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Associations Among Neighborhood Characteristics and Sexual Risk Behavior Among Black and White MSM Living in a Major Urban Area. - AIDS and behavior
Identifying neighborhood characteristics associated with sexual HIV risk behavior among gay, bisexual and other men who have sex with men (MSM) living in urban areas may inform the development of policies and programs to reduce risk and subsequently HIV prevalence in urban areas. New York City M2M was a cross-sectional study designed to identify neighborhood-level characteristics associated with sexual risk behaviors among MSM living in New York City. This paper presents results of an analysis of neighborhood-level indicators of three distinct social theories of influence of the neighborhood environment on human behavior: physical disorder, social disorganization and social norms theories. Using multilevel modeling on a sample of 766 MSM stratified by race/ethnicity, we found little support for the role of social disorganization on the sexual risk behavior of MSM, whereas different indicators of physical disorder exerted negative effects across race groups. Our results suggest that the beneficial effects of housing stock maintenance and general neighborhood physical orderliness and cleanliness may have positive effects beyond those traditionally studied for African American MSM and that the field needs novel theorizing regarding whether and how neighborhood or virtual community-level factors relate to sexual behavior among MSM.
Long-acting rilpivirine as potential pre-exposure prophylaxis for HIV-1 prevention (the MWRI-01 study): an open-label, phase 1, compartmental, pharmacokinetic and pharmacodynamic assessment. - The lancet. HIV
Long-acting injectable antiretroviral agents are being developed for HIV-1 prevention. The MWRI-01 study was done to characterise the safety, acceptability, and pharmacokinetic and pharmacodynamic profile of long-acting rilpivirine.We did a phase 1 open-label study at the University of Pittsburgh. We enrolled healthy individuals (aged 18-45 years) who were seronegative for HIV-1. Participants were assigned alternately one intramuscular dose of either 1200 mg or 600 mg long-acting rilpivirine, beginning with the 1200 mg dose. We obtained plasma specimens, genital and rectal fluids, and tissue samples (rectal, cervical, and vaginal) before and after exposure to long-acting rilpivirine for assessment of pharmacokinetics and ex-vivo biopsy challenge with HIV-1. Our primary objective was to characterise product safety, and the analysis included all enrolled participants. This trial is registered with ClinicalTrials.gov, number NCT01656018.36 participants were enrolled into the study, of whom 24 were women and 12 men. 12 women and six men received each dose. 204 adverse events were reported among the 36 participants, of which 200 (98%) were grade 1-2. The most common adverse event was injection site reaction. All grade 3 and 4 adverse events were deemed not related to rilpivirine. Geometric mean (90% CI) concentrations in plasma of rilpivirine at day 28 post dose were 53 ng/mL (38-67) in women and 43 ng/mL (23-63) in men for the 1200 mg dose and 28 ng/mL (19-37) in women and 17 ng/mL (9-24) in men for the 600 mg dose. The tissue-to-plasma ratio for rilpivirine in rectal tissue was about two-fold higher than in vaginal and cervical tissue (1Â·10-1Â·53 vs 0Â·61-0Â·72 and 0Â·50-0Â·71, respectively). Exposure to long-acting rilpivirine suppressed viral replication significantly in rectal tissue (p<0Â·0001), and this suppression persisted for up to 4 months. By contrast, no viral suppression was seen in cervical or vaginal tissue.Ongoing research will characterise longer term safety and acceptability of multiple injections and help ascertain whether long-acting rilpivirine should advance to assessment of efficacy in preventing HIV-1 infection.Bill & Melinda Gates Foundation.Copyright Ã‚Â© 2016 Elsevier Ltd. All rights reserved.
Congruence of Home, Social and Sex Neighborhoods among Men Who Have Sex with Men, NYCM2M Study. - Journal of urban health : bulletin of the New York Academy of Medicine
Substantial literature demonstrates the influence of the neighborhood environment on health behaviors and outcomes. But limited research examines on how gay and bisexual men experience and exist in various geographic and virtual spaces and how this relates to their sexual behavior. New York City Men 2 Men (NYCM2M) was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use, and depression among men who have sex with men (MSM) living in NYC. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. Whether key neighborhoods of human activity, where a participant resided (termed home), socialized (termed social), or had sex most often (termed sex), were the same or different was evaluated. "Congruence" (or the sameness) of home, social, and most often sex neighborhood was reported by 17Â % of men, while 30Â % reported that none of their neighborhoods were the same. The largest group of men (39Â %) reported that their home and sex neighborhoods were the same but their social neighborhood was different while 10Â % reported that their home neighborhood was different than their social and sex neighborhood; 5Â % men reported same home and social neighborhoods with a different sex neighborhood. Complete neighborhood incongruence was highest among men who were Black and/or Latino, had lower education and personal income levels, and had greater financial insecurity. In adjusted analysis, serodiscordant condomless anal intercourse and condomless anal intercourse with partners from the Internet or mobile applications were significantly associated with having the same social and sex (but not home) neighborhoods. Understanding the complexity of how different spaces and places relate to the health and sexual behavior of MSM is essential for focusing interventions to best reach various populations of interest.
Psychosocial and Behavioral Characteristics of High-Risk Men Who Have Sex with Men (MSM) of Unknown HIV Positive Serostatus in Bangkok, Thailand. - AIDS and behavior
HIV prevalence remains high in men who have sex with men (MSM) in Bangkok. Even though resources for HIV testing and treatment are available for all, a large proportion of MSM still do not get HIV tested. We studied high risk MSM who are unaware of their HIV status to help maximize effectiveness of our resources. Convenience sampling was conducted among MSM who came for HIV testing at the Thai Red Cross Anonymous Clinic and two popular drop-in centers in Bangkok. Inclusion criteria were MSM aged >18Â years, have not been tested positive for HIV, who reported â‰¥1 of the following in the previous 6Â months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection diagnosis. Audio-Computer-Assisted Self-Interview was used to assess psychosocial profile, sexual risks, and HIV testing patterns prior to being informed of their HIV positive status. Among 499 high-risk MSM enrolled, theÂ median age was 24.8Â years and 112 (22Â %) tested HIV-positive. Among the HIV-positive participants, 92Â % self-identified as gay (versus bisexual), 39Â % attained a bachelors degree or higher, 65Â % had monthly income 10,000-29,999 baht ($280-830 USD), 10Â % had vaginal or anal sex with a woman in the past 12Â months, 39Â % had condomless receptive sex with men and 21Â % went to Lat Phrao to find a sexual partner. Compared to HIV negative MSM, HIV-positive MSM had less HIV testing: 31Â % had ever been tested for HIV, 12Â % had been tested in the past 6Â months; but were more likely to guess correctly their positive status (31Â %). Regarding psychosocial variables among HIV-positive MSM, 7Â % had regular methamphetamine use in the past 3Â months, 10Â % had >2 sources of discrimination, and 8Â % had >2 sources of discrimination due to being MSM. In multivariable model, age<30Â year old, self-identified as gay, had monthly income <50,000 baht ($1400 USD), had anal sex with men in past 12Â months, had >2 sources of discrimination because of being MSM, did not get HIV test in past 6Â months, and guess of positive HIV were significantly associated with HIV positive status. Young MSM with lower socioeconomic status (SES) should be prioritized for innovative approaches to promoting awareness and uptake of HIV testing. Societal stigmatization of MSM should be addressed as a potential barrier to uptake of voluntary HIV testing. Resilience factors among these marginalized MSM who still test frequently and remain HIV-negative despite residing in a context with community viral loads and discrimination should also be studied in order to curb the HIV epidemic in Bangkok.
Psycho-social Correlates of Condom Use and HIV Testing among MSM Refugees in Beirut, Lebanon. - AIDS and behavior
MSM refugees have to deal with personal challenges and social/structural adversaries based on their refugee status on top of their sexual identity. To better customize interventions beside this population, we explored psycho-social and structural correlates of condom use and HIV testing in Lebanon by surveying and testing 150 participants. 67Â % self-identified as gay. 84.6Â % reported any unprotected anal intercourse (UAI) with men in the prior 3Â months. Those who engaged in UAI, were lest comfortable with a doctor, didn't know where to get free HIV testing, experienced discrimination based on their refugee status and spent more time with their refugee peers, were less inclined to have seen a doctor in the past 12Â month or knew where to get free HIV testing. Ever having been HIV tested was associated with being comfortable with medical doctors, knowing where to get HIV testing and spending time with other peer refugees. HIV prevention and testing promotion efforts targeting MSM refugees need to account for structural barriers, while fighting discrimination is crucial for a healthy sexual identity development.
HIV Prevalence and Demographic Determinants of Unprotected Anal Sex and HIV Testing among Male Refugees Who have Sex with Men in Beirut, Lebanon. - AIDS and behavior
Men who have sex with men (MSM), the same as refugees are at higher risk for health issues including HIV infection. With the large influx of refugees to Lebanon, and to better understand HIV transmission in this setting, we explored the socio-demographic correlates of condom use and HIV testing among MSM refugees in Beirut, by surveying and testing 150 participants. 67Â % self-identified as gay, 84.6Â % of respondents reported unprotected anal intercourse (UAI) in the prior 3Â months, and 56.7Â % with men of positive or unknown HIV status (UAIPU). 2.7Â % tested positive for HIV, and 36Â % reported having engaged in sex work. Men in a relationship and men who self-identified as gay had higher odds of UAI, of ever been tested, but lower odds of UAIPU. HIV prevention and testing promotion efforts targeting MSM refugees need to account for how men self-identify in relation to their sexual behavior and relationship status. Such efforts also should place emphasis on MSM of lower socio-economic status.
Differences Between Men Who Have Sex with Men (MSM) with Low CD4 Cell Counts at Their First HIV Test and MSM with Higher CD4 Counts in Bangkok, Thailand. - AIDS and behavior
Although HIV prevalence remains high among Bangkok's MSM early HIV testing as an entry point to ART has not been successfully implemented among in this population. Men who present late for initial HIV testing are a particular concern in the context of the Bangkok HIV epidemic, in that if long-term positives have had condomless sex during the time that they remained untreated they are likely to have been efficient transmitters of infection, to say nothing of the implications for their own health. A sequential sample of MSM who tested HIV positive, and CD4 counts, was taken at the Thai Red Cross Anonymous Clinic and two drop-in centers in Bangkok. Inclusion criteria were MSM agedÂ >18Â years, having not tested HIV positive earlier, who reportedÂ â‰¥1 of the following in the previous 6Â months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection (STI) diagnosis. Analysis was conducted by distinguishing between three groups of CD4 counts:Â <200, 200-500,Â >500 cells/Î¼ to identify the social and behavioral characteristics of the men who presented late for HIV testing. Median CD4 was 325 cells/Î¼(nÂ =Â 95). MSM with initial CD4<Â 200 cells/Î¼ were significantly more likely to report problematic alcohol use. They were also more likely to report receptive anal sex and more likely to be engaged in sex work. MSM with CD4<Â 200 cells/Î¼ were less likely to report recent HIV testing. Main barriers to HIV testing included being afraid of finding out that they were HIV positive and concerns about efficacy and side effects of HIV treatment.Â HIV stigma and concerns about treatment are still widespread and are potential barriers to HIV care among MSM in Bangkok. These barriers may work to keep men from finding out their positive HIV status in a timely manner. Thai MSM need to be made aware of the current availability of friendly HIV testing and ART services, and public health programs need to work to change their perceptions regarding ART itself. These same types of strategies might also work to destigmatize HIV and MSM within Thai society as a whole.
Overview of the University of Pittsburgh/amfAR Training Program in HIV Prevention Research for MSM and Male-to-Female Transgender Populations in Low- and Middle-Income Countries. - AIDS and behavior
Gay men, other men who have sex with men and transgender (GMT) populations suffer a disproportionate burden of HIV disease around the globe, which is directly attributable to the virulently homophobic environments in which many GMT people live. In addition to the direct effects of homophobia on GMT individuals, the ongoing marginalization of GMT people has meant that there is limited social capital on which effective HIV prevention and care programs can be built in many low- and middle-income countries (LMIC). Thus, meaningful responses meant to address the dire situation of GMT populations in LMIC settings must include a combination of bold and innovative approaches if efforts to end the epidemic are to have any chance of making a real difference. The HIV Scholars Program at the University of Pittsburgh's Center for LGBT Health Research is a prime example of a creative and dynamic approach to raising the expertise needed within GMT populations to respond to the global HIV/AIDS pandemic.
Immunostimulatory Activity of the Cytokine-Based Biologic, IRX-2, on Human Papillomavirus-Exposed Langerhans Cells. - Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research
Langerhans cells (LCs) are the antigen-presenting cells of the epithelial layer and are responsible for initiating immune responses against skin and mucosa-invading viruses. Human papillomavirus (HPV)-mediated suppression of LC function is a crucial mechanism of HPV immune evasion, which can lead to persistent infection and development of several human cancers, including cervical, anal, and head and neck cancers. The cell-derived cytokine-based biologic, IRX-2, consists of multiple well-defined cytokines and is broadly active on various immune cell subsets. In this study, we investigated primary human LC activation after exposure to HPV16, followed by treatment with IRX-2 in vitro, and evaluated their subsequent ability to induce HPV16-specific T cells. In contrast to its activity on dendritic cells, HPV16 alone is not sufficient to induce phenotypic and functional activation of LCs. However, IRX-2 induces a significant upregulation of antigen presentation and costimulatory molecules, T helper 1 (Th1)-associated cytokine release, and chemokine-directed migration of LCs pre-exposed to HPV16. Furthermore, LCs treated with IRX-2 after HPV16 exposure induced CD8(+) T-cell responses against specific HLA-A*0201-binding HPV16 T-cell epitopes. The present study suggests that IRX-2 is an attractive immunomodulator for assisting the immune response in eradication of HPV-infected cells, thereby potentially preventing HPV-induced cancers.
Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). - AIDS and behavior
The current analysis evaluates interest in and acceptability of daily PrEP during short episodes of anticipated increased risk (i.e. Epi-PrEP). In 2013, U.S. members of an internet-based MSM sexual networking site were invited to complete a survey about HIV prevention practices in the context of vacationing. 7305 MSM responded to the survey. Of respondents who had vacationed in the past year, 25.6Â % reported condomless anal sex (CAS) with new male sex partners while vacationing. Most (92.6Â %) respondents agreed that having to use PrEP every day was a barrier to PrEP use and 74.3Â % indicated they would take PrEP if they knew it would be helpful for short periods of anticipated increased risk. MSM who reported increased CAS while on vacation in the past year were more likely to indicate that they would take PrEP if it were helpful when used for short periods than respondents who did not (aORÂ =Â 2.02, 95Â % CI 1.59-2.56, pÂ <Â 0.001). Studies designed to evaluate uptake, adherence, and protective benefit of short PrEP courses are warranted.
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