Influence of Stigma on Pre-Exposure Prophylaxis (PrEP) Care Continuum Among Men and Transwomen Who Have Sex with Men (MTWSM) in the United States

Ssenyonjo, Jude; Shrestha, Roman; Copenhaver, Michael

doi:10.11648/j.ijhpebs.20190502.18

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…In minoritized communities (i.e., Black/Latino SMM and trans women), PrEP-related stigma has been associated with other types of stigma and HIV prevention behaviors (Ssenyonjo et al, 2019; Turan et al, 2019; Wohl et al, 2013). For Latino SMM, there is an intrinsic connection between believing that PrEP is only suited for those who engage in high-risk sexual behaviors (colloquially known as “PrEP whores”) and the assessment that one would benefit from PrEP (Brooks, Landrian, et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

The use of a Spanish-translated PrEP Stigma Scale among the Latino sample of the UNITE cohort study.

Robles¹,

López-Matos²,

Cienfuegos-Szalay³

et al. 2024

Stigma and Health

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Preexposure prophylaxis (PrEP)-related stigma is linked to inadequate PrEP uptake, yet there are no validated scales to test this association among Spanish-speaking Latino sexual minority men (SMM). The present study examined if the Spanish-translated PrEP Stigma Scale (PSS) was psychometrically appropriate for implementing in Spanish language-dominant Latino SMM. Recruitment was conducted using geosocial networking applications, social media sites, and email blasts (N = 3,049). First, we utilized item response theory (IRT) modeling to evaluate the reliability of the PSS items and the latent construct across both language groups (n English = 2,844 and n Spanish = 205). Subsequently, we applied the PSS scale in a theoretical application by examining its association with key steps in the PrEP uptake cascade (i.e., perceived PrEP candidacy, PrEP willingness, PrEP intentions, and having spoken to provider about PrEP) stratified by language. Results of the IRT analyses provided evidence that the translated version of the PSS was appropriate for use among this sample. Further, among English respondents, PrEP stigma was negatively associated with perceived PrEP candidacy (B = −0.30, p ≤ .001), PrEP willingness (B = −0.46, p ≤ .001), and PrEP intentions (B = −0.23, p = .003). PrEP stigma, among Spanish respondents, was not significantly associated with any of the PrEP cascade steps. This study demonstrated that the PSS scale performs adequately for both English-and Spanish-speaking Latino SMM. However, researchers and health professionals alike should pay close attention to the nuanced effects in U.S.-based English-and Spanishlanguage samples as PrEP stigma may impact the PrEP cascade for one language sample and not the other.

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Section: Discussionmentioning

confidence: 99%

The use of a Spanish-translated PrEP Stigma Scale among the Latino sample of the UNITE cohort study.

Robles¹,

López-Matos²,

Cienfuegos-Szalay³

et al. 2024

Stigma and Health

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“…Furthermore, one-third had multiple PrEP indications. Existing literature, largely from developed countries, indicates that between 32% and 78% [4][5][6][7][8][9] of MSM meet similar PrEP eligibility criteria. Using 2017 National HIV Behavioral Surveillance Study data, Finlayson et al 4 reported that 45% of U. MSM recruited through venue-based sampling likely met clinical indications for PrEP based on the CDC criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Using 2017 National HIV Behavioral Surveillance Study data, Finlayson et al 4 reported that 45% of U. MSM recruited through venue-based sampling likely met clinical indications for PrEP based on the CDC criteria. This analysis, like others, [5][6][7][8] relied on self-report of risk factors including history of STI, whereas our study also included current STI diagnosis. Excluding these baseline STI results would have resulted in a lower proportion of participants meeting indications for PrEP (59.6% [53.1%-65.7%]) and failure to identify 66 PrEP-eligible MSM, suggesting that assessments of PrEP eligibility among MSM that rely solely on self-reported STI history may be underestimates.…”

Section: Discussionmentioning

confidence: 99%

Substantial Need for Preexposure Prophylaxis Among Men Who Have Sex With Men in Hanoi, Vietnam

Bhatia

Minh

et al. 2021

Sexual Trans Dis

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We used data from the Health in Men-Hanoi cohort to determine the proportion of HIV-negative men who have sex with men with PrEP indications in Hanoi. Among 717 men who have sex with men, 537 (72.2% [66.6%-77.3%]) had ≥1 PrEP indication, signaling a substantial need for PrEP scale-up. Condomless anal intercourse was the most frequent indication (68.7% [60.3%-76.1%]), followed by previous/current sexually transmitted infection (59.4% [51.0%-67.2%]).

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A novel modelling framework to simulate the effects of HIV stigma on HIV transmission dynamics

Bisanzio,

Roberts,

Stelmach

et al. 2024

Preprint

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Introduction HIV remains a global public health challenge, with social determinants such as stigma influencing transmission dynamics, access to testing, and treatment. HIV stigma shapes both individual behaviour and community responses to HIV. However, modelling approaches have rarely represented the complex role of stigma in HIV epidemics. Our study introduces an innovative modelling framework designed to capture the interplay between stigma and HIV transmission dynamics. Methods We modelled effects of anticipated, internalised, and experienced HIV stigma on HIV testing, antiretroviral treatment initiation, and treatment adherence. We built an individual-based model representing the HIV epidemic (HIV-IBM) in a USA-like population of 3 million individuals that accounts for community demography, behaviour, and healthcare access. Stigma parameters were based on a scoping review focused on the prevalence and effects of stigma in people living with and without HIV. HIV-IBM was used to assess effects of interventions targeting different types of stigma. We tested reductions of stigma by 50% and 100% across the simulated population and performed a sensitivity analysis to identify effects of each type of stigma on the simulated HIV epidemic. Results Without reduced stigma, the HIV-IBM had an annual incidence rate of 12.6 (95% credible interval [CI]: 11.4-13.5) new cases per 100,000 people. Reducing the overall level of stigma in the population by 50% resulted in an annual incidence rate of 9.6 (95% CI: 8.6-10.3) per 100,000, and a 100% reduction in stigma resulted in an annual incidence rate of just 6.8 (95% CI: 6.1-7.3) per 100,000. In addition to reducing HIV incidence, reducing stigma resulted in a substantial increase of viral suppression among people living with HIV (50% stigma reduction: +10.5%; 100% stigma reduction: +16.4%). Sensitivity analysis showed that outcomes resulting from interventions targeting each type of stigma were highly heterogeneous. Conclusion Simulation results suggest that reducing HIV stigma could have a large effect on HIV incidence and viral suppression. Our model framework provides a dynamic approach to understanding the role of stigma in HIV outcomes that facilitates exploration of stigma reduction strategies and offers insights to inform evidence-based policies and interventions for reducing stigma and curtailing HIV.

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Influence of Stigma on Pre-Exposure Prophylaxis (PrEP) Care Continuum Among Men and Transwomen Who Have Sex with Men (MTWSM) in the United States

Cited by 3 publications

References 26 publications

The use of a Spanish-translated PrEP Stigma Scale among the Latino sample of the UNITE cohort study.

The use of a Spanish-translated PrEP Stigma Scale among the Latino sample of the UNITE cohort study.

Substantial Need for Preexposure Prophylaxis Among Men Who Have Sex With Men in Hanoi, Vietnam

A novel modelling framework to simulate the effects of HIV stigma on HIV transmission dynamics

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