women in Salvador, a large urban centre of north-east Brazil. Interviews were transcribed, translated and coded for analysis. Deductive codes confirmed factors identified in the literature review. Inductive codes highlighted new factors emerging from the initial coding. 'Quality' was defined according to global and national guidelines as HIV testing with informed and voluntary consent, counselling and confidentiality (3Cs). No pregnant woman experienced all elements of the 3Cs. Three women did not experience any informed and voluntary consent, counselling or confidentiality. Few women provided consent overall and none received pre-test counselling. Post-test counselling and confidentiality of services were more consistently provided. This study suggests that testing in Salvador - the third-largest city in the country - is not of the quality called for by global and national guidelines, despite the fact that HIV testing is being routinely provided for HIV-positive pregnant women in Brazil. Going forward, additional clarity around the 3Cs is necessary to improve how the quality, not just the quantity, of HIV services is measured.

Concurrent sexual partnerships, or sexual partnerships that overlap in time, have been associated with HIV and sexually transmitted infections (STI) infection. How best to measure concurrency and the personal characteristics and predictors of concurrency are not yet well understood. We compared two frequently used concurrency definitions, including a self-reported measure based on participant response regarding overlapping sex with partners, and the UNAIDS measure based on overlapping dates of last sex and intention to have sex again. We performed multivariable logistic regression analyses to identify socio-demographic, behavioral, and structural predictors of concurrency among 1,542 patients at an urban STI clinic in Jackson, Mississippi. Nearly half (44%) reported concurrency based on self-reported sex with other partners, and 26% reported concurrency according to the UNAIDS concurrency measure. Using the self-reported concurrency measure, the strongest predictors of concurrency were perceived partner concurrency, drug use at last sex, having more than 10 lifetime partners, and being recently incarcerated. Strongest predictors of concurrency using the UNAIDS measure were lifetime number of partners and perceived partner concurrency. Concurrency is highly prevalent in this population in the Deep South and social, structural and behavioral factors were important predictors of concurrency for both measures. Future research should use time anchored data collection methods and biomarkers to assess whether both definitions of concurrency are associated with HIV outcomes.

Recent attention to culturally competent care has largely overlooked the needs of older LGB adults. To address this, we conducted a systematic literature review and make recommendations for how the healthcare workforce can reduce sexual-orientation-based disparities. We searched PubMed, PsycINFO & CINAHL for manuscripts 1/1/10-6/19/18 (n=799), deduplicating, dually-screening abstracts (n=80), reviewing full-text articles (n=44), and classifying relevant articles (n=27) into five domains of cultural competency and associated recommendations: 1) Physical environment: display pictures with older same-sex couples and LGB-identified symbols; 2) Education/staffing: expand to include older-specific LGB issues, especially for key conditions (e.g., cancer, dementia,) and hire LGB-identified administrative/clinical staff; 3) Inclusive language and communication: review terminology on forms, electronic health records, and used with patients to ensure a broad range of terms (e.g., partner/spouse) and note older LGB may have more limited understanding/comfort with terminologies (e.g., self-identify as ‘something else’ instead of ‘gay/lesbian’ or ‘bisexual’); 4) Patient histories: discuss how factors particular to their sexual orientation (e.g., level of outness) may affect their support networks; 5) Subgroup differences: consider specific health concerns by sexual minority subgroups (e.g., healthy weight for lesbian women, HIV for gay men, and negative health outcomes for bisexual adults related to their simultaneous isolation from sexual minority and heterosexual communities) and note additional challenges based on characteristics such as race/ethnicity and urbanicity. Cutting across these domains are the ways in which local and national policies affect healthcare access and surrogacy (e.g., legality of same-sex partners to obtain health insurance, participation in medical decision making/visitation).

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-06-15T14:27:09Z No. of bitstreams: 1 Dourado Ines. 2014 resumo.docx: 14029 bytes, checksum: 051f8aebca192aa8a87ad69545986b10 (MD5) Made available in DSpace on 2015-06-15T14:27:09Z (GMT). No. of bitstreams: 1 Dourado Ines. 2014 resumo.docx: 14029 bytes, checksum: 051f8aebca192aa8a87ad69545986b10 (MD5) Previous issue date: 2014 Research on pregnancy termination largely assumes HIV status is the only reason why HIV-positive women contemplate abortion. As antiretroviral treatment (ART) becomes increasingly available and women are living longer, healthier lives, the time has come to consider the influence of other factors on HIV-positive women's reproductive decision-making. Because ART has been free and universally available to Brazilians for more than two decades, Brazil provides a unique context in which to explore these issues. A total of 25 semi-structured interviews exploring women's pregnancy termination decision-making were conducted with women receiving care at the Reference Centre for HIV/AIDS in Salvador, Brazil. Interviews were transcribed, translated into English and coded for analysis. HIV played different roles in women's decision-making. In all, 13 HIV-positive women did not consider terminating their pregnancy. Influential factors described by those who did consider terminating their pregnancy included fear of HIV transmission, fear of HIV-related stigma, family size, economic constraints, partner and provider influence, as well as lack of access to pregnancy termination services and abortifacients. For some HIV-positive women in Brazil, HIV can be the only reason to consider terminating a pregnancy, but other factors are significant. A thorough understanding of all variables affecting reproductive decision-making is necessary for enhancing services and policies and better meeting the needs and rights of HIV-positive women. London

Objectives Late presentation to HIV/AIDS services compromises treatment outcomes and misses opportunities for biomedical and behavioral prevention. There has been significant heterogeneity in how the term “late presentation” (LP) has been used in the literature. In 2011, a consensus definition was reached using CD4 counts to define and measure late presenters and while it is useful for clinical care, the consensus definition has several important limitations that we discuss in this article.

Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-26T18:34:55Z No. of bitstreams: 1 Ines Dourado 4. 2016.pdf: 215346 bytes, checksum: c0c823d6db4538eae23dc87a130c5189 (MD5) Made available in DSpace on 2017-05-26T18:34:55Z (GMT). No. of bitstreams: 1 Ines Dourado 4. 2016.pdf: 215346 bytes, checksum: c0c823d6db4538eae23dc87a130c5189 (MD5) OBJECTIVE: To analyze the factors associated with late presentation to HIV/AIDS services among heterosexual men. METHODS: Men infected by HIV who self-identified as heterosexual (n = 543) were included in the study. Descriptive, biivariate and logistic regression analyses were performed to evaluate the factors associated with late presentation (defined as individuals whose first CD4 count was

The US HIV/AIDS epidemic is concentrated in the Deep South, yet factors contributing to HIV transmission are not fully understood. We examined relationships between substance use, sexual partnership characteristics, and condom non-use in an African American sample of STI clinic attendees in Jackson, Mississippi. We assessed condom non-use at last intercourse with up to three recent sexual partners reported by participants between January and June 2011. Participant- and partner-level correlates of condom non-use were examined using generalized estimating equations. The 1295 participants reported 2880 intercourse events, of which 1490 (51.7 %) involved condom non-use. Older age, lower educational attainment, reporting financial or material dependence on a sex partner, sex with a primary partner, and higher frequency of sex were associated with increased odds of condomless sex. HIV prevention efforts in the South should address underlying socioeconomic disparities and structural determinants that result in partner dependency and sexual risk behavior.

Trans persons, including transvestites and transsexual women, show disproportionately high HIV/AIDS rates when compared to the rest of the population. However, few quantitative/qualitative studies have addressed trans persons in Brazil. Thus, a team of researchers from different fields is developing an interdisciplinary research project with the objective of shedding light on living conditions and ways of life among transvestites and transsexual women, while investigating determinant factors for HIV infection, syphilis, and hepatitis B and C. The article is intended to describe the experience with the implementation and development of an ethno-epidemiological study in Salvador, Bahia State, Brazil. Mapping the population began with a formative survey that was crucial for orienting the epidemiological survey. The production of ethno-epidemiological data posed a daily challenge for the researchers, triggering a series of reflections on the limits of our concepts and categories for translating the diversity of study participants' practices and experiences.

Background Mississippi has among the highest prevalence of sexually transmitted infections (STIs) in the United States. Understanding sexual networks can provide insight into risk factors for transmission and guide prevention interventions. Methods Participants included 1437 primarily African American (95%) adults presenting for care at an STI clinic in Jackson, Mississippi. Latent class analysis identified underlying population subgroups with unique patterns of response on a comprehensive set of 14 sexual partner variables, such as living with or having a child with a partner, partner dependence and trust, 1-time sexual encounters, multiple main partners, substance use, sexual concurrency, and incarceration. Classes were compared on participant age, sex, sexual orientation, public assistance, lifetime partners, relationship status, and self-reported past-year STI. Results Three classes emerged. Class 1 (n = 746) participants were less dependent on partners and less likely to live with or have a child with a partner. Class 2 participants (n = 427) endorsed multiple STI risk factors, including partner incarceration, 6 or more lifetime partners, sexual concurrency, 1-time sexual encounters, and substance use at last sex. Class 3 participants (n = 226) were more likely to be in dependent, committed relationships with children. Class 2 had a higher proportion of self-report past-year STIs (36.7%) compared with classes 1 (26.6%) and 3 (26.1%). Conclusions Certain partner factors such as incarceration, substance use, and concurrency may contribute to increased STI risk. Partner factors may be useful proxies for STI risks and could be useful questions to include in screening questionnaires in clinical settings.

Findings: Data from 63 unique study participants, including 27 individual interviews and five separate focus groups, were analyzed. Major themes supported the effectiveness of community-based prevention strategies in community uptake of key messages. Successful approaches for targeting reticent subpopulations included enlisting support from religious leaders and village elders to secure trust from community members. Bidirectional, dynamic methods of communication were also identified as essential characteristics of behaviour change, rather than relying on static materials such as informational posters and pre-taped PSAs. Messages focusing on the lethality of disease were found to reduce essential care-seeking behaviours. Interpretation: Local Red Cross volunteers and staff are ideally placed for social mobilization efforts to prevent transmission, combat misinformation in the event of an Ebola outbreak. They often have an established relationship with community members and understand the anthropological background, which can be a challenge for incoming foreign aid workers. The community-based work of this cadre is an essential component of the response effort complementary to the clinical work. Findings and lessons learned from this research provide the groundwork for continuing response efforts, as well as for future Ebola and infectious disease outbreaks in similar international settings. Funding: The study was supported by funding from IFRC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of its sponsors. Abstract #: 02CD007