142 results on '"Stephenson, Rob"'
Search Results
2. Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States
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Sharma, Akshay, Gandhi, Monica, Sallabank, Gregory, Merrill, Leland, and Stephenson, Rob
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- 2023
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3. Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia
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Metheny, Nicholas, Stephenson, Rob, Darbes, Lynae A., Chavanduka, Tanaka M. D., Essack, Zaynab, and van Rooyen, Heidi
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- 2022
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4. Race-Based Medical Mistrust, HIV-Related Stigma, and ART Adherence in a Diverse Sample of Men Who Have Sex with Men with HIV
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Meyers-Pantele, Stephanie A., Sullivan, Patrick, Mansergh, Gordon, Hirshfield, Sabina, Stephenson, Rob, and Horvath, Keith J.
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- 2022
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5. PrEP Use and Persistence Among Young Sexual Minority Men 17–24 Years Old During the COVID-19 Pandemic
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Hong, Chenglin, Horvath, Keith J., Stephenson, Rob, Nelson, Kimberly M., Petroll, Andrew E., Walsh, Jennifer L., and John, Steven A.
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- 2022
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6. COVID-19-Related Disruptions to HIV Testing and Prevention Among Young Sexual Minority Men 17–24 Years Old: A Qualitative Study Using Synchronous Online Focus Groups, April–September 2020
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Zapata, Juan Pablo, Dang, Madeline, Quinn, Katherine G., Horvath, Keith J., Stephenson, Rob, Dickson-Gomez, Julia, and John, Steven A.
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- 2022
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7. A Systematic Review of Technology-Assisted HIV Testing Interventions
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Horvath, Keith J., Walker, Teresa, Mireles, Linda, Bauermeister, Jose A., Hightow-Weidman, Lisa, and Stephenson, Rob
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- 2020
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8. The Influence of Relationship Dynamics and Sexual Agreements on Perceived Partner Support and Benefit of PrEP Use Among Same-Sex Male Couples in the U.S.
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Kahle, Erin M., Sharma, Akshay, Sullivan, Stephen, and Stephenson, Rob
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- 2020
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9. Towards the Development of an Intimate Partner Violence Screening Tool for Gay and Bisexual Men
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Stephenson, Rob, Hall, Casey D, Williams, Whitney, Sato, Kimi N, and Finneran, Catherine
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IPV ,MSM ,HIV ,Screening ,Public Health - Abstract
Introduction: Recent research suggests that gay and bisexual men experience intimate partner violence (IPV) at rates comparable to heterosexual women. However, current screening tools used to identify persons experiencing IPV were largely created for use with heterosexual women. Given the high prevalence of IPV among gay and bisexual men in the United States, the lack of IPV screening tools that reflect the lived realities of gay and bisexual men is problematic. This paper describes the development of a short-form IPV screening tool intended to be used with gay and bisexual men.Methods: A novel definition of IPV, informed by formative Focus Group Discussions, was derived from a quantitative survey of approximately 1,100 venue-recruited gay and bisexual men. From this new definition, a draft IPV screening tool was created. After expert review (n=13) and cognitive interviews with gay and bisexual men (n=47), a screening tool of six questions was finalized. A national, online-recruited sample (n=822) was used to compare rates of IPV identified by the novel tool and current standard tools.Results: The six-item, short-form tool created through the six-stage research process captured a significantly higher prevalence of recent experience of IPV compared to a current and commonly used screening tool (30.7% versus 7.5%, p
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- 2013
10. Relationship Dynamics in the Context of Binge Drinking and Polydrug Use Among Same-Sex Male Couples in Atlanta, Boston, and Chicago
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Mimiaga, Matthew J., Suarez, Nicolas, Garofalo, Robert, Frank, John, Ogunbajo, Adedotun, Brown, Emily, Bratcher, Anna, Pardee, Dana, Hidalgo, Marco A., Hoehnle, Sam, Restar, Arjee, Wimbly, Taylor, Thai, Jennie, Sullivan, Patrick S., and Stephenson, Rob
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- 2019
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11. Social Capital, Depressive Symptoms, and HIV Viral Suppression Among Young Black, Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV
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Hussen, Sophia A., Easley, Kirk A., Smith, Justin C., Shenvi, Neeta, Harper, Gary W., Camacho-Gonzalez, Andres F., Stephenson, Rob, and del Rio, Carlos
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- 2018
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12. Inter-partner and Temporal Variations in the Perception of Sexual Risk for HIV
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Goldenberg, Tamar, Darbes, Lynae A., and Stephenson, Rob
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- 2018
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13. “It Was Supposed To Be a Onetime Thing”: Experiences of Romantic and Sexual Relationship Typologies Among Young Gay, Bisexual, and Other Men Who Have Sex with Men
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Sullivan, Stephen P., Pingel, Emily S., Stephenson, Rob, and Bauermeister, José A.
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- 2018
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14. “I consider being gay a very high risk factor”: How Perceptions of a Partner’s Sexual Identity Influence Perceptions of HIV Risk Among Gay and Bisexual Men
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Goldenberg, Tamar, Finneran, Catherine, Sullivan, Stephen P., Andes, Karen L., and Stephenson, Rob
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- 2017
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15. Factors associated with mobile app‐based ordering of HIV self‐test kits among men who have sex with men in Atlanta, Detroit and New York City: an exploratory secondary analysis of a randomized control trial.
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Mancuso, Noah, Mansergh, Gordon, Stephenson, Rob, Horvath, Keith J., Hirshfield, Sabina, Bauermeister, Jose A., Chiasson, Mary Ann, Downing, Martin J., and Sullivan, Patrick S.
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HIV testing kits ,DIAGNOSIS of HIV infections ,SECONDARY analysis ,INDEPENDENT variables ,BISEXUAL men - Abstract
Introduction: The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self‐test kits are becoming more available around the United States via web and app‐based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self‐test kit utilization among MSM in M‐cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. Methods: We conducted an exploratory secondary analysis of self‐report and in‐app data collected from the intervention arm of the M‐Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self‐test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). Results: Over half of the 417 intervention participants ordered an HIV self‐test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18–2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13–1.70). There was no difference in HIV self‐test kit ordering by income, race/ethnicity or age. Conclusions: HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self‐test kits in reaching populations with suboptimal testing rates and shows that self‐testing may supplement community‐based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Willingness to use couples HIV testing and discussion of sexual agreements among heterosexuals
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Stephenson, Rob, Finneran, Catherine, Goldenberg, Tamar, Coury-Doniger, Patricia, Senn, Theresa E, Urban, Marguerite, Schwartz, Ann, and Sullivan, Patrick
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- 2015
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17. Mapping LGBTQ+ Youth Resource Density Across Four High HIV Prevalence Corridors in the US.
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Sallabank, Gregory, Chavanduka, Tanaka M. D., Walsh, Alison R., Sullivan, Patrick, Wolfe, James, Filipowicz, Rebecca, Bonar, Erin E., Horvath, Keith J., Hailu, Benyam, Bauermeister, José, and Stephenson, Rob
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LGBTQ+ youth ,SEXUAL minorities ,HIV ,BISEXUAL men ,GEOSPATIAL data ,TEENAGE girls ,GAY community - Abstract
Introduction: Studies using geospatial data to understand LGBTQ+-friendly sexual health and wellness resource availability have often focused on services catered to adults. While HIV rates have increased in adolescents in recent years, few studies have explored disparities in resource access for adolescent gay and bisexual men (AGBMSM). Methods: We used geospatial data of resources (collected and verified 2017–2018) from the iReach app to understand disparities in resource access for AGBMSM within and between 4 high HIV prevalence corridors in the US. Results: AGBMSM in non-metro areas had access to fewer resources and some rural counties had no LGBTQ+ -friendly resources. Corridors comprising states with legacies of punitive laws targeting sexual and gender minorities demonstrate stark geographic disparities across the US. Conclusions: Policy-makers must understand the granularity of disparities within regions. Online resources may be able to surmount LGBTQ+ resource deserts. However, physical access to LGBTQ+ -friendly services must be improved as a fundamental strategy for reducing HIV among AGBMSM. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Willingness to use and preferences for long‐acting injectable PrEP among sexual and gender minority populations in the southern United States, 2021–2022: cross‐sectional study.
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Schoenberg, Paige, Edwards, O. Winslow, Merrill, Leland, Martinez, Cristian Acero, Stephenson, Rob, Sullivan, Patrick S., and Jones, Jeb
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SEXUAL minorities ,ANAL sex ,HUMAN sexuality ,PRE-exposure prophylaxis ,HIV prevention - Abstract
Introduction: Long‐acting injectable (LAI) pre‐exposure prophylaxis (PrEP) for HIV prevention was approved by the U.S. Food and Drug Administration in 2021. LAI PrEP is more effective than oral PrEP. However, it is not clear whether the groups most at risk of HIV in the United States will use LAI PrEP. Willingness to use LAI PrEP and preference for LAI versus oral PrEP has not been reported for sexual and gender minority (SGM) people in the southern United States, where the HIV epidemic is concentrated. Our goal was to assess willingness to use LAI PrEP and preference for oral versus LAI PrEP among SGM people in the southern United States and to assess differences in willingness by demographics and sexual behaviour. Methods: We conducted an online, cross‐sectional survey of SGM people aged 15–34 years in the southern United States (n = 583). Participants reported willingness to use LAI PrEP and preferences for LAI PrEP versus daily oral PrEP. We assessed bivariate associations and adjusted prevalence ratios for the LAI‐PrEP‐related outcomes and key demographic and behavioural characteristics. Results: Overall, 68% of all participants (n = 393) reported being willing to use LAI PrEP that provides protection against HIV for 3 months. Of those, most (n = 320, 81%) indicated a preference for using LAI PrEP, compared to a daily oral pill or no preference. Willingness to use LAI PrEP was more common among transgender and non‐binary participants and participants who engaged in condomless anal intercourse in the last 6 months. Hispanic participants were more likely and non‐Hispanic Black participants were less likely to report willingness to use LAI PrEP compared to non‐Hispanic White participants. Conclusions: Willingness to use LAI PrEP was high among SGM people in the southern United States, although there were some important differences in willingness based on demographic characteristics. Decreased willingness to use LAI PrEP among groups who are disproportionately affected by the HIV epidemic, such as non‐Hispanic Black SGM people, could exacerbate existing disparities in HIV incidence. LAI PrEP is an acceptable option among SGM populations in the southern United States, but strategies will be needed to ensure equitable implementation. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Homophobia and Communal Coping for HIV Risk Management Among Gay Men in Relationships
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Stachowski, Courtney and Stephenson, Rob
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- 2015
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20. Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: an application of the ADAPT-ITT framework
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Sullivan, Patrick S, Stephenson, Rob, Grazter, Beau, Wingood, Gina, Diclemente, Ralph, Allen, Susan, Hoff, Colleen, Salazar, Laura, Scales, Lamont, Montgomery, Jeanne, Schwartz, Ann, Barnes, Jasper, and Grabbe, Kristina
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- 2014
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21. The Prevalence of Undiagnosed HIV Serodiscordance Among Male Couples Presenting for HIV Testing
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Sullivan, Patrick S., Wall, Kristin M., O’Hara, Brandon, Jones, Jeb, Barnes, Jasper, DiClemente, Ralph, Hoff, Colleen, Scales, Lamont, Salazar, Laura F., Sanchez, Travis, White, Darcy, Wingood, Gina, Allen, Susan, and Stephenson, Rob
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- 2014
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22. Social Network Composition and Sexual Risk-Taking Among Gay and Bisexual Men in Atlanta, GA
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Finneran, Catherine and Stephenson, Rob
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- 2014
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23. Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study.
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Storholm, Erik D., Siconolfi, Dan E., Wagner, Glenn J., Wenjing Huang, Nacht, Carrie L., Sallabank, Greg, Felner, Jennifer K., Wolf, Joshua, Lee, Sarita D., and Stephenson, Rob
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INTIMATE partner violence ,HIV prevention ,SEXUAL minority men ,PRE-exposure prophylaxis ,SEXUALLY transmitted diseases - Abstract
Background: Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. Objective: This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. Methods: This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. Results: Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. Conclusions: This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. [ABSTRACT FROM AUTHOR]
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- 2022
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24. Pre-Exposure Prophylaxis Stigma and Beliefs in the Efficacy of Pre-Exposure Prophylaxis: An Analysis of a Cross-Sectional Survey of Male Couples in the United States.
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Stephenson, Rob, Chavanduka, Tanaka M. D., Sullivan, Stephen P., and Mitchell, Jason W.
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Increasing the use of pre-exposure prophylaxis (PrEP) among male couples is critical to the success of the United States' Ending the HIV Epidemic campaign. By leveraging dyadic data from a larger cross-sectional study of male couples, the present analysis examined individual, partner, and relationship characteristics associated with PrEP stigma and perceived efficacy of PrEP. Actor–Partner Independence Models were fit separately for both outcomes. Individual and partner risk behaviors, including substance use, binge drinking, and higher number of condomless casual sex partners, were associated with lower levels of both PrEP stigma and belief in the efficacy of PrEP. Networks that supported PrEP use were associated with decreased PrEP stigma and increased belief in PrEP efficacy. Stigma-informed PrEP interventions for couples should be considered foundational to the success of the United States' Ending the HIV Epidemic campaign. [ABSTRACT FROM AUTHOR]
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- 2022
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25. Study Evaluating Self-Collected Specimen Return for HIV, Bacterial STI, and Potential Pre-Exposure Prophylaxis Adherence Testing Among Sexual Minority Men in the United States.
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Sharma, Akshay, Gandhi, Monica, Sallabank, Gregory, Merrill, Leland, and Stephenson, Rob
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SEXUAL minority men ,PRE-exposure prophylaxis ,SEXUALLY transmitted diseases ,HIV - Abstract
Web-based HIV and sexually transmitted infection (STI) prevention studies are increasingly requesting gay, bisexual, and other men who have sex with men (GBMSM) to return self-collected specimens for laboratory processing. Some studies have solicited self-collected extragenital swabs for gonorrhea and chlamydia testing, but to date, none have solicited self-collected hair samples for pre-exposure prophylaxis (PrEP) adherence testing. Project Caboodle! offered 100 racially/ethnically diverse GBMSM aged 18 to 34 years residing across the United States a choice to self-collect at home and return by mail any of the following: a finger-stick blood sample (for HIV testing), a pharyngeal swab, a rectal swab and a urine specimen (for gonorrhea and chlamydia testing), and a hair sample (to visually assess its adequacy for PrEP drug level testing). Despite not incentivizing specimen return, 51% mailed back at least one type of specimen within 6 weeks (1% returned three specimens, 11% returned four specimens and 39% returned all five specimens). The majority of returned specimens were adequate for laboratory processing. Significantly more participants without a college education (p =.0003) and those who were working full-time or part-time (p =.0070) did not return any specimens. In addition, lower levels of HIV-related knowledge (p =.0390), STI-related knowledge (p =.0162), concern about contracting HIV (p =.0484), and concern about contracting STIs (p =.0108) were observed among participants who did not return any specimens. Self-collection of specimens holds promise as a remote monitoring strategy that could supplement testing in clinical settings, but a better understanding of why some GBMSM may choose to fully, partially, or not engage in this approach is warranted. [ABSTRACT FROM AUTHOR]
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- 2022
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26. The Relationship Between Alcohol Consumption and Unprotected Sex Among Known HIV-discordant Couples in Rwanda and Zambia
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Coldiron, Matthew E., Stephenson, Rob, Chomba, Elwyn, Vwalika, Cheswa, Karita, Etienne, Kayitenkore, Kayitesi, Tichacek, Amanda, Isanhart, Leia, Allen, Susan, and Haworth, Alan
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- 2008
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27. Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States.
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Jones, Jeb, Edwards, O. Winslow, Merrill, Leland, Sullivan, Patrick S., and Stephenson, Rob
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SEXUAL minorities ,HIV prevention ,MEDICAL personnel ,DIGITAL health ,MOBILE apps - Abstract
Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app's features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. [ABSTRACT FROM AUTHOR]
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- 2022
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28. A Skills-Based HIV Serostatus Disclosure Intervention for Sexual Minority Men in South Africa: Protocol for Intervention Adaptation and a Pilot Randomized Controlled Trial.
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Daniels, Joseph, Peters, Remco P. H., Medina-Marino, Andrew, Bongo, Cikizwa, and Stephenson, Rob
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HIV infections ,SEXUAL minority men ,MEN who have sex with men ,PUBLIC health - Abstract
Background: Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is a high HIV transmission risk within HIV-discordant partnerships, but an existing intervention may address these outcomes, if adapted effectively. Healthy Relationships (HR) is a behavioral intervention that was originally delivered in groups and in person over 5 sessions to develop coping skills for managing HIV-related stress and sexually risky situations, enhance decision-making skills for HIV disclosure to partners, and establish and maintain safer sex practices with partners. HR effectively improves prevention behaviors but has yet to be tailored to a non-US context. Objective: We aim to adapt HR into a new culturally grounded intervention entitled Speaking Out & Allying Relationships for GBMSM and then assess its feasibility in Eastern Cape, South Africa. Methods: The study will have 2 aims. For aim 1--adaptation--we will use a human-centered design approach. Initial intervention tailoring will involve integrating Undetectable=Untransmittable and pre-exposure prophylaxis education, developing intervention content for a videoconference format, and designing role-plays and movies for skill building based on preliminary data. Afterward, interviews and surveys will be administered to GBMSM to assess intervention preferences, and a focus group will be conducted with health care providers and information technology experts to assess the intervention's design. Finally, a usability test will be performed to determine functionality and content understanding. Participants will be GBMSM living with HIV (n=15) who are in a relationship and health care providers and information technology (n=7) experts working in HIV care and programming with this population. For aim 2, we will examine the feasibility of the adapted intervention by using a pilot randomized control design. There will be 60 individuals per arm. Feasibility surveys and interviews will be conducted with the intervention arm, and behavioral and biomedical assessments for relationship and treatment adherence outcomes will be collected for both arms. All participants will be GBMSM living with HIV who are in a relationship with an HIV-negative or unknown status partner. Results: Intervention adaptation began in August 2021. Initial tailoring and the refining of GBMSM intervention preferences were completed in December 2021. Usability and feasibility assessments are due to be completed by March 2022 and February 2024, respectively. Conclusions: GBMSM need efficacious interventions that tackle partnership dynamics, HIV prevention, and treatment outcomes for antiretroviral treatment adherence and viral suppression in South Africa. Harnessing everyday technology use for social networking (eg, videoconferences), Undetectable=Untransmittable education, and pre-exposure prophylaxis to update an existing intervention for South African GBMSM has the potential to strengthen relationship communication about HIV treatment and prevention and, in turn, improve outcomes. [ABSTRACT FROM AUTHOR]
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- 2022
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29. Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana.
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Gutin, Sarah A., Harper, Gary W., Moshashane, Neo, Ramontshonyana, Kehumile, Stephenson, Rob, Shade, Starley B., Harries, Jane, Mmeje, Okeoma, Ramogola-Masire, Doreen, and Morroni, Chelsea
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CONCEPTION ,SAFE sex ,HIV ,SOCIAL stigma - Abstract
Background: A significant proportion (20-59%) of people living with HIV in sub-Saharan Africa desire childbearing, are of reproductive age, and are in sero-different relationships (~50%). Thus it is plausible that some portion of new HIV transmissions are due to attempts to become pregnant. Safer conception (SC) methods that effectively reduce the risk of HIV transmission exist and can be made available in resource-constrained settings. Few studies in the region, and none in Botswana, have quantitatively examined the correlates of information, motivation, and behavioral skills for SC uptake.Methods: We surveyed 356 women living with HIV from 6/2018 to 12/2018 at six public-sector health clinics in Gaborone, Botswana. Participants were 18-40 years old, not pregnant, and desired future children or were unsure about their childbearing plans. We examined correlates of SC information, motivation, and behavioral skills using nested linear regression models, adjusting for socio-demographic, interpersonal, and structural variables.Results: Knowledge of SC methods varied widely. While some SC methods were well known (medical male circumcision by 83%, antiretroviral therapy for viral suppression by 64%), most other methods were known by less than 40% of participants. Our final models reveal that stigma as well as relationship and partner factors affect SC information, motivation, and behavioral skills. Both internalized childbearing stigma (ß=-0.50, 95%CI:-0.17, -0.02) and perceived community childbearing stigma were negatively associated with SC information (ß=-0.09, 95%CI:-0.80, -0.21). Anticipated (ß=-0.06, 95%CI:-0.12, -0.003) and internalized stigma (ß=-0.27, 95%CI:-0.44; -0.10) were associated with decreased SC motivation, while perceived community childbearing stigma was associated with increased SC motivation (ß=0.07, 95%CI:0.02, 0.11). Finally, internalized childbearing stigma was associated with decreased SC behavioral skills (ß=-0.80, 95%CI: -1.12, -0.47) while SC information (ß=0.24, 95%CI:0.12, 0.36), motivation (ß=0.36, 95%CI:0.15, 0.58), and perceived partner willingness to use SC (ß=0.47, 95%CI:0.36, 0.57) were positively associated with behavioral skills CONCLUSIONS: Low SC method-specific information levels are concerning since almost half (47%) of the study participants reported they were in sero-different relationships and desired more children. Findings highlight the importance of addressing HIV stigma and partner dynamics in interventions to improve SC information, motivation, and behavioral skills. [ABSTRACT FROM AUTHOR]- Published
- 2021
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30. Brief intervention to prevent HIV, STI and unintended pregnancies: preliminary results of a feasibility study from the perspective of healthcare providers in Peru.
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Jiron, Jean Pierre, Sandoval, Clara, Enciso, Juan Carlos, De Vasconcelos, Ana Sofía, Blondeel, Karel, Bakunina, Nataliia, Lesco, Galina, Toskin, Igor, Stephenson, Rob, and Caceres, Carlos F.
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MEDICAL personnel ,REPRODUCTIVE health services ,SEXUAL health ,HEALTH facilities ,FEASIBILITY studies ,PHYSICIANS ,HIV - Abstract
Background: Brief interventions have proven to be valuable instruments for the treatment and care of clients with diverse health needs, due to their potential to impact both the individual and the population. In this regard, the Brief Sexuality-Related Communication (BSC) is presented as a viable and effective alternative for addressing sexual and reproductive health problems, assessing risk behaviors and motivating clients to generate behavioral change. Since health providers are key actors in treatment and prevention, it is essential to know their perceptions about the BSC intervention, as well as its acceptability in different contexts, with diverse client populations. Thus, the following paper reflects the findings of the perceptions and experiences of health providers in Peru from the first phase of the Feasibility study of a BSC intervention to prevent STIs and unintended pregnancies.Methods: This is the first phase of a multisite and multiphase study of the feasibility of a BSC intervention. We conducted twenty in-depth interviews (IDI) with health care providers (physicians, obstetricians, psychologists, nurses and peer counselors) recruited from three health care institutions in Peru: The Tahuantinsuyo Bajo Maternal and Child Center (CMI) and the San José Maternal and Child Center, both located in the capital city, Lima; and La Caleta Hospital located in Chimbote, northern coast of Peru. Participating health providers included those working at the HIV/STI Reference service and the family planning/reproductive health service. The IDI addressed three domains: 1) Acceptability of the BSC intervention; 2) Perceived willingness to implement the BSC intervention; and 3) Considerations for the Implementation of the BSC intervention.Results: Health providers expressed high acceptance of the BSC intervention, considering it as a useful and effective instrument to address sexual and reproductive health problems with all clients; however, some providers had some concerns about the real impact of the intervention to achieve significant behavior change. On the other hand, health providers showed high willingness to learn and implement the BSC intervention, affirming their commitment to learn new techniques and strategies that could allow them to improve their knowledge and the quality of their care. Health care providers consider it necessary to take into account the barriers that arise in the implementation of the BSC intervention, such as the structural limitations to access, the providers' abilities to deliver the intervention effectively, and the participants' reception of the intervention. Finally, providers consider it essential to establish the BSC intervention in a normative framework that allows it to receive the support of the health departments and eventually enforces implementation.Conclusions: Health providers consider the BSC intervention as an interesting and exciting behavioral intervention to deal with the sexual and reproductive health issues existing in different populations, and seemed highly willing to adapt and implement it, hoping that it become beneficial to all client populations to prevent HIV/STIs and unintended pregnancies. [ABSTRACT FROM AUTHOR]- Published
- 2021
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31. Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic.
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Stephenson, Rob, Walsh, Alison R., Chavanduka, Tanaka M. D., Sallabank, Gregory, Horvath, Keith J., Castel, Amanda D., Bonar, Erin E., Hightow-Weidman, Lisa, Bauermeister, Jose A., and Sullivan, Patrick S.
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COVID-19 pandemic , *HIV prevention , *YOUTH services , *CORRIDORS (Ecology) , *LGBTQ+ youth , *PEARSON correlation (Statistics) , *HIV - Abstract
Background: Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. Methods: We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). Results: There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0–14.33 per 10,000 youth aged 13–24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county's available LGBTQ+ youth-friendly HIV service providers and their HIV burden. Conclusions: As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth. [ABSTRACT FROM AUTHOR]
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- 2021
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32. Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities.
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Kota, Krishna Kiran, Mansergh, Gordon, Stephenson, Rob, Hirshfield, Sabina, and Sullivan, Patrick
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HIV infections ,CONFIDENCE intervals ,SOCIOECONOMIC factors ,RESEARCH funding ,PREVENTIVE medicine ,MEN who have sex with men ,ODDS ratio ,DATA analysis software ,GAY men - Abstract
HIV pre-exposure prophylaxis (PrEP) is a preventive medication that could reduce new infections among men who have sex with men (MSM). There are limited data on differing reasons for PrEP nonuse by condomless anal sex (CAS). We examined demographic and behavioral variables associated with PrEP use and reasons for PrEP nonuse by CAS. Data are from the M-cubed Study, collected in a 2018 baseline assessment of MSM (n = 798) in Atlanta, Detroit, and New York City. Participants reported current PrEP use (31%), previous use (8%), and never use (61%). MSM reporting CAS [adjusted odds ratio (aOR) = 2.60, confidence interval (95% CI) = 1.73–3.91], age 18–29 (aOR = 2.11, 95% CI = 1.26–3.52), 30–39 (aOR = 2.12, 95% CI = 1.25–3.59), with a college degree (aOR = 1.96, 95% CI = 1.20–3.21), or postgraduate education (aOR = 2.58, 95% CI = 1.51–4.40) had greater odds of current (vs. never) use; uninsured (aOR = 0.30, 95% CI = 0.16–0.57) men had lower odds of current (vs. never) use. For never use, more MSM who reported CAS (vs. did not) endorsed the following reasons (p's < 0.05): Insurance wouldn't cover PrEP (20% vs. 12%), Didn't know where to get it (33% vs. 24%) and fewer reported Didn't need PrEP (23% vs. 39%) and Started a committed relationship (7% vs. 25%). For discontinuation, more MSM who reported CAS (vs. did not) endorsed Worry about the safety of PrEP (19% vs. 3%). Efforts are needed to enhance PrEP as an option among older, less educated, and uninsured MSM. These findings may inform how providers can facilitate PrEP use by messaging on access and safety for MSM who reported CAS. [ABSTRACT FROM AUTHOR]
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- 2021
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33. Preference for using a variety of future HIV pre‐exposure prophylaxis products among men who have sex with men in three US cities.
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Mansergh, Gordon, Kota, Krishna Kiran, Stephenson, Rob, Hirshfield, Sabina, and Sullivan, Patrick
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MEN who have sex with men ,PRE-exposure prophylaxis ,UNSAFE sex ,ANAL sex ,HIV prevention - Abstract
Background: Daily oral pre‐exposure prophylaxis (PrEP) is available and recommended for men who have sex with men (MSM) at risk for HIV infection. Other HIV prevention products are being developed, including long‐acting injectable (LAI) and event‐based oral and topical formulations. Understanding preferences for potential products by MSM can help direct further development of prevention messaging. Methods: We present baseline data from HIV‐negative participants enrolled in the US Mobile Messaging for Men (M‐cubed) Study. Participants were asked their likelihood of and rank order preference for using daily oral PrEP and various potential prevention products (one‐ to ‐three‐month injections, 2‐1‐1 sexual event oral dosing, anal or penile gel, or anal suppository), and their sociodemographic characteristics. Bivariate and multivariable logistics regression assessed demographic associations with likelihood of use and rank order preference. Results: Overall, most MSM reported a likelihood of using LAI (74%), sexual event‐based pills (67%) and penile gel (64%). Men who reported recent unprotected (condomless and PrEPless) anal sex most preferred a penile gel formulation (74%), followed closely by LAI and event‐based pills (73% each). Current PrEP users (vs. non‐users) had greater odds of reporting likelihood to use LAI (AOR = 3.29, 95% CI = 2.12 to 5.11), whereas men reporting recent unprotected anal sex had a greater odds of likelihood to use a penile gel (AOR = 1.79, 95% CI = 1.27 to 2.52) and an anal suppository (AOR = 1.48, 95% CI = 1.08 to 2.02). Hispanic/Latino (vs. White) MSM (AOR = 2.29, 95% CI = 1.40 to 3.73) and, marginally, Black MSM (AOR = 1.54, 95% CI = 1.00 to 2.38) had greater odds of reporting likelihood to use penile gel. Similar patterns were found for rank ordering preference of products, including condoms. Conclusions: Most MSM were interested in using various potential future HIV prevention products, especially LAI. However, two typologies of potential users emerged: men who prefer sexual event‐based methods (condoms, event‐based pill, sexual gels and suppositories) and men who prefer non‐sexual event‐based methods (daily pill, LAI). Men who reported recent unprotected anal sex preferred a penile gel product most, followed closely by sexual event‐based pills and LAI. Racial/ethnic differences were noted as well. These findings on product preferences can help in formulation development and messaging. [ABSTRACT FROM AUTHOR]
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- 2021
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34. The Development and Testing of a Relationship Skills Intervention to Improve HIV Prevention Uptake Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Their Primary Partners (We Prevent): Protocol for a Randomized Controlled Trial
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Gamarel, Kristi E, Darbes, Lynae A, Hightow-Weidman, Lisa, Sullivan, Patrick, and Stephenson, Rob
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medicine.medical_specialty ,020205 medical informatics ,telehealth ,Motivational interviewing ,men who have sex with men ,Context (language use) ,02 engineering and technology ,Telehealth ,Men who have sex with men ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,adolescents ,030212 general & internal medicine ,Session (computer science) ,couples ,Original Paper ,business.industry ,HIV ,General Medicine ,Family medicine ,business ,Dyad - Abstract
Background: Young gay, bisexual, and other men who have sex with men (YMSM) continue to be the group most heavily impacted by HIV in the United States. Substantial evidence indicates that up to two-thirds of new HIV infections occur in the context of a main partnership. Couples HIV testing and counseling (CHTC) has been shown to be a promising and effective strategy for increasing HIV prevention uptake among male couples; however, YMSM who are new to relationships may not have yet developed the efficacy, negotiation, and communication skills to navigate HIV testing in their relationship and communicate around developing a prevention plan. Objective: This study aims to develop and test a relationship skills–focused HIV prevention intervention for YMSM and their partners. The intervention consists of two telehealth-delivered sessions: the first focuses on relationship skills and the second consists of CHTC and prevention planning. Both sessions are attended by both members of the dyad. Methods: This protocol describes the development of the proposed intervention (We Prevent) and pilot test to examine its feasibility and preliminary efficacy. The intervention will include two motivational interviewing–based sessions: session one is a relationship skills–building session, focused on techniques to explore and build communication skills in a relationship, to help YMSM develop and enhance necessary skills for their current and future relationships; the second session is a CHTC session with YMSM and their partners, to help them develop an HIV prevention plan. Through qualitative data collection and a one-arm pilot with YMSM, we will develop and refine a developmentally appropriate relationship skills session as an addition to the current CHTC intervention. We will then conduct a pilot randomized controlled trial (RCT), comparing the acceptability, feasibility, and preliminary efficacy of the adapted two-session telehealth intervention for YMSM versus a control group receiving one session only—a CHTC session delivered via telehealth. Results: The We Prevent intervention is designed to increase uptake of HIV prevention, shown through self-reported reductions in condomless sex and increases in knowledge and uptake of pre-exposure prophylaxis. In addition, the intervention is designed to increase HIV and sexually transmitted infection (STI) testing. STI incidence is examined as a secondary outcome. A cost-input analysis will examine the costs associated with intervention delivery to inform future scale-up of the intervention. Conclusions: Drawing on theory and existing CHTC protocols delivered with video-based counseling, this proposed intervention affords the opportunity to empower YMSM with the skills necessary to communicate with their partners and protect themselves from HIV in their current and future relationships. Trial Registration: Clinicaltrials.gov NCT03551938; https://clinicaltrials.gov/ct2/show/NCT03551938 (Archived by WebCite at http://www.webcitation.org/73omJCz1a) International Registered Report Identifier (IRRID): RR1-10.2196/10370
- Published
- 2019
35. Contrasting the Perceived Severity of COVID-19 and HIV Infection in an Online Survey of Gay, Bisexual, and Other Men Who Have Sex With Men During the U.S. COVID-19 Epidemic.
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Stephenson, Rob, Chavanduka, Tanaka M. D., Rosso, Matthew T., Sullivan, Stephen P., Pitter, Renée A., Hunter, Alexis S., and Rogers, Erin
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While there is evidence of variations in the risk perceptions of COVID-19 and that they are linked to both engagement in health-protective behaviors and poor mental health outcomes, there has been a lack of attention to how individuals perceive the risk of COVID-19 relative to other infectious diseases. This paper examines the relative perceptions of the severity of COVID-19 and HIV among a sample of U.S. gay, bisexual, and other men who have sex with men (GBMSMs). The “Love and Sex in the Time of COVID-19” survey was conducted online from April 2020 to May 2020. GBMSMs were recruited through paid banner advertisements featured on social networking platforms, resulting in a sample size of 696. The analysis considers differences in responses to two scales: the Perceived Severity of HIV Infection and the Perceived Severity of COVID-19 Infection. Participants perceived greater seriousness for HIV infection (mean 46.67, range 17–65) than for COVID-19 infection (mean 38.81, range 13–62). Some items reflecting more proximal impacts of infection (anxiety, loss of sleep, and impact on employment) were similar for HIV and COVID-19. Those aged over 25 and those who perceived higher prevalence of COVID-19 in the United States or their state were more likely to report COVID-19 as more severe than HIV. There is a need to develop nuanced public health messages for GBMSMs that convey the ongoing simultaneous health threats of both HIV and COVID-19. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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36. Power relations in sexual agreements among male couples in Southern Africa.
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Essack, Zaynab, Lynch, Ingrid, Kaunda, Chammah J., Stephenson, Rob, Darbes, Lynae, and van Rooyen, Heidi
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CRITICAL theory ,HUMAN sexuality ,LIBIDO ,HIV prevention ,COUPLES - Abstract
Sexual agreements between same-sex practising men facilitate communication about health promotion activities, including HIV prevention. In African contexts, male couples negotiate their sexual agreements in relation to rigid cultural prescriptions about male power and privilege, intense hostility towards same-sex sexualities and persistent heterogendered socio-cultural norms. Yet the impact of such norms on relationship practices and HIV risk among male couples remains inadequately explored. This qualitative study examined the role of gendered power disparities in establishing sexual agreements among male couples in two Southern African contexts. Eighteen male couples completed in-depth interviews focused on relationship practices, including sexual agreements. The research employed critical social theory to analyse power relations and socio-cultural norms shaping male couples' explicit and implicit sexual agreements, with a focus on implications for HIV risk. The findings outline different types of and motivations for sexual agreements among male couples, including qualified non-monogamy with female partners only. The study illustrates how Southern African male-male sexual practices remain embedded in a cultural context favouring the replication of heteronormative sexual behaviours and relationship practices. These heterogendered norms impact negatively on the process of establishing explicit, mutually agreed-upon sexual agreements, and thus place male couples at increased risk for HIV. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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37. Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014.
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Winskell, Kate, Singleton, Robyn, Sabben, Gaëlle, Tiendrébéogo, Georges, Obong'o, Chris, Dia, Fatim Louise, Nkambule-Vilakati, Siphiwe, Mbakwem, Benjamin, and Stephenson, Rob
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HIV infection transmission ,COLLECTIVE representation ,CIRCUMCISION ,HIV prevention ,HIV ,CONDOM use ,ZIKA virus - Abstract
HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre- and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10–24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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38. Feasibility and Acceptability of an HIV/AIDS Self-Management Education Program for HIV-Positive Men Who Have Sex With Men in Thailand.
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Khumsaen, Natawan and Stephenson, Rob
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DIAGNOSIS of HIV infections , *HIV prevention , *AIDS education , *HEALTH promotion , *PSYCHOLOGY of HIV-positive persons , *QUALITY of life , *SELF-management (Psychology) , *PILOT projects , *RANDOMIZED controlled trials , *HIV seroconversion , *EVALUATION of human services programs , *MEN who have sex with men - Abstract
This pilot study examined the feasibility and acceptability of the HIV/AIDS self-management education program-Thai (HASMEP-T) for HIV-positive Thai men who have sex with men (MSM). HASMEP-T is a group-based adaptation of the evidence-based intervention, HASMEP. Participants were 40 Thai MSM living with HIV aged 18 years or older, recruited from an HIV clinic housed in a hospital in Thailand. Results support the feasibility of recruitment, screening, eligibility, and retention methods. The majority of the participants reported that the intervention was acceptable and met their initial expectations. Furthermore, all recruited participants in the intervention group (n = 20) completed HASMEP-T. Overall, intervention group participants demonstrated significant increases in all aspects of HIV self-management (p <.05), as well as improvement in quality of life in the psychological domain (p <.05). Our findings provide preliminary support for the large-scale, randomized-controlled trial of the efficacy of HASMEPT to promote self-management behaviors among HIV-positive Thai MSM. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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39. A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial
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Winskell, Kate, Sabben, Gaëlle, Akelo, Victor, Ondeng'e, Ken, Obong'o, Christopher, Stephenson, Rob, Warhol, David, and Mudhune, Victor
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narrative ,medicine.medical_specialty ,Health Informatics ,Information technology ,smartphone ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Condom ,Randomized controlled trial ,law ,medicine ,030212 general & internal medicine ,serious game ,mHealth ,Original Paper ,youth ,030505 public health ,Sub-Saharan Africa ,Descriptive statistics ,pilot study ,Behavior change ,HIV ,T58.5-58.64 ,Kenya ,Focus group ,mhealth ,randomized controlled trial ,Physical therapy ,Survey data collection ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,Psychology ,Social cognitive theory - Abstract
BackgroundThere is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. ObjectiveTo pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. MethodsTumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. ResultsIntervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P
- Published
- 2018
40. Reducing HIV Vulnerability Through a Multilevel Life Skills Intervention for Adolescent Men (The iREACH Project): Protocol for a Randomized Controlled Trial
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Bauermeister, Jose, Sullivan, Patrick S, Gravens, Laura, Wolfe, James, Countryman, Kristina, Smith-Bankhead, Neena, Drab, Ryan A, Sallabank, Gregory, Helms, Jordan D, Khatibi, Kristie, Filipowicz, Rebecca, Horvath, Keith Joseph, Bonar, Erin, Castel, Amanda, Hightow-Weidman, Lisa, Guest, Jodie, and Stephenson, Rob
- Subjects
Gerontology ,LGBTQ ,Ethnic group ,Psychological intervention ,Life skills ,Men who have sex with men ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Randomized controlled trial ,law ,Intervention (counseling) ,Protocol ,Medicine ,030212 general & internal medicine ,mHealth ,030505 public health ,business.industry ,HIV ,Social environment ,General Medicine ,sexuality ,3. Good health ,life skills ,adolescence ,0305 other medical science ,business - Abstract
Background: Few HIV interventions have demonstrated efficacy in reducing HIV risk among adolescent men who have sex with men (AMSM), and fewer still have recognized the unique needs of AMSM based on race/ethnicity or geographical setting. Recognizing that youths’ HIV vulnerability is intricately tied to their development and social context, delivering life skills training during adolescence might delay the onset or reduce the consequences of risk factors for HIV acquisition and equip AMSM with the skills to navigate HIV prevention. This protocol describes the development and testing of iREACH, an online multilevel life skills intervention for AMSM. Objective: This randomized controlled trial (RCT) aims to test the efficacy of an online-delivered life skills intervention, iREACH, on cognitive and behavioral HIV-related outcomes for AMSM. Methods: iREACH is a prospective RCT of approximately 600 cisgender adolescent males aged 13 to 18 years who report same-sex attractions. The intervention will be tested with a racial/ethnically diverse sample (≥50% racial/ethnic minority) of AMSM living in four regions in the United States: (1) Chicago to Detroit, (2) Washington, DC to Atlanta, (3) San Francisco to San Diego, and (4) Memphis to New Orleans. Results: This project is currently recruiting participants. Recruitment began in March 2018. Conclusions: iREACH represents a significant innovation in the development and testing of a tailored life skills-focused intervention for AMSM, and has the potential to fill a significant gap in HIV prevention intervention programming and research for AMSM. Registered Report Identifier: RR1-10.2196/10174
- Published
- 2018
41. Perceptions of HIV Self-Management Roles and Challenges in Adolescents, Caregivers, and Health Care Providers.
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Mutumba, Massy, Musiime, Victor, Mugerwa, Henry, Nakyambadde, Hellen, Gautam, Anudeeta, Matama, Christine, and Stephenson, Rob
- Abstract
Self-management of HIV is a desirable goal for the millions of adolescent persons living with HIV (PLWH). Adolescent PLWH continue to experience poor HIV care outcomes, primarily due to poor rates of medication adherence and retention in care, highlighting a need to develop adolescent self-management skills. The aim of our study was to examine adolescent, caregiver, and health care provider perceptions of adolescent PLWH self-management roles, barriers, and facilitators. Swendeman et al.'s self-management framework for chronic diseases guided the analyses. Participant narratives highlighted perceptions of their responsibilities and related challenges with regard to self-management of HIV by adolescents. Our findings highlighted the complexity of HIV self-management for adolescents and underscored the need for multifaceted programs to strengthen adolescent–caregiver–health care provider partnerships in order to improve adolescent PLWH health and wellbeing. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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42. Correction: Cost of peer mystery shopping to increase cultural competency in community clinics offering HIV/STI testing to young men who have sex with men: results from the get connected trial.
- Author
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Phillips, Victoria L., Xue, Ashley, Castillo, Marné, Santiago, Dalia, Wimbly, Taylor, Hightow-Weidman, Lisa B., Stephenson, Rob, and Bauermeister, José A.
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YOUNG men ,CULTURAL competence ,MYSTERY shopping ,COMMUNITIES ,HIV ,PEERS - Abstract
References 1 Phillips VL, Xue A, Castillo M. Cost of peer mystery shopping to increase cultural competency in community clinics offering HIV/STI testing to young men who have sex with men: results from the get connected trial. B Correction b : B I Health Econ Rev i b B 13 b , B 34 (2023) b https://doi.org/10.1186/s13561-023-00447-6 Following publication of the original article [[1]], the authors identified an error in the surname of Lisa B. Hightow-Weidman. [Extracted from the article]
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- 2023
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43. Home-Based HIV Testing and Counseling for Male Couples (Project Nexus): A Protocol for a Randomized Controlled Trial
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Stephenson, Rob, Freeland, Ryan, Sullivan, Stephen P, Riley, Erin, Johnson, Brent A, Mitchell, Jason, McFarland, Deborah, and Sullivan, Patrick S
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medicine.medical_specialty ,Telemedicine ,Human sexuality ,Context (language use) ,law.invention ,Men who have sex with men ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Protocol ,Medicine ,030212 general & internal medicine ,030505 public health ,business.industry ,HIV ,General Medicine ,Clinical trial ,Family medicine ,Residence ,telemedicine ,Rural area ,0305 other medical science ,business ,male couples ,Clinical psychology - Abstract
Background: HIV prevalence remains high among men who have sex with men (MSM) in the United States, yet the majority of research has focused on MSM as individuals, not as dyads, and has discussed HIV risks primarily in the context of casual sex. Nexus is an online prevention program that combines home-based HIV testing and couples HIV testing and counseling (CHTC). It allows partners in dyadic MSM relationships to receive HIV testing and care in the comfort of their designated residence, via video-based chat. By using video-based technologies (eg, VSee video chat), male couples receive counseling and support from a remote online counselor, while testing for HIV at home. Objective: This randomized control trial (RCT) aims to examine the effects of video-based counseling combined with home-based HIV testing on couples’ management of HIV risk, formation and adherence to explicit sexual agreements, and sexual risk-taking. Methods: The research implements a prospective RCT of 400 online-recruited male couples: 200 self-reported concordant-negative couples and 200 self-reported discordant couples. Couples in the control arm will receive one or two home-based HIV self-testing kits and will be asked to report their results via the study’s website. Couples in the experimental arm will receive one or two home-based HIV self-testing kits and will conduct these tests together under the facilitation of a remotely located counselor during a prescheduled VSee-based video CHTC session. Study assessments are taken at baseline, as well as at 3- and 6-month follow-up sessions. Results: Project Nexus was launched in April 2016 and is ongoing. To date, 219 eligible couples have been enrolled and randomized. Conclusions: Combining home-based HIV testing with video-based counseling creates an opportunity to expand CHTC to male couples who (1) live outside metro areas, (2) live in rural areas without access to testing services or LGBTQ resources, or (3) feel that current clinic-based testing is not for them (eg, due to fears of discrimination associated with HIV and/or sexuality). Clinical Trial: ClinicalTrials.gov NCT02335138; https://clinicaltrials.gov/ct2/show/NCT02335138 (Archived by WebCite at http://www.webcitation.org/6qHxtNIdW) [JMIR Res Protoc 2017;6(5):e101]
- Published
- 2017
44. Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies: A systematic review.
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De Vasconcelos, Sofia, Toskin, Igor, Cooper, Bergen, Chollier, Marie, Stephenson, Rob, Blondeel, Karel, Troussier, Thierry, and Kiarie, James
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HIV prevention ,PREVENTION of sexually transmitted diseases ,UNPLANNED pregnancy ,BEHAVIOR modification ,REPRODUCTIVE health services - Abstract
Background: Behaviour-change interventions have been consistently considered an essential part of comprehensive HIV, STI and unintended pregnancy prevention. In 2015, the World Health Organization reviewed and assessed existing evidence on brief behavioural interventions, leading to the publication of Brief sexuality-related communication: recommendations for a public health approach. This guideline recommends the use of brief behaviour intervention and communication programmes to promote sexual health and to prevent HIV, STIs, and unintended pregnancies in primary health services, particularly sexual and reproductive health services. Objective: With the purpose of informing the development of a brief behaviour intervention in sexual and reproductive health, we conducted a systematic review of brief intervention to prevent HIV, STI and unintended pregnancies, to identify behaviour change techniques (BCTs) used in health care settings. Methods: Participants from all ages and genders were included. Brief interventions delivered in ≤ 60 minutes were included. Data was extracted, and interventions were coded following the Behaviour Change Techniques Taxonomy (BCTTv1) guidelines. Results: Of the 6.687 articles identified, 355 were reviewed and 37 studies were included. In effective interventions, we identified 48 behaviour change techniques (BCTs). A core set of 8 frequently used behaviour change techniques was identified: “Problem solving”, “Feedback on behaviour”, “Social support (unspecified)”, “Instructions on how to perform the behaviour”, “Information about health consequences”, “Information about social and environmental consequences”, “Demonstration of the behaviour” and “Credible source”. Conclusions: The technical content of brief behaviour interventions was identified in a reliable and standardized way providing preliminary indications on potentially effective techniques to achieve behaviour change. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
45. Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men.
- Author
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Shaver, John, Sullivan, Patrick, Siegler, Aaron, de Voux, Alex, Phaswana-Mafuya, Nancy, Bekker, Linda-Gail, Baral, Stefan D., Wirtz, Andrea L., Beyrer, Chris, Brown, Ben, and Stephenson, Rob
- Abstract
Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIV-prevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
46. Building a Mobile HIV Prevention App for Men Who Have Sex With Men: An Iterative and Community-Driven Process
- Author
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Goldenberg, Tamar, McDougal, Sarah J, Sullivan, Patrick S, Stekler, Joanne D, and Stephenson, Rob
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medicine.medical_specialty ,020205 medical informatics ,Download ,Population ,Internet privacy ,Psychological intervention ,Health Informatics ,02 engineering and technology ,Men who have sex with men ,World Wide Web ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Acquired immunodeficiency syndrome (AIDS) ,mobile app ,mental disorders ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Mobile technology ,MSM ,030212 general & internal medicine ,education ,Original Paper ,education.field_of_study ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,HIV ,medicine.disease ,Focus group ,3. Good health ,AIDS ,community ,Psychology ,business - Abstract
Background: Gay, bisexual, and other men who have sex with men (MSM) account for a disproportionate burden of new HIV infections in the United States. Mobile technology presents an opportunity for innovative interventions for HIV prevention. Some HIV prevention apps currently exist; however, it is challenging to encourage users to download these apps and use them regularly. An iterative research process that centers on the community’s needs and preferences may increase the uptake, adherence, and ultimate effectiveness of mobile apps for HIV prevention. Objective: The aim of this paper is to provide a case study to illustrate how an iterative community approach to a mobile HIV prevention app can lead to changes in app content to appropriately address the needs and the desires of the target community. Methods: In this three-phase study, we conducted focus group discussions (FGDs) with MSM and HIV testing counselors in Atlanta, Seattle, and US rural regions to learn preferences for building a mobile HIV prevention app. We used data from these groups to build a beta version of the app and theater tested it in additional FGDs. A thematic data analysis examined how this approach addressed preferences and concerns expressed by the participants. Results: There was an increased willingness to use the app during theater testing than during the first phase of FGDs. Many concerns that were identified in phase one (eg, disagreements about reminders for HIV testing, concerns about app privacy) were considered in building the beta version. Participants perceived these features as strengths during theater testing. However, some disagreements were still present, especially regarding the tone and language of the app. Conclusions: These findings highlight the benefits of using an interactive and community-driven process to collect data on app preferences when building a mobile HIV prevention app. Through this process, we learned how to be inclusive of the larger MSM population without marginalizing some app users. Though some issues in phase one were able to be addressed, disagreements still occurred in theater testing. If the app is going to address a large and diverse risk group, we cannot include niche functionality that may offend some of the target population. [JMIR Public Health Surveill 2015;1(2):e18]
- Published
- 2015
47. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men
- Author
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Goldenberg, Tamar, McDougal, Sarah J, Sullivan, Patrick S, Stekler, Joanne D, and Stephenson, Rob
- Subjects
HIV prevention ,Applied psychology ,Psychological intervention ,Health Informatics ,Information technology ,Interpersonal communication ,Men who have sex with men ,Intervention (counseling) ,mental disorders ,Medicine ,MSM ,mobile phone app ,mHealth ,Original Paper ,business.industry ,HIV ,virus diseases ,Usability ,T58.5-58.64 ,Focus group ,3. Good health ,Mobile phone ,Public aspects of medicine ,RA1-1270 ,business ,Social psychology - Abstract
BackgroundThe Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. ObjectiveThe purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. MethodsWe conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. ResultsParticipants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men’s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. ConclusionsIn summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app’s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful.
- Published
- 2014
48. Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study.
- Author
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Hussen, Sophia A., Chakraborty, Rana, Knezevic, Andrea, Camacho-Gonzalez, Andres, Huang, Eugene, Stephenson, Rob, and del Rio, Carlos
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YOUNG adults ,PEDIATRICS ,MEDICAL care ,HIV infections ,HOSPITAL care - Abstract
Introduction: The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. Methods: We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Results: Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p = 0.002). Conclusions: Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year in the adult setting. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
49. Intimate partner violence is linked to less HIV testing uptake among high-risk, HIV-negative women in Atlanta.
- Author
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Etudo, Ogechukwu, Metheny, Nicholas, Stephenson, Rob, and Kalokhe, Ameeta S.
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HIV infection risk factors ,HEALTH services accessibility ,SEX crimes ,CROSS-sectional method ,INTIMATE partner violence ,AIDS serodiagnosis - Abstract
Increased risk of HIV acquisition among intimate partner violence (IPV) survivors underscores the need for regular HIV testing, but IPV-associated shame, stigma, and control may hinder uptake. Between March and November 2014, we conducted a cross-sectional study of 79 HIV-negative, high-risk women aged 18–50 in Atlanta, Georgia, to explore whether IPV experience was associated with less uptake of HIV testing, and fewer motivations and more reported barriers to HIV testing uptake. Psychological and physical and/or sexual abuse was significantly associated with less past-year HIV testing (p = .022 andp = .030, respectively), longer time since last HIV test (r = 0.282,p = .012, andr = 0.282,p = .012, respectively), and more reported barriers to HIV testing (r = 0.406,p = .004, andr = 0.389,p = .006). While requiring further validation, these preliminary findings suggest IPV survivors need additional support to access HIV testing services. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
50. Geospatial Indicators of Space and Place: A Review of Multilevel Studies of HIV Prevention and Care Outcomes Among Young Men Who Have Sex With Men in the United States.
- Author
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Bauermeister, José A., Connochie, Daniel, Eaton, Lisa, Demers, Michele, and Stephenson, Rob
- Subjects
POPULATION aging ,HIV ,RACIAL minorities ,MINORITIES ,GEOSPATIAL data - Abstract
Young men who have sex with men (YMSM), particularly YMSM who are racial/ethnic minorities, are disproportionately affected by the human immunodeficiency virus (HIV) epidemic in the United States. These HIV disparities have been linked to demographic, social, and physical geospatial characteristics. The objective of this scoping review was to summarize the existing evidence from multilevel studies examining how geospatial characteristics are associated with HIV prevention and care outcomes among YMSM populations. Our literature search uncovered 126 peer-reviewed articles, of which 17 were eligible for inclusion based on our review criteria. Nine studies examined geospatial characteristics as predictors of HIV prevention outcomes. Nine of the 17 studies reported HIV care outcomes. From the synthesis regarding the current state of research around geospatial correlates of behavioral and biological HIV risk, we propose strategies to move the field forward in order to inform the design of future multilevel research and intervention studies for this population. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
- Full Text
- View/download PDF
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