Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020.

OBJECTIVES: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. METHODS: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. RESULTS: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). CONCLUSION: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.

The Preexposure Prophylaxis Care Continuum Among Mexican Men Who Have Sex With Men and Transwomen: A Qualitative Study.

BACKGROUND: This article describes perceptions and experiences related to the preexposure prophylaxis (PrEP) care continuum of Mexican men who have sex with men (MSM) and transwomen (TW). METHODS: Between June and July 2020, we applied 24 online semistructured interviews regarding PrEP use with 10 PrEP users, 6 ex-users, and 8 potential users (at risk, not enrolled). RESULTS: Awareness: TW did not always receive the information they needed from trusted people. Acceptability: Potential users were reluctant to use PrEP because of fear of adverse effects, and only a few participants worried about stigma. Uptake: Potential users missed their enrollment visit and did not know how to reschedule. Adherence: Barriers included routine changes interfering with PrEP-taking habits (arriving home later, traveling, etc.), whereas feeling protected was reported as a facilitator. Retention: Ex-users quit PrEP services, mostly without reducing their HIV risk, because of difficulties keeping appointments and fearing long-term effects. CONCLUSION: Inclusive awareness activities, tackling misbeliefs regarding adverse effects, and more flexible services may improve PrEP usage and enhance its impact.

HIV Care Disengagement and Antiretroviral Treatment Discontinuation in Mexico: A Qualitative Study Based on the Ecological Model Among Men Who Have Sex With Men.

ABSTRACT: In 2018, 24% of Mexican men living with HIV were disengaged from HIV care, which impedes their use of antiretroviral treatment (ART). To identify HIV care disengagement and/or ART discontinuation factors using an ecological framework, we conducted 22 semi-structured interviews with men who have sex with men from the HIV state clinic of Tabasco, Mexico. HIV care disengagement was attributed to interpersonal, organizational, and community factors, whereas ART discontinuation was attributed to intrapersonal and interpersonal factors. Intrapersonal factors were burden of ART, substance use, mental health problems, and feeling well or ill. Interpersonal factors included family stigma or support, and partner discouragement. Factors at the organizational level were HIV care-related: inconvenient follow-ups, negative provider interactions, and reentry obstacles; and work-related: absences, work stigma, and travel. Community factors were social stigma and economic means. Interventions should target multiple levels of interdependent factors, distinguishing between HIV care disengagement and ART discontinuation factors.

Variations in Sexual Behaviors by Use of Specific Substances Among Vancouver Gay, Bisexual, and Other Men Who Have Sex with Men: An Event-Level Analysis.

Event-level studies measure substance use and sexual behaviors happening during a specific sexual encounter, ensuring that both variables are temporally paired. This study explored the event-level associations between a range of sexual behaviors (masturbation, anal sex, oral sex, rimming, fisting, sex toys, and group sex) and five sexualized substances (poppers, methamphetamine, GHB, ecstasy/MDMA, and ketamine) used during 11,582 sexual events reported by 762 gay, bisexual, and other men who have sex with men (GBMSM) in Vancouver, Canada. Data were obtained from a prospective cohort of GBMSM who self-reported their behaviors via computer-based questionnaires on their last sexual encounter with up to five of their most recent partners in the past six months. These clustered data were analyzed with multivariable generalized linear mixed models. Participants reported popper use in 16.1% of sexual encounters, methamphetamine in 8.6%, gamma-hydroxybutyrate (GHB) in 4.1%, ecstasy/3,4-methylenedioxymethamphetamine (MDMA) in 3.3%, and ketamine in 1.5%. Condomless receptive anal sex (25.0% of events) was associated with increased odds of using poppers, methamphetamine, GHB, and ecstasy/MDMA. Group sex (13.1% of events) and sharing sex toys (2.0% of events) were more likely with the use of all five substances. Receiving money/drugs/goods in exchange for sex (2.5% of events) was associated with increased odds of poppers, methamphetamine, GHB, and ecstasy/MDMA use. GBMSM living with HIV (29.9% of participants) had higher odds of using poppers, methamphetamine, and GHB, but lower odds of using ecstasy/MDMA. In conclusion, these event-level results suggest public health strategies are needed to address the possible negative impacts of sexualized substance use among GBMSM.

Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach.

BACKGROUND: Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators. METHODS: We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS. RESULTS: Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions. CONCLUSIONS: While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

Validation of the Bolino and Turnley's Impression Management Scale in a Mexican Sample / Validación de la Escala de Manejo de Impresiones de Bolino y Turnley en una Muestra Mexicana

Abstract Impression Management (IM) states that: 1) People know how others perceive them, 2) People attempt to control such perceptions. Bolino and Turnley (1999) developed an IM Scale based on Jones and Pittman's (1982) taxonomy of five strategies: Self-promotion, Ingratiation, Exemplification, Intimidation, and Supplication. The purpose of this study was to validate the IM Scale using a Mexican sample, evaluating reliability scores and dimensionality. A nomological network for IM was performed considering the Five-factor Personality traits, Social desirability, and Sense of control. Results prove adequate internal reliability and confirm the instrument's five factor structure. Our psychometric findings support the premise that IM may overlap with other psychological constructs, providing evidence of its construct validity.

Resumen El Manejo de Impresión (MI) se refiere a que: 1) Las personas generalmente saben cómo son percibidas por otras personas, 2) La gente intenta controlar dichas percepciones. Bolino y Turnley (1999) desarrollaron una Escala de MI con base en la taxonomía de Jones y Pittman (1982) de cinco estrategias: Autopromoción, Congraciamiento, Ejemplificación, Intimidación, y Súplica. El objetivo de este estudio fue validar la Escala de MI en una muestra mexicana, evaluando puntajes de consistencia interna y dimensionalidad. Se realizó una red nomológica para el MI considerando los Cinco Factores de Personalidad, Deseabilidad Social, y Control Percibido. Los resultados muestran una consistencia interna adecuada y confirman las cinco estrategias originalmente planteadas. Los hallazgos apoyan la premisa de que el MI incluye otros constructos psicológicos, dando evidencia adicional de su validez de constructo.

Structural Equivalence of an Attitude Toward Religion Scale in Mexico, Nicaragua and China / Equivalencia estructural de una escala de actitud hacia la religión en México, Nicaragua y China

The Attitude toward Catholicism, Judaism, Hinduism, and Islam scales (Francis & Enger, 2002; Francis & Katz, 2007; Francis, Santosh, Robbins, & Vij, 2008; Sahin & Francis, 2002) were adapted for this study into a single scale that measures overall attitudes towards religion. The resulting Attitude toward Religion (ATR) Scale was adapted into both Spanish and Chinese and administered in Mexico (n = 265), Nicaragua (n = 296), and China (n = 460) to a total of 1,021 individuals (59% women, 41% men; Mage = 22.4 years, SD = 7.01 years). The scale's structural equivalence (i.e. Does the instrument measure the same construct in each country?) was assessed using Exploratory Factor Analyses and pairwise comparisons. Strong evidence for structural equivalence was provided by the analyses' results, as we obtained a one-dimensional solution (labeled Attitude Toward Religion, ATR) in all three countries and Tucker's Phi test was very close to 1. These findings support the unidimensional solution for attitudes toward religions obtained in previous scales and broaden the scope for these studies in several cultural contexts. Further implications are discussed.

Las Escalas de Actitudes hacia el Catolicismo, Judaismo, Hinduismo e Islam (Francis & Enger, 2002; Francis & Katz, 2007; Francis, Santosh, Robbins, & Vij, 2008; Sahin & Francis, 2002) fueron adaptadas en este estudio a una sola escala que evalúa actitudes globales hacia la religión. La escala resultante de Actitudes Hacia la Religión (AHR) fue adaptada a español y chino y fue administrada en México (n=265), Nicaragua (n=296) y China (n=460) a una muestra total de 1021 individuos (59% mujeres, 41% hombres; Medad=22.4 años, DE = 7.01 años). La equivalencia estructural de la escala (¿El instrumento mide el mismo constructo en cada pais?) fue evaluada utilizando Análisis Factoriales Exploratorios y comparaciones por pares. Los resultados muestran evidencia sólida de equivalencia estructural, ya que se obtuvo una solución unidimensional (a la que se llamó Actitud Hacia la Religión) en los tres países y el valor de Phi de Tucker fue muy cercano a 1. Estos hallazgos apoyan la solución unidimensional de actitudes hacia la religión obtenida por investigaciones previas y amplian el alcance de estos estudios en diferentes contextos culturales. Otras implicaciones también se discuten a profundidad.

La deseabilidad social revalorada: más que una distorsión, una necesidad de aprobación social / Social Desirability Reconsidered: More than Distortion, the Need for Social Approval

La deseabilidad social se ha conceptuado a través de los años principalmente como una tendencia a contestar un cuestionario de personalidad dando una imagen demasiado favorable de uno mismo. El estudio tuvo como objetivo evidenciar que la Deseabilidad Social es una medida sustantiva de personalidad que refleja una necesidad de aprobación social (NAS), más que un sesgo en las respuestas individuales. Para la realización del estudio colaboraron 1,235 participantes provenientes del D.F. Michoacán y Coahuila, de los cuales el 56% eran mujeres, con una media de edad de 28 años, de la población general. Se aplicaron 12 escalas psicológicas que con base en la literatura sugerían convergencia y divergencia tanto teórica como empírica respecto a las dos dimensiones identificadas como NAS-Positiva y NAS-Negativa, incluidas la exageración, honestidad, auto-estima y auto-monitoreo. Se identificó la red nomológica entre las variables de interés y las variables criterio. Tanto la NAS-Positiva y NAS-Negativa resultaron estar diferenciadas principalmente de la exageración y del automonitoreo. Finalmente se identificaron algunas variables asociadas a la NAS haciendo coincidente algunos hallazgos previos tales como que la agradabilidad, la regulación emocional, la orientación religiosa y el autocontrol son buenos predictores de ambos tipos de NAS.

Social desirability has been conceptualized through many years as a tendency to present oneself in a very fashionable picture. The aim of the present study is to demonstrate that social desirability is a substantive measure of a personality trait that reflects a need for social approval (NSA), rather than an individual response bias. A total sample of 1,235 participants of general population from the Federal District, Michoacan and Coahuila States was recruited, 56% were women, with a mean age of 28 years. Twelve scales were chosen from the extensive scientific literature of social desirability to prove convergence and divergence association to the current topic of need for social approval. Over-claiming, honesty, self-esteem, an self- monitoring scales were associated with the two dimension of Positive and Negative- NSA. The nomological network was identified between the variables of interest and the criterion variables. Both, positive and negative dimension of NSA clearly differentiate from Over-claiming and self-monitoring. Finally, agreeableness, emotional regulation, religious orientation and self-control are good predictors of both types of NSA.