Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

Abstract

HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n=28,779), approximately 75% reported ever being tested for HIV and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR=1.29; 95%CI=1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR=1.18; 95%CI=0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR=1.55; 95%CI=1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.

Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta‐analysis

“…The flow diagram of study selection is shown in Figure . Fifty‐three studies, composed of 22,603 participants in ART from 25 LAC countries, met eligibility criteria for the systematic review (Table ) . The median number of participants in ART per study was 201 [range: 13 – 3343; interquartile range (IQR): 394 – 125].…”

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America

“…Previous work has shown a substantial burden of psychiatric morbidity among HIV-infected individuals in Latin America (Aguilar-Gaxiola et al, 2006 ; Kamat et al, 2013 ), as well as a syndemic of psychosocial problems and sexual risk behavior in this population (Mimiaga et al, 2015a ). If individuals with comorbid psychiatric disorders are both more likely to engage in sexual risk-taking behavior and less likely to be taking or adherent to ART, they may represent a group that is at particularly high risk of onward transmission (Magidson et al, 2015 ), further indicating that interventions to address psychiatric and substance use may be particularly important strategies for HIV prevention in Latin America.…”

“…Respondents completed an anonymous survey to characterize sexual health, including sexual practices, substance use, and relevant psychological concerns. The measures used for this analysis are described below and have been described in detail elsewhere (Biello et al, 2014 ; Magidson et al, 2015 ; Mimiaga et al, 2015a ).…”

Investigating Sociodemographic Factors and HIV Risk Behaviors Associated With Social Networking Among Adolescents in Soweto, South Africa: A Cross-Sectional Survey

“…Studies (Yonker et al, 2015) have also shown that using social networking among adolescents and young adults concerning their health choices has proven to be an essential medium of communication [ 34 ]. Magidson et al (2015) demonstrated the effective use of social networking to engage HIV positive adult men who have sex with men in care [ 35 ]. In sub-Saharan Africa, published literature on social networking among adolescent samples is limited.…”