Perspectives of the COVID-19 pandemic and vaccination among racially and ethnically diverse gay, bisexual, and other men who have sex with men with and without HIV in the US South: findings from qualitative individual in-depth interviews.

The impact of COVID-19 on specific populations, including gay, bisexual, and other men who have sex with men (GBMSM), varies based on a range of factors such as access to health care, underlying health behaviors and conditions, and social determinants of health. Our community-based participatory research partnership sought to better understand perspectives about and experiences with the COVID-19 pandemic, COVID-19 vaccination, and related health care among GBMSM. We collected, analyzed, and interpreted qualitative in-depth interview data from a diverse sample of GBMSM (N = 30) in North Carolina, USA. Using purposive sampling, we recruited native English (n = 15) and Spanish (n = 15) speakers and persons with HIV (n = 13) and persons without HIV (n = 17). We analyzed interview data using constant comparison, an approach to grounded theory. Participant mean was 33.4 (SD = 8.5) years. Sixteen themes emerged that were categorized into five domains: trust/mistrust of politicians, healthcare professionals, and the US government (n = 4 themes); engagement in COVID-19 prevention strategies (n = 2 themes); attitudes towards COVID-19 vaccination (n = 3 themes); access to and use of health care (n = 4 themes); and impact of COVID-19 on social determinants of health and mental health (n = 3 themes). This research increases our understanding of the COVID-19 pandemic among particularly minoritized and underserved communities: racially and ethnically diverse, English- and Spanish-speaking GBMSM with and without HIV in the US South. By addressing the unique needs and concerns of these communities, we can promote more equitable public health responses; enhance preventive healthcare delivery; improve preparedness for subsequent outbreaks (e.g., mpox), epidemics, and pandemics; and be better equipped to support delivery and uptake of potential future preventive HIV vaccines among communities impacted by health disparities.

Waldman JS ，Alonzo J ，Mann-Jackson L ，Aguilar-Palma SK ，Garcia M ，Smart BD ，Rhodes SD ... -  《BMC INFECTIOUS DISEASES》

Suspected Mpox Symptoms and Testing in Men Who Have Sex With Men in the United States: Cross-Sectional Study.

The 2022 mpox outbreak in the United States disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Uptake of mpox testing may be related to symptomology, sociodemographic characteristics, and behavioral characteristics. This study aimed to describe suspected mpox symptoms and testing uptake among a sample of GBMSM recruited via the internet in the United States in August 2022. We conducted a rapid internet-based mpox survey from August 5 to 15, 2022, among cisgender men 15 years and older who had previously participated in the 2021 American Men's Internet Survey. We estimated the prevalence of suspected mpox symptoms (fever or rash or sores with unknown cause in the last 3 mo) and uptake of mpox testing. We calculated adjusted prevalence ratios (aPRs) and 95% CIs for associations between participant characteristics and suspected mpox symptoms and summarized characteristics of GBMSM reporting mpox testing. Among symptomatic GBMSM who did not receive mpox testing, we described testing self-efficacy, barriers, and facilitators. Of 824 GBMSM, 126 (15.3%) reported at least 1 mpox symptom in the last 3 months; 58/126 (46%) with rash or sores, 57 (45.2%) with fever, and 11 (8.7%) with both. Increased prevalence of suspected mpox symptoms was associated with condomless anal sex (CAS; aPR 1.53, 95% CI 1.06-2.20). Mpox testing was reported by 9/824 GBMSM (1%), including 5 with symptoms. Most GBMSM reporting mpox testing were non-Hispanic White men (7/9 vs 1 Black and 1 Hispanic or Latino man), and all 9 lived in urban areas. Most reported having an sexually transmitted infections test (8/9), 2 or more partners (8/9), CAS (7/9), and group sex (6/9) in the last 3 months. Of those tested, 3 reported living with HIV and all were on treatment, whereas the remaining 6 men without HIV reported current pre-exposure prophylaxis (PrEP) use. Of symptomatic GBMSM who did not report mpox testing, 47/105 (44.8%) had low mpox testing self-efficacy. Among those with low self-efficacy, the most common barriers to testing were not knowing where to get tested (40/47, 85.1%) and difficulty getting appointments (23/47, 48.9%). Among those with high testing self-efficacy (58/105, 55.2%), the most common facilitators to testing were knowing where to test (52/58, 89.7%), convenient site hours (40/58, 69%), and low-cost testing (38/58, 65.5%). While all GBMSM who reported testing for mpox were linked to HIV treatment or PrEP, those with symptoms but no mpox testing reported fewer such links. This suggests targeted outreach is needed to reduce structural barriers to mpox services among GBMSM in rural areas, Black and Hispanic or Latino GBMSM, and GBMSM living with HIV. Sustaining and scaling community-tailored messaging to promote testing and vaccination represent critical interventions for mpox control among GBMSM in the United States.

Atkins K ，Carpino T ，Rao A ，Sanchez T ，Edwards OW ，Hannah M ，Sullivan PS ，Ogale YP ，Abara WE ，Delaney KP ，Baral SD ... -  《JMIR Public Health and Surveillance》

Recruitment of Young Gay, Bisexual, and Other Men Who Have Sex With Men for a Web-Based Human Papillomavirus Vaccination Intervention: Differences in Participant Characteristics and Study Engagement by Recruitment Source in a Randomized Controlled Trial.

Young gay, bisexual, and other men who have sex with men have been referred to as a "hard-to-reach" or "hidden" community in terms of recruiting for research studies. With widespread internet use among this group and young adults in general, web-based avenues represent an important approach for reaching and recruiting members of this community. However, little is known about how participants recruited from various web-based sources may differ from one another. This study aimed to determine how young gay, bisexual, and other men who have sex with men recruited from various web-based sources differ from one another in terms of participant characteristics and study engagement. Data were collected as part of a randomized controlled trial of Outsmart HPV, a web-based human papillomavirus (HPV) vaccination intervention for young gay, bisexual, and other men who have sex with men. From 2019 to 2021, we recruited young gay, bisexual, and other men who have sex with men in the United States who were aged 18-25 years and not vaccinated against HPV (n=1227) through various web-based avenues. We classified each participant as being recruited from either (1) social media (eg, Facebook, Instagram, Snapchat), (2) a dating app (eg, Grindr, Scruff), or (3) some other digital recruitment source (eg, existing research panel, university-based organization). Analyses compared participants from these 3 groups on demographic and health-related characteristics and metrics involving study engagement. Most demographic and health-related characteristics differed by web-based recruitment source, including race or ethnicity (P<.001), relationship status (P<.001), education level (P<.001), employment status (P<.001), sexual self-identity (P<.001), health insurance status (P<.001), disclosure of sexual orientation (P=.048), and connectedness to the LGBTQ (lesbian, gay, bisexual, transgender, queer) community (P<.001) The type of device used by participants during study enrollment also differed across groups, with smartphone use higher among participants recruited via dating apps (n=660, 96.6%) compared to those recruited via social media (n=318, 78.9%) or other digital sources (n=85, 60.3%; P<.001). Participants recruited via social media were more likely than those recruited via dating apps to complete follow-up surveys at 3 different timepoints (odds ratios 1.52-2.09, P=.001-.008). These participants also spent a longer amount of time viewing intervention content about HPV vaccination (3.14 minutes vs 2.67 minutes; P=.02). We were able to recruit a large national sample of young gay, bisexual, and other men who have sex with men for a web-based HPV vaccination intervention via multiple methodologies. Participants differed on a range of demographic and health-related characteristics, as well as metrics related to study engagement, based on whether they were recruited from social media, a dating app, or some other digital recruitment source. Findings highlight key issues and considerations that can help researchers better plan and customize future web-based recruitment efforts of young gay, bisexual, and other men who have sex with men. ClinicalTrials.gov NCT04032106; https://clinicaltrials.gov/study/NCT04032106. RR2-10.2196/16294.

Marshall DJ ，Gower AL ，Katz ML ，Bauermeister JA ，Shoben AB ，Reiter PL ... -  《JOURNAL OF MEDICAL INTERNET RESEARCH》

Stigmas experienced by sexual and gender minority people with HIV in the Dominican Republic: a qualitative study.

As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings. We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics. Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software. On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide. Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.

Budhwani H ，Ruiz De León I ，Waters J ，Nash P ，Bond CL ，Varas-Díaz N ，Naar S ，Nyblade L ，Paulino-Ramírez R ，Turan JM ... -  《-》

The effect of combination prevention strategies on HIV incidence among gay and bisexual men who have sex with men in the UK: a model-based analysis.

In the UK, the number of new HIV diagnoses among gay and bisexual men who have sex with men (GBMSM) has decreased substantially. We aimed to understand the contribution of different interventions in reducing HIV incidence so far; to estimate future HIV incidence with continuation of current policies and with further scaling up of current interventions; and to estimate the maximum additional annual cost that should be spent towards these interventions for them to offer value for money. We calibrated a dynamic, individual-based, stochastic simulation model, the HIV Synthesis Model, to multiple sources of data on HIV among GBMSM aged 15 years or older in the UK. Primarily these were routine HIV surveillance data collected by the UK Health Security Agency. We compared HIV incidence in 2022 with the counterfactual incidence: if HIV testing rates stopped increasing in 2012 and the policy of antiretroviral therapy (ART) at diagnosis was not introduced in mid-2015; if pre-exposure prophylaxis (PrEP) was not introduced; if condom use was low from 2012 in all GBMSM, at levels similar to those observed in 1980; and in the first and second scenario combined. We also projected future outcomes under the assumption of continuation of current policies and considering increases in PrEP and HIV testing uptake and a decrease in condomless sex. Our model estimated a 77% (90% uncertainty interval [UI] 61-88) decline in HIV incidence since around 2014, with an estimated 597 infections ([90% UI 312-956]; 1·1 per 1000 person-years [90% UI 0·6-1·8]) in men aged 15-64 years in 2022. Both PrEP introduction and increased HIV testing with ART initiation at diagnosis each had a substantial effect on HIV incidence. Without PrEP introduction, we estimate there would have been 2·16 times the number of infections that actually occurred (90% UI 1·06-3·75) between 2012 and 2022; without increased HIV testing and ART initiation at diagnosis there would have been 2·18 times the number of infections that actually occurred (1·18-3·60), and if condomless sex was at the levels before the HIV epidemic, there would have been 2·27 times the number of infections that actually occurred (0·9-5·4). If rates of testing, ART use, and PrEP use remain as they are currently, there is a predicted decline in incidence to 388 HIV infections in 2025 (90% UI 226-650) and to 263 (137-433) in 2030. Increases in HIV testing and PrEP use were predicted to accelerate the decline in HIV incidence. Given the quality-adjusted life-year (QALY) benefit and a cost-effectiveness threshold of £30 000 per QALY gained, in order to be cost-effective an additional £1·62 million could be spent per year to increase testing levels by 34% (90% UI 25-46) and PrEP use by 55% (10-107). To achieve that, a 16% reduction in the cost of delivery of testing and PrEP would be required. Combination prevention, including a PrEP strategy, played a major role in the reduction in HIV incidence observed so far in the UK among GBMSM. Continuation of current activities should lead to a continued decline; however, it is unlikely to lead to reaching the target of fewer than 50 HIV infections per year among GBMSM by 2030. It will be important to reduce costs for testing and PrEP for their continued expansion to be cost-effective. National Institute for Health Research under its Programme Grants for Applied Research Programme and Medical Research Council-UK Research and Innovation.

Cambiano V ，Miners A ，Lampe FC ，McCormack S ，Gill ON ，Hart G ，Fenton KA ，Cairns G ，Thompson M ，Delpech V ，Rodger AJ ，Phillips AN ... -  《Lancet HIV》