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Abstract Background It is still unknown whether the mechanisms proposed by the Reserve Capacity Model (RCM) explaining socio-economic health and wellbeing inequities in high income countries can be applied to low-income countries. This study investigates whether different reserve capacities (intra-, inter-personal, and tangible) can explain the association between relative socio-economic position (SEP) and wellbeing outcome measures among Ethiopian women working in Foreign Direct Investment (FDI). Method Using a cross-sectional design, we collected quantitative survey data among 2,515 women working in the apparel and floriculture sectors in Ethiopia, measuring GHQ-12 mental health problems, multi-dimensional wellbeing, relative SEP, psychological capital (PsyCap), social support (emotional and financial social support network), and tangible assets (e.g., owning mobile phone, having access to toilet facilities). We used cluster-adjusted structural equation modelling to test whether PsyCap, social support, and/or tangible assets mediate the association between relative SEP (IV) and GHQ-12 mental health problems and multi-dimensional wellbeing (DVs). Results PsyCap and the size of the financial support network significantly mediate the socio-economic gradient in both wellbeing outcomes. The size of the emotional social support network shows no association with multi-dimensional wellbeing and shows an unexpected negative association with GHQ-12 mental health problems scores, including a significant mediation effect. Tangible assets show no association with the wellbeing outcome measures and do not mediate socio-economic mental health problems and wellbeing inequities. Conclusions The RCM can be applied in low-income countries, although in unexpected ways. Similar to findings from high-income countries, PsyCap and size of the financial social support network show significant mediation effects in explaining mental health problems and wellbeing inequities in Ethiopia. These reserves could therefore serve as a buffer for socio-economic inequities in mental health and wellbeing and can therefore assist in decreasing these inequities for women working in FDI sectors in Ethiopia.

Background Meaningful involvement of people with HIV and affected communities in HIV cure research is essential to ensuring that cure research efforts are conducted transparently, socially justly, and ethically. This study set out to investigate how people with HIV and affected communities are involved in cure research in the Netherlands and explore what can be done to optimize involvement and engagement. Methods Eighty-five semi-structured online, telephone, and face-to-face interviews were conducted with people with HIV (N = 30), key populations (N = 35), and key informants (KI; N = 20) in the field of HIV. The interviews were analyzed using reflexive thematic analysis. Results Awareness of the meaningful involvement of people with HIV (MIPA) efforts was low among people with HIV and key populations, which contrasted with KI, who exhibited greater awareness. People with HIV and KI emphasized the importance of MIPA in ensuring the representation of lived experiences in HIV cure research and fostering trust between communities and researchers. Practical implementations of MIPA were unclear, ultimately resulting in difficulties defining MIPA beyond clinical trial participation. People with HIV and key populations also doubted their skills and self-efficacy to make meaningful contributions when confronted with involvement beyond participating in research and clinical trials. Conclusions MIPA is crucial for improving the quality, transparency, and ethical conduct of HIV cure research. It emphasizes the need for increased awareness and funding, standardized guidelines to ensure meaningful involvement, and combat tokenism and misconceptions.

Abstract Introduction In France, oral pre‐exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco‐epidemiology surveillance data and regional MSM population estimations to model the spatio‐temporal distribution of PrEP uptake among MSM in France 2016–2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake. Methods We first applied Bayesian spatial analyses with survey‐surveillance‐based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV‐negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio‐temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall‐ and new‐PrEP uptake from 2016 to 2021 across France. Results HIV‐negative and PrEP‐eligible MSM populations vary regionally across France. Île‐de‐France was estimated to have the highest MSM density compared to other French regions. According to the final spatio‐temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher‐than‐average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle‐Aquitaine to 38.2% [36.5%;39.9%] in Centre‐Val‐de‐Loire in 2021). Conclusions Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV‐negative MSM population is feasible and applicable. Spatio‐temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.

HIV treatment adherence in Indonesia is a major challenge. Although previous studies have demonstrated several barriers and facilitators to adherence, studies providing a comprehensive analysis from both PLHIV and HIV service providers’ perspectives are limited, especially in Indonesia. In this qualitative study with 30 people living with HIV on treatment (PLHIV-OT) and 20 HIV service providers (HSPs), we explored, via online interviews, the barriers and facilitators to antiretroviral therapy (ART) adherence using a socioecological approach. Both PLHIV-OT and HSPs reported stigma as a major barrier at each socioecological level, including public stigma at the societal level, stigma in healthcare settings, and self-stigma at the intrapersonal level. Stigma reduction must therefore be prioritized. PLHIV-OT and HSPs also reported support from significant others and HSPs as the foremost facilitators to ART adherence. The enablement of support networks is thus an important key to improved ART adherence. Overall, the societal level and health system barriers to ART adherence should be addressed in order to remove barriers and enhance the facilitators at the subordinate socioecological levels.

The current monkeypox epidemic is most prevalent among men who have sex with men (MSM). PrEP users and MSM with HIV (MSMHIV) are considered at highest risk of monkeypox infection in The Netherlands, and are being targeted for monkeypox vaccination. Together with the epidemiological evidence, perceived concern and risk are also relevant for decision making about health behaviour, e.g., vaccination uptake. It is thus timely to examine which subpopulations among MSM consider themselves to be most at risk and are most concerned about monkeypox. This study aimed to help determine if the current measures to curb the epidemic are successfully targeted or not in The Netherlands. We conducted an online survey among 394 MSM living in The Netherlands. We first calculated the prevalence and standardised prevalence ratio (SPR) of high perceived monkeypox concern/risk by PrEP-use and HIV status. We then conducted two multivariable logistic regression analyses to investigate perceived monkeypox concern/risk and their potential socio-demographic/behavioural/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern about and 30% showed high perceived risk of monkeypox infection. PrEP users (SPR = 0.83) showed a significantly lower chance of perceived concern; in addition, MSMHIV (SPR = 2.09) were found to have a significantly higher chance of perceiving high risk of monkeypox infection. In the multivariable logistic analyses, non-PrEP users (aOR = 2.55) were more likely to perceive higher concern, while MSM who were retired (aOR = 0.23) and who had had chemsex recently (aOR = 0.63) were less likely to perceive higher concern. MSMHIV (aOR = 4.29) and MSM who had an unknown/undisclosed HIV status (aOR = 6.07), who had attended private sex parties (aOR = 2.10), and who knew people who have/had monkeypox (aOR = 2.10) were more likely to perceive a higher risk for monkeypox infection. We found that high perceived risk (aOR = 2.97) and high perceived concern (aOR = 3.13) were correlated with each other. In sum, only one-third of MSM living in The Netherlands considered themselves at high risk of monkeypox infection, and only half of them reported high concern. We identified a potential discrepancy between “actual risk” and perceived risk of and concern about monkeypox among MSM in this early stage of the monkeypox epidemic in The Netherlands, especially among PrEP users and MSMHIV. More refined public health communication strategies may be needed to improve the understanding and knowledge of the “actual risk” of monkeypox infections among MSM sub-populations, to facilitate health behaviour uptake.

Sexual healthcare aims to reduce HIV and sexually transmitted infections (STIs) by promoting testing and prevention. To better reach men who have sex with men (MSM), additional strategies are needed. Here, we describe development of an intervention, which is part of a broader HIV/STI home-care program, targeted to reach MSM and motivate them to use self-sampling tests. Self-sampling includes blood sampling (finger prick) for HIV, hepatitis B, and syphilis, and a urine sample and oral and anorectal swab samples for chlamydia and gonorrhea. Intervention mapping, a systematic six-step approach, was used to guide the development process: (1) needs assessment including interviews with MSM, (2) create a matrix of change, (3) selection of theory-based methods and practical strategies, (4) intervention development, (5) implementation plan, and (6) evaluation (not included in this paper). Stakeholders were involved to increase program support and feasibility. The needs assessment revealed that testing barriers among MSM related to stigma, time, and privacy concerns. Barriers among healthcare providers related to time, competing priorities, lack of expertise, and guideline restrictions. Included intervention components are designed to overcome these barriers, e.g., engaging role models, with a website with a role model story, and providing tailored information. Methods to reach MSM were a variety of information channels (posters, flyers, and audio-visual displays) and delivery modes, such as advertisements on websites and invitational cards (online and paper) distributed by healthcare providers and MSM themselves (social network testing/peer testing). Our intervention aims to encourage MSM to engage in testing, re-testing, and providing a test to peer MSM. Evidence-based methods to overcome barriers were included to reach and motivate an increased number of MSM. Using intervention mapping stimulated systematic evidence-based decision making and adapting the intervention to the target audience and setting. The next step (step 6) is to implement and evaluate the intervention.

Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate in combination with emtricitabine (FTC) is a highly effective form of HIV prevention. Endeavors of health-care providers and activists in many countries over the world are directed at making access to PrEP possible, or increasing PrEP use among men-who-have-sex-with-men (MSM). We argue while this effort is necessary, we also need to consider modes of HIV prevention after a period of PrEP use. PrEP uptake is not a one-way street, meaning that individuals may discontinue PrEP use, either voluntarily and involuntarily. Voluntary discontinued PrEP use in conjunction with decreased or no HIV risk exposure is unproblematic, but involuntary discontinuations with continuous high level of HIV risk exposure calls for tailored post-PrEP use HIV prevention. We present a case study of an MSM individual who discontinued PrEP for medical reasons (renal function) and seroconverted soon afterward, to illustrate the need for tailored HIV prevention post-PrEP. Furthermore, we provide additional contexts of PrEP discontinuation leading to populations that are in need for post-PrEP types of HIV prevention. Subsequently, we present suggestions for modes of post-PrEP HIV prevention based on knowledge–communication–choice model. Community organization and health-care providers should consider and prepare their HIV prevention consulting protocols for such types of clients and add post-PrEP HIV prevention measures to their consulting offer.

URN: urn:nbn:de:0114-fqs0002377

Virtual seminars as a form of tele-learning are becoming a well-established instructional form within universities and educational offers for adults. The critical gist of many virtual seminar projects are two problem sets, typical for tele-learning applications: low media-competence and low participation rates. During a virtual seminar, based at the University of Goettingen and at the Rensselaer Politechnic Institute, Troy, New York, these phenomena were investigated. Communication media for the seminar were synchronous (chat) as well as asynchronous CMC tools. A clear positive result of media competence training was an overall good achievement and a higher participation rate both in off-topic, casual and in on-topic communication. The focus of the article is on the qualitative analysis of a chat-protocol, revealing a number of critical phenomena which should be considered in the planning and implementation of virtual seminars. URN: urn:nbn:de:0114-fqs0001278

IntroductionTransgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals.MethodsWe conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP).ResultsBased on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4-84.8) for trans feminine individuals and 6.8 (95% CI 3.6-13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established.ConclusionTrans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

The question how intergroup bias can be alleviated is of much theoretical and practical interest. Whereas diversity training and the multiculturalism ideology are two approaches prominent in practice, most theoretical models on reducing intergroup bias are based on social-identity theory and self-categorization theory. This social-identity perspective assumes that similar processes lead to intergroup bias in very different intergroup contexts if people identify with the respective social groups. A recent prominent model based on these theories is the ingroup-projection model. As this model assumes, an ingroup's norms and standards are applied to outgroups included in a common superordinate category (this is called ingroup projection). Intergroup bias results because the outgroup fulfils these norms and standards less than the ingroup. Importantly, if the diversity of the superordinate category is induced as the norm, ingroup projection and thus intergroup bias should be reduced. The present research delineates and tests how general this process is. We propose that ingroup prototypicality is not only an outcome variable, as the ingroup-projection model originally assumes, but can also be an important moderator. We hypothesize that for members considering their ingroup highly prototypical ("pars pro toto", large majorities), the superordinate group's diversity may question their ingroup's position and thus elicit threat and intergroup bias. In contrast, for members who consider their group as less prototypical (one among several, or "una inter pares" groups), activating diversity should, as originally assumed in the ingroup-projection model, reduce intergroup bias. Three experiments (total N = 345) supported these predictions in the contexts of groups defined by gender or nationality. Taken together, the ingroup-projection model can explain under which conditions activating superordinate-category diversity induces tolerance, and when it may backfire. We discuss in how far the ingroup-projection model can integrate conflicting findings on the multiculturalism ideology.

Human beings have a strong tendency to imitate. Evidence from motor priming paradigms suggests that people automatically tend to imitate observed actions such as hand gestures by performing mirror-congruent movements (e.g., lifting one's right finger upon observing a left finger movement; from a mirror perspective). Many observed actions however, do not require mirror-congruent responses but afford complementary (fitting) responses instead (e.g., handing over a cup; shaking hands). Crucially, whereas mirror-congruent responses don't require physical interaction with another person, complementary actions often do. Given that most experiments studying motor priming have used stimuli devoid of contextual information, this space or interaction-dependency of complementary responses has not yet been assessed. To address this issue, we let participants perform a task in which they had to mirror or complement a hand gesture (fist or open hand) performed by an actor depicted either within or outside of reach. In three studies, we observed faster reaction times and less response errors for complementary relative to mirrored hand movements in response to open hand gestures (i.e., 'hand-shaking') irrespective of the perceived interpersonal distance of the actor. This complementary effect could not be accounted for by a low-level spatial cueing effect. These results demonstrate that humans have a strong and automatic tendency to respond by performing complementary actions. In addition, our findings underline the limitations of manipulations of space in modulating effects of motor priming and the perception of affordances.

Despite men-who-have-sex-with-men (MSM) from Latin America (LA) are still a vulnerable population for known health-related conditions and social problems, availability of comparable data across LA countries for assessment and monitoring purposes is limited. The objective of this article is to present the study design and the questionnaire of LAMIS-2018 (Latin America MSM Internet Survey), its recruitment strategy, rates and sources by country, and the lessons learned from its implementation. LAMIS-2018 was a cross-sectional, internet-based survey targeting MSM living in 18 LA countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela) that gathered data about sexual behaviors, HIV/STI and viral hepatitis knowledge, prophylactic use of antiretrovirals, psychosocial health, and access to sexual health services. The survey went online for four months and was available in three languages (Spanish, Portuguese, and Dutch). Promotion was carried out using dating apps, websites, social networks, and by community-based and academic organizations of each participating country directly in gay venues and in their own premises. Overall, 64,655 MSM participated in LAMIS-2018. Dating apps and websites were the most important recruitment source in most countries, except for Honduras, Nicaragua, and Suriname, where community-based organizations recruited most of the participants. Beyond the LAMIS-2018 implementation description, we highlight the feasibility of such a study in this context, based on the collaboration between community-based and academic organizations to obtain a large sample of MSM in the region. LAMIS-2018 data will contribute to identify determinants of risk behaviors and prevention needs of vulnerable MSM populations in each country of the region.

Any large dataset can be analyzed in a number of ways, and it is possible that the use of different analysis strategies will lead to different results and conclusions. One way to assess whether the results obtained depend on the analysis strategy chosen is to employ multiple analysts and leave each of them free to follow their own approach. Here, we present consensus-based guidance for conducting and reporting such multi-analyst studies, and we discuss how broader adoption of the multi-analyst approach has the potential to strengthen the robustness of results and conclusions obtained from analyses of datasets in basic and applied research.

The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. "High objective risk" (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18-29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), "rather high"/ "high" self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women.