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Kit meets Covington
When Kit Bridges moves to England to attend an elite equestrian boarding school, she struggles with grief from her mother's death and her fear of riding after a bad fall.
Book
HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States
Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: “there is a cure for HIV, but the government is withholding it from the poor” was independently associated with higher PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.
Journal Article
My flawless life
\"At the most elite private school in Washington, DC., whenever anyone has a problem that they need to go away, they hire Hana Yang Lerner. Hana is a fixer. She knows who to call, what to say, and how to make sure secrets stay where they belong--buried. She can fix anything. Except her own life, which was destroyed when her father, senator Skip Lerner, was arrested for an accident that left one woman nearly dead. Now Hana's reputation is ruined and her friends are gone. So when she gets a job from an anonymous client called 'Three' to follow her former best friend, Luce Herrera, Hana realizes this might be her way of getting back her old life. But the dangerous thing about digging is that you never know what you'll unearth. As Hana uncovers a dark truth about her supposedly flawless classmates, she's forced to face a secret of her own\"-- Provided by publisher.
Book
Transgender Women’s Concerns and Preferences on Potential Future Long-Acting Biomedical HIV Prevention Strategies: The Case of Injections and Implanted Medication Delivery Devices (IMDDs)
There are several long-acting biomedical HIV prevention products in the development pipeline, including injections and implanted medication delivery devices (IMDDs). It is critical to understand concerns and preferences on the use of these products in populations that shoulder a disproportionate burden of the HIV epidemic, such as transgender women. This will allow researchers and public health professionals to construct interventions tailored to the needs of these women to promote optimal use of these tools. In studies of other biomedical HIV prevention products (e.g., oral PrEP) it is clear that transgender women have unique concerns related to the use of these strategies. This may have an impact on this group’s uptake and sustained use of longacting HIV prevention products. This study conducted four focus groups with N = 18 transgender women in New York City to understand their concerns and preferences on long-acting PrEP injections and IMDDs. Findings showed that participants were overwhelmingly positive about long-acting HIV prevention strategies, though they had some apprehensions. Overall, participants felt that injections and IMDDs could help address adherence challenges, and that transgender-specific needs should be addressed during clinical trials. Also, there were concerns related to injection or IMDD logistics, concerns about injections’ or IMDDs’ presence in the body, and familiarity with these products affected participants’ opinions on them. Findings from this work can be used to inform protocols, measures, materials, and adherence interventions in future initiatives for transgender women using PrEP injections or IMDDs.
Journal Article
Promise boys
J.B., Ramón, and Trey, students of the Urban Promise Prep School, must follow the school's strict rules, but when their principal is murdered, the three boys must band together to track down the real killer before they are arrested.
Book
HIV prevention: better choice for better coverage
Introduction Antiretroviral‐based pre‐exposure prophylaxis (PrEP) is today an established, effective and safe method of HIV prevention used in multiple countries worldwide by a broad range of populations at risk of HIV infection. Biomedical innovations are critical in supporting the primary prevention of HIV; however, their potential can only be maximized if end‐user challenges are recognized, described and used to develop next‐generation models. Discussion First‐generation PrEP, a daily oral pill, is highly efficacious, discreet and affords users the ability to commence and conclude treatment rapidly. However, consistent daily adherence and persistence is challenging, especially among younger populations, due in part to side effects, the risk of stock‐outs and a lack of pill storage options. Second‐generation PrEP, longer acting agents that require less frequent dosing, could overcome such challenges. Agents that have shown efficacy in clinical trials include a monthly vaginal ring and PrEP injectables to be administered every 8 weeks, while products in development include 6 monthly injectables, oral therapy that uses monthly rather than daily pills, implants and the potential for long‐acting passive immunization. Conclusions Second‐generation PrEP agents will have the potential to offer improved adherence and less frequent reminders once they have undergone further development and the delivery systems that will best support them have been established. In order to pursue global UNAIDS targets of reducing new HIV infections to fewer than 500,000 annually by 2025, and to ensure that all people have access to prevention options that meet their specific prevention needs, both early and next‐generation PrEP options are needed.
Journal Article
Prospective study of oral pre‐exposure prophylaxis initiation and adherence among young women in KwaZulu‐Natal, South Africa
Introduction Oral tenofovir disoproxil fumarate/emtricitabine pre‐exposure prophylaxis (PrEP), introduced into South Africa (SA) in 2016, has increasingly become part of HIV prevention standard of care. Given the urgent need for increased HIV prevention efforts for young women in SA, we conducted an implementation study to explore oral PrEP initiation and adherence, and the impact of oral PrEP on HIV incidence in this group. Methods This prospective cohort study (CAPRISA 082) was conducted at two sites (urban and rural) in KwaZulu‐Natal, between March 2016 and February 2018. HIV‐negative, sexually active women, aged 18–30 years, were enrolled and followed for approximately 10 months. Oral PrEP was offered as part of a comprehensive HIV prevention package. Adherence to oral PrEP was measured using pill counts and tenofovir‐diphosphate (TFV‐DP) levels. Characteristics of oral PrEP initiators versus non‐initiators were compared using risk ratios. HIV incidence rates were measured using Poisson regression. Results Of 425 women enrolled, 262 (62%) initiated oral PrEP. Uptake was significantly higher at the rural site compared to the urban site (78% [n = 203/259] vs. 36% [n = 59/166], respectively, p‐value<0.001). Approximately 25% and 50% had stopped using oral PrEP by 3 and 12 months post‐initiation, respectively. Median pill count adherence was 90% (interquartile range: 81–97%); however, TFV‐DP was only detected in 13% of samples tested, that is 56/431 samples from 97 (37%) participants who initiated oral PrEP. In total, 11 women seroconverted yielding an HIV incidence rate of 2.81 per 100 person‐years (95% confidence interval: 1.40–5.03). Nine of 11 seroconverters had initiated oral PrEP; however, all showed drug levels equivalent to taking one to zero tablets per week. Among women who initiated oral PrEP, >50% had discontinued using oral PrEP by study end, with side effects, such as diarrhoea, nausea, headaches and rash, being the most frequent reason for discontinuation. Conclusions Despite moderate oral PrEP initiation and high pill count adherence, adherence as measured by TFV‐DP levels was low and early discontinuation was high. The overall HIV incidence rate was high underscoring the critical need to address barriers to oral PrEP initiation, adherence and continued use, as well as expanding HIV prevention options for young women.
Journal Article
Successful Integration of HIV PrEP in Primary Care and Women’s Health Clinical Practice: A Model for Implementation
Ending the HIV Epidemic is contingent upon the increased utilization of pre-exposure prophylaxis (PrEP). The majority of PrEP in the United States is prescribed in specialty care settings; however, to achieve national implementation goals, it is necessary to expand PrEP services in primary care and women’s health clinics. To this end, a prospective cohort study was conducted of health care providers participating in one of three rounds of a virtual program aimed at increasing the number of PrEP prescribers in primary care and women’s health clinics within the NYC Health and Hospitals network, the public healthcare system of New York City. Provider prescribing behavior was compared at pre-intervention (August 2018–September 2019) and post-intervention (October 2019–February 2021). Among 104 providers, the number prescribing PrEP increased from 12 (11.5%) to 51 (49%) and the number of individual patients on PrEP increased from 19 to 128. The program utilized clinical integration models centering on existing STI management workflows and was associated with increased numbers of PrEP prescribers and volume of prescriptions in primary care and women’s health clinics. The dissemination of similar programs could support national scale-up of PrEP.
Journal Article
Pre-exposure prophylaxis use and discontinuation among Brazilian gay, bisexual, and other men who have sex with men: examining the role of internalized homonegativity and discrimination
Background
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy yet use and persistence among populations at high vulnerability to HIV in Brazil remains suboptimal. We sought to quantify internalized homonegativity and discrimination using multi-item validated instruments and to estimate their associations with PrEP use and discontinuation among gay, bisexual, and other men who have sex with men (MSM).
Methods
A cross-sectional, web-based survey was conducted from November 2021 to January 2022, recruiting a convenience sample of MSM through dating apps and social media. The survey assessed sociodemographic characteristics, sexual behavior, substance use, HIV transmission knowledge (using the HIV Knowledge Assessment tool), internalized homonegativity (using the Reactions to Homosexuality Scale), and experiences of discrimination (using the Explicit Discrimination Scale). PrEP use was assessed with response options “I have never used PrEP” (henceforth “never used”), “I am currently using PrEP” (henceforth “current use”), and “I used PrEP in the past but stopped” (henceforth “discontinuation”). Unadjusted and adjusted associations between internalized homonegativity and discrimination and the outcomes a) “current use” of PrEP compared to “never use”, and b) “discontinuation” compared to “current use”, were estimated using logistic regression models.
Results
The analytic sample consisted of 2,840 participants, with PrEP use patterns distributed as follows: 71.3% had never used PrEP, 22.8% were current users, and 5.9% had discontinued use. Unadjusted analyses indicated negative associations between internalized homonegativity and discrimination scores with current PrEP use (with higher scores leading to decreased odds of “current use”), and positive associations with PrEP discontinuation (higher scores leading to increased odds of “discontinuation”). After adjusting for potential confounders, higher internalized homonegativity was associated with decreased odds of “current use” (adjusted odds ratio [aOR] = 0.88, 95% confidence interval [CI] = 0.78–0.99) per 1 standard deviation [SD] increase in score) and more experiences of discrimination was associated with increased odds of “discontinuation” (aOR = 1.24, 95% CI: 1.03–1.50 per 1 SD increase in score).
Discussion
Our findings support the hypothesis that psychological distress from self-stigmatization and discrimination undermines PrEP use and persistence. Public health strategies need to integrate stigma-reduction and culturally competent, LGBTQIAPN+-affirming services to support PrEP as an effective prevention strategy.
Journal Article
Interest in Switching to On-Demand HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Users of Daily PrEP: An Online Survey
We surveyed 970 PrEPX study participants to evaluate interest in switching from daily to on-demand PrEP in a study setting. Interested respondents (n = 469, 48%) more commonly reported PrEP cessation (adjusted odds ratio [aOR], 3.0; P < .001), difficulty with adherence (aOR, 1.6; P = .029), infrequent sex (aOR, 3.7; P < .001), and toxicity concerns (aOR, 2.7; P < .001).
Journal Article