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1.
JMIR Public Health Surveill ; 8(6): e33538, 2022 Jun 27.
Article in English | MEDLINE | ID: covidwho-1910863

ABSTRACT

BACKGROUND: Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men's ability to access services is not fully understood. OBJECTIVE: The aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic. METHODS: Our study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men's Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one's health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. RESULTS: With 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=-1.39, 95% CI -1.42 to -1.36; P<.001). CONCLUSIONS: HIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide.


Subject(s)
COVID-19 , HIV Infections , Health Services Accessibility , Sexual and Gender Minorities , Adult , Bisexuality , COVID-19/epidemiology , Delivery of Health Care , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Pandemics
2.
J Acquir Immune Defic Syndr ; 87(1): 644-651, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1865024

ABSTRACT

BACKGROUND: The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING: Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans. METHODS: We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS: A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSIONS: More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.


Subject(s)
COVID-19/epidemiology , HIV Infections/drug therapy , HIV Infections/prevention & control , Homosexuality, Male/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adult , Humans , Male , Middle Aged , Pre-Exposure Prophylaxis/statistics & numerical data , SARS-CoV-2/isolation & purification , Self-Testing , Sexual Behavior , Social Networking , Surveys and Questionnaires , Young Adult
3.
Glob Public Health ; 17(6): 827-842, 2022 06.
Article in English | MEDLINE | ID: covidwho-1795459

ABSTRACT

As COVID-19 continues to persist, there is a need to examine its impact among sexual and gender minority individuals, especially those with intersecting vulnerabilities. We conducted a cross-sectional survey with a global sample of sexual and gender minority individuals (n = 21,795) from October 25, 2020 to November 19, 2020, through a social networking app. We characterised the HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 mitigation response and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many sexual and gender minority individuals reported interruptions to HIV prevention and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, individuals with a history of sex work, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among sexual and gender minority individuals.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Sexual and Gender Minorities , COVID-19/epidemiology , Cross-Sectional Studies , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Minority Groups , SARS-CoV-2 , Sexual Behavior
4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-320725

ABSTRACT

There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n= 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many men not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. Consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. Findings underscore the crucial need to mitigate the multifaceted impacts of COVID-19 among gay men and other MSM, especially for those with intersecting vulnerabilities.

5.
PLoS One ; 16(7): e0254724, 2021.
Article in English | MEDLINE | ID: covidwho-1315892

ABSTRACT

OBJECTIVE: To determine if men who have sex with men (MSM) with cocaine use disorder (CUD) and actively-using cocaine could be enrolled and retained in a pharmacologic intervention trial of lorcaserin-a novel 5-HT2cR agonist-and determine the degree to which participants would adhere to study procedures. METHODS: This was a phase II randomized, double-blind, placebo-controlled pilot study with 2:1 random parallel group assignment to daily extended-release oral lorcaserin 20 mg versus placebo (clinicaltrials.gov identifier-NCT03192995). Twenty-two of a planned 45 cisgender MSM with CUD were enrolled and had weekly follow-up visits during a 12-week treatment period, with substance use counseling, urine specimen collection, and completion of audio-computer assisted self-interview (ACASI) behavioral risk assessments. Adherence was measured by medication event monitoring systems (MEMS) caps and self-report. This study was terminated early because of an FDA safety alert for lorcaserin's long-term use. RESULTS: Eighty-six percent completed the trial, with 82% of weekly study follow-up visits completed. Adherence was 55.3% (lorcaserin 51.6% vs. placebo 66.2%) by MEMS cap and 56.9% (56.5% vs. placebo 57.9%) by self-report and did not differ significantly by treatment assignment. Intention-to-treat analyses (ITT) did not show differences in cocaine positivity by urine screen between the lorcaserin and placebo groups by 12 week follow-up (incidence risk ratio [IRR]: 0.96; 95%CI = 0.24-3.82, P = 0.95). However, self-reported cocaine use in timeline follow-back declined more significantly in the lorcaserin group compared to placebo (IRR: 0.66; 95%CI = 0.49-0.88; P = 0.004). CONCLUSION: We found that it is feasible, acceptable, and tolerable to conduct a placebo-controlled pharmacologic trial for MSM with CUD who are actively using cocaine. Lorcaserin was not associated with significant reductions in cocaine use by urine testing, but was associated with significant reductions in self-reported cocaine use. Future research may be needed to continue to explore the potential utility of 5-HT2cR agonists.


Subject(s)
Amphetamine-Related Disorders , Homosexuality, Male , Adult , Benzazepines , Double-Blind Method , Humans , Male , Middle Aged , Pilot Projects
6.
J Acquir Immune Defic Syndr ; 87(1): 644-651, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1029820

ABSTRACT

BACKGROUND: The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING: Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans. METHODS: We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS: A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSIONS: More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.


Subject(s)
COVID-19/epidemiology , HIV Infections/drug therapy , HIV Infections/prevention & control , Homosexuality, Male/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Adult , Humans , Male , Middle Aged , Pre-Exposure Prophylaxis/statistics & numerical data , SARS-CoV-2/isolation & purification , Self-Testing , Sexual Behavior , Social Networking , Surveys and Questionnaires , Young Adult
7.
AIDS Behav ; 25(2): 311-321, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-639050

ABSTRACT

There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.


RESUMEN: Existe una necesidad urgente para medir los impactos de COVID-19 entre hombres gay y otros hombres que tienen sexo con hombres (HSH). Hemos conducido una encuesta multifuncional con una prueba mundial de hombres gay y otros HSH (n = 2732) desde el 16 de Abril hasta el 4 de Mayo del 2020, a través de una aplicación de red social. Nosotros caracterizamos los impactos económicos, de salud mental, prevención del VIH y tratamiento del VIH e impactos a COVID-19 y la respuesta de COVID-19, y examinamos si subgrupos de nuestra población de estudio fueron impactados desproporcionadamente por COVID-19. Muchos hombres no tan solo reportaron consecuencias económicas y de salud mental, sino también interrupciones de prevención y de pruebas de VIH, y cuidado del VIH y servicios de tratamiento. Encontramos consecuencias más significantes entre personas viviendo con VIH, grupos raciales/etnicos, migrantes, sexo servidores, y groupos socioeconomicamente disfavorecidos. Los resultados subrayan la necesidad crucial de mitigar los impactos multifacéticos de COVID-19 entre los hombres homosexuales y otros HSH, especialmente para aquellos con vulnerabilidades entrelazadas.


Subject(s)
COVID-19/psychology , Health Services Accessibility/statistics & numerical data , Homosexuality, Male/psychology , Mental Health/statistics & numerical data , Cross-Sectional Studies , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Male , SARS-CoV-2
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