Outcomes of sacral neuromodulation in male patients with overactive bladder, chronic pelvic pain, and fecal incontinence.

INTRODUCTION: Despite the growing body of literature on sacral neuromodulation (SNM) outcomes, research focusing on male patients remains limited and often represented by small cohorts nested within a larger study of mostly women. Herein, we evaluated the outcomes of SNM in a male-only cohort with overactive bladder (OAB), fecal incontinence (FI), chronic bladder pain, and neurogenic lower urinary tract dysfunction (NLUTD). MATERIALS AND METHODS: This retrospective cohort study included 64 male patients who underwent SNM insertion between 2013 and 2021 at a high-volume tertiary center. Indications for SNM therapy included OAB, FI, chronic pelvic pain, and NLUTD. Descriptive statistics, Fisher's and t-test were used in analysis. RESULTS: The mean age was 57.7 ± 13.4 years, and the most frequent reason for SNM insertion was idiopathic OAB (72%), FI (16%), pelvic pain (11%), and NLUTD (11%). A majority (84%) of men received treatment prior to SNM insertion. 84% reported satisfaction and 92% symptom improvement within the first year, and these improvements persisted beyond 1 year in 73% of patients. Mean follow up was 52.7 ± 21.0 months. The complication rate was 23%, and the need for adjunct treatments was significantly reduced (73% to 27%, p < 0.001). Treatment outcomes did not differ significantly between various indications for SNM therapy or the presence of benign prostatic hyperplasia (BPH). CONCLUSION: SNM is an effective and safe procedure for male patients with neurogenic and non-neurogenic OAB, pelvic pain, and FI. Over 70% of patients experienced symptomatic improvement and remained satisfied in the mid to long term follow up. BPH does not seem to hinder treatment outcomes.

The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis.

BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. METHODS: We leveraged programmatic data collected by the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the 'pre-restriction' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the 'high-level restriction' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. CONCLUSION: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals.

BACKGROUND: Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts. METHODS: Thirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT. RESULTS: While alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism. CONCLUSIONS: This study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT02185274.

Longitudinal relationship between pre-exposure prophylaxis motivation and change in adherence among men who have sex with men in Western China.

INTRODUCTION: The efficacy of pre-exposure prophylaxis (PrEP) is highly dependent on adherence, and adherence behavior is influenced by motivation. The aim of this study was to explore the longitudinal relationship between PrEP motivation and change in adherence among men who have sex with men (MSM) in Western China. METHODS: From November 2019 to June 2021, we conducted a PrEP prospective cohort study. Motivation to take medicine was measured by the PrEP Motivation Scale at baseline, and was grouped into different levels of latent categories by Latent Profile Analysis (LPA). A multinomial logistic regression model was used to explore the longitudinal relationship between change in adherence (improvement, decline, no change) and different levels of PrEP motivation. RESULTS: MSM were divided into two categories of PrEP motivation, a "high motivation group" (n = 506, 69.89%) and a "low motivation group" (n = 218, 30.11%). High PrEP motivation had no significant effect on the change in short-term adherence, however, it contributed to the improvement in long-term adherence [odds ratio (OR) = 3.028 (1.100-8.332), p = 0.031]. The predictive power of the adherence model was significantly enhanced with the addition of the PrEP motivation factor. CONCLUSIONS: There was a positive correlation between high PrEP motivation at baseline and an improvement in long-term adherence. Surveillance and intervention of PrEP motivation in MSM can increase their adherence, and then promote PrEP efficacy.

Using an interactive web application to identify pre-exposure prophylaxis adherence among men who have sex with men.

Background: Men who have sex with men (MSM) are at a high risk for HIV infection. While pre-exposure prophylaxis (PrEP) is an effective oral preventive strategy, its success is largely dependent on consistent medication adherence. Objective: The aim of this study was to develop the machine learning web application and evaluate the performance in predicting PrEP adherence. Methods: The PrEP prospective cohort study of the MSM population conducted in Western China from 2019 to 2023, and we collected adherence data and personal characteristics data from 747 MSM. Predictor variables were screened and the performance of several machine learning methods in predicting nonadherent behaviors were compared. Results: A total of 11 candidate variables were screened that predicted nonadherent behaviors. We developed and evaluated five machine learning models that performed well in predicting adherence. Attitudes of male sexual partners, self-efficacy, HIV testing, number of male sexual partners, and risk perception were the most important predictors of adherence. The optimal prediction model was displayed in a shiny web application for online calculation of the probability of occurrence of nonadherent behaviors among MSM. Conclusions: Machine learning performed well in predicting nonadherent behaviors among MSM. An interactive and intuitive web application can help identify individuals who may have nonadherent behaviors, resulting in improved medication adherence and increased prevention efficacy.

The impact of mosaic loss of the Y chromosome (mLOY) in men of advanced age.

The Y chromosome has long been considered to be a "genetic wasteland" harboring only few genes essentially involved in male sex development and spermatogenesis. However, the discovery of mosaic loss of the Y chromosome (mLOY) in older men has led to revisiting of the potential impact of the Y chromosome on health and the pathophysiological processes of multiple diseases such as cancer, Alzheimer's disease and cardiovascular disease. Hence, developing more sensitive techniques for the detection of mLOY has become an emergent concern. In this article, we present a comprehensive review of the literature regarding mLOY. Additionally, we discuss the emerging discoveries concerning mLOY as well as the underlying mechanisms promoting disease in men of advanced age.

Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study.

Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27-73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60-90-min semi-structured interview via an audio-visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment-related stressor. Participants typically initiated help-seeking by consulting a General Practitioner. Long delays were reported from initial help-seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.

Prediction model of weight control experience in men with obesity in their 30 s and 40 s using decision tree analysis.

Obesity is an abnormal and potentially dangerous condition caused by excess body fat accumulation. The number of people with obesity is increasing worldwide. Obesity is the primary cause of various diseases; therefore, it is crucial to make efforts to control body weight. Identifying the factors that influence men with obesity to attempt to control and not control their weight is essential. The objective of this study was to create a prediction model for weight control experience among Korean men in their 30 s and 40 s. We analyzed data from the 2022 Community Health Survey and included 12,311 men who were overweight or obese. The men were divided into two groups based on their weight control experience: (1) Yes group (n = 9405) and (2) No group (n = 2906). Chi-square and independent t-tests were used to compare general and health-related characteristics between the groups. Decision tree analysis was used to build a prediction model for weight control experience. A split-sample test was conducted to validate the model. From the results of this study, various models predicting weight control experience were derived. From the decision tree model without setting the first node, those who weighed below average, had a high school diploma or less, and did not know their blood sugar levels had the highest probability of not controlling their weight at 55.3%. In the prediction model where the first node was set to age, those in their 40 s who thought their weight was below average and were unaware of their blood sugar levels had the highest rate of not trying to control their weight at 50.1%. In the prediction model where the first node was set to BMI, those who were overweight but thought their weight was below average and had a high school diploma or less had the highest rate of not trying to control their weight at 51.5%. There is an urgent need to provide obesity prevention and management education to those who have no weight control experience, particularly those at high risk, as identified in this study.

Using the andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 american men's internet survey.

BACKGROUND: Pre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen's Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S. METHODS: Data from the 2020 American Men's Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI95%). RESULTS: Out of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI95% =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI95% =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI95% =1.02, 1.06). There were no observed differences in men's willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status. CONCLUSIONS: Strategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.

Systematic Review of the Effectiveness and Experiences of Treatment for Men With Borderline Personality Disorder.

In clinical settings, among individuals diagnosed with borderline personality disorder (BPD), typically 75% are female and 25% male, although this discrepancy is not reported in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD. We aimed to review the effectiveness and experiences of treatment for men with BPD and outline future research priorities to promote better recovery. We searched Ovid MEDLINE and PsycINFO for eligible studies from inception until July 29, 2022. Peer-reviewed primary research articles on treatment effectiveness or experience for men with BPD were included. Data from eligible studies were synthesized in a narrative review. The protocol of our review was pre-registered on PROSPERO (CRD42022351908). Seventeen studies met the inclusion criteria, and men with BPD from eight countries were represented. Psychological therapies included Dialectical Behavioral Therapy, Systems Training for Emotional Predictability and Problem Solving, Mentalization Based Therapy, and psychoanalytic therapy. Pharmacologic treatment included topiramate, divalproex Extended-Release, and high-dose baclofen. Five studies investigated the service utilization of men with BPD. Compared to women, men were less likely to access treatment for BPD or find treatment helpful. Our findings demonstrated the potential efficacy of psychotherapy and pharmacologic interventions in reducing anger, aggression, and rule-breaking behavior, with limited evidence for reduction in suicide-related outcomes. Our findings are limited by inadequate power and heterogeneity of the included studies. Further research with larger sample sizes and qualitative studies is needed to better understand the treatment experience for men with BPD.

Egg Consumption and 4-Year Change in Cognitive Function in Older Men and Women: The Rancho Bernardo Study.

The effect of dietary cholesterol on cognitive function is debatable. While eggs contain high levels of dietary cholesterol, they provide nutrients beneficial for cognitive function. This study examined the effects of egg consumption on change in cognitive function among 890 ambulatory adults (N = 357 men; N = 533 women) aged ≥55 years from the Rancho Bernardo Study who attended clinic visits in 1988-1991 and 1992-1996. Egg intake was obtained in 1988-1991 with a food frequency questionnaire. The Mini-Mental Status Exam (MMSE), Trails B, and category fluency were administered at both visits to assess cognitive performance. Sex-specific multiple regression analyses tested associations of egg intake with changes in cognitive function after adjustment for confounders. The mean time between visits was 4.1 ± 0.5 years; average ages were 70.1 ± 8.4 in men and 71.5 ± 8.8 in women (p = 0.0163). More men consumed eggs at higher levels than women; while 14% of men and 16.5% of women reported never eating eggs, 7.0% of men and 3.8% of women reported intakes ≥5/week (p = 0.0013). In women, after adjustment for covariates, egg consumption was associated with less decline in category fluency (beta = -0.10, p = 0.0241). Other associations were nonsignificant in women, and no associations were found in men. Results suggest that egg consumption has a small beneficial effect on semantic memory in women. The lack of decline observed in both sexes suggests that egg consumption does not have detrimental effects and may even have a role in the maintenance of cognitive function.

Autoimmune Thyroiditis Mitigates the Effect of Metformin on Plasma Prolactin Concentration in Men with Drug-Induced Hyperprolactinemia.

Metformin inhibits the secretory function of overactive anterior pituitary cells, including lactotropes. In women of childbearing age, this effect was absent if they had coexisting autoimmune (Hashimoto) thyroiditis. The current study was aimed at investigating whether autoimmune thyroiditis modulates the impact of metformin on the plasma prolactin concentration in men. This prospective cohort study included two groups of middle-aged or elderly men with drug-induced hyperprolactinemia, namely subjects with concomitant Hashimoto thyroiditis (group A) and subjects with normal thyroid function (group B), who were matched for baseline prolactin concentration and insulin sensitivity. Titers of thyroid peroxidase and thyroglobulin antibodies, levels of C-reactive protein, markers of glucose homeostasis, concentrations of pituitary hormones (prolactin, thyrotropin, gonadotropins, and adrenocorticotropic hormone), free thyroxine, free triiodothyronine, testosterone, and insulin growth factor-1 were measured before and six months after treatment with metformin. Both study groups differed in titers of both antibodies and concentrations of C-reactive protein. The drug reduced the total and monomeric prolactin concentration only in group B, and the impact on prolactin correlated with the improvement in insulin sensitivity and systemic inflammation. There were no differences between the follow-up and baseline levels of the remaining hormones. The results allow us to conclude that autoimmune thyroiditis mitigates the impact of metformin on prolactin secretion in men.

Revisiting the Prevalence of Unhealthy Alcohol Use Among Ethnic Minority Immigrant Gay, Bisexual Men, and Other Men Who Have Sex with Men in North America: A Systematic Review and Meta-analysis.

Unhealthy alcohol use is a significant public health concern among ethnic minority immigrant gay, bisexual men, and other men who have sex with men (GBMSM) in North America. The definition of unhealthy alcohol use is any use that increases the risk of health consequences or has already led to negative health consequences. Despite its association with various health problems, this issue remains understudied in this population. Therefore, we aim to synthesize key findings to provide the prevalence of unhealthy alcohol use and related factors among this population in North America. We conducted a comprehensive literature search in multiple scientific databases to identify studies on alcohol use among ethnic minority immigrant GBMSM. Using random-effect modeling strategies, we aggregate and weigh the individual estimates, providing a pooled prevalence of unhealthy alcohol use within this population. Our review included 20 articles with 2971 participants (i.e., 53% were Latino, 45% were Asian/Pacific Islanders, and 2% were African). The meta-analysis revealed that 64% (95% CI 0.50, 0.78) of the participants reported recent alcohol use, while 44% (95% CI 0.30, 0.59) engaged in unhealthy alcohol use. Co-occurring health issues identified in the studies are other substance use (32%; 95% CI 0.21, 0.45), positive HIV status (39%; 95% CI 0.14, 0.67), and mental health issues (39%; 95% CI 0.21, 0.58). We also identified several factors associated with unhealthy alcohol use, including risky sexual behaviors, experiences of discrimination based on race and sexual orientation, and experiences of abuse. However, meta-regression results revealed no statistically significant associations between alcohol use and co-occurring health problems. This is the first study to systematically review unhealthy alcohol use among ethnic minority immigrant GBMSM. Despite the high burden of alcohol use, there is a dearth of research among Asian and African GBMSM. Our findings underscore the need for more research in these groups and provide insights to inform targeted clinical prevention and early intervention strategies to mitigate the adverse consequences of unhealthy alcohol use among ethnic minority immigrant GBMSM.

Fertility services for gay men: A website content analysis of US fertility clinics and sperm banks.

BACKGROUND: Fertility preservation and subsequent third-party reproduction represents a principal pathway by which gay and bisexual cisgender men may have biologically related children. Previous studies of a similar design have commented on the availability of fertility services for sexually and gender diverse communities, but none have investigated access to the aforementioned services for this specific population. OBJECTIVES: To assess the availability of fertility preservation and third-party reproduction services for gay and bisexual cisgender men across US fertility clinics and sperm banks. MATERIALS AND METHODS: A content analysis was performed on a sample of fertility clinic and sperm bank websites compiled from three online sources. Sample construction and analysis were completed in 2023. Each website was systematically examined by two separate coders with a third coder deciding any discrepancies. Website coding followed a pre-constructed standardized questionnaire. Logistic regression analysis was used to identify statistically significant differences. RESULTS: A total of 675 clinic and sperm bank websites (136 academic and 539 private) were analyzed. Five hundred and two (74.4%) offered third-party reproduction and 326 (48.3%) offered fertility preservation for gay and bisexual cisgender men. Furthermore, 248 websites (36.7%) featured some form of disqualifying language either directly communicating or implying exclusion of gay and bisexual cisgender men from these services. Private facilities were more likely to offer third-party reproduction (odds ratio [OR] = 1.88, p < 0.01) but less likely to offer fertility preservation (OR = 0.68, p < 0.05) compared with academic affiliated facilities. Lastly, states in the highest Human Rights Campaign Equality Index tier were significantly more likely to offer third-party reproduction (OR = 2.50, p < 0.01) than the lowest tier. DISCUSSION AND CONCLUSION: These findings demonstrate great variability in access to fertility preservation and third-party reproduction services. Geography and ambiguity in facility-specific policies represent persistent barriers to family building for gay and bisexual cisgender men.

Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention.

Importance: HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. Objective: To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. Design: We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. Setting: We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Participants: Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. Intervention: The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Main outcome measures: Received an HIV test in the prior six months. Results: There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001). Conclusions: The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. Trial Registration: This trial is registered with clinicaltrials.gov (NCT02786615). Funding: National Institute on Drug Abuse (NIDA), grant number R01DA040513.

Gay and Bisexual Men's Perceptions about a Potential HIV Vaccine within a Post-COVID-19 Era: A Qualitative Study.

To end the HIV epidemic, there is need for targeted strategies to reduce HIV incidence for those most vulnerable, including an HIV vaccine. This study seeks to understand the perceptions that non-PrEP using gay and bisexual men and other men who have sex with men (GBMSM) have about a potential HIV vaccine, while contextualizing their perspectives within the context of heightened vaccine hesitancy that has emerged since the COVID-19 pandemic. Between March and May of 2022, GBMSM (N = 20) participated in in-depth interviews, which assessed their perceptions about an HIV vaccine. Interviews were analysed using a codebook approach to thematic analysis. We oversampled for those unvaccinated against COVID-19 as a proxy for vaccine hesitation. Participants expressed a range of enthusiastic support, cautious optimism and skepticism when presented with the possibility of an HIV vaccine. Factors that drove willingness to receive an HIV vaccine included community-oriented altruism, individualized risk-benefit assessment, and/or the perception that a vaccine could provide a beneficial shift in sexual experiences. Participants also expressed hesitations about receiving an HIV vaccine, including concerns about potential side-effects and efficacy, as well as mistrust in the vaccine development process. Notably, participants often evaluated the vaccine in comparison to PrEP and condoms. Participants offered specific insights into information they would like to receive about an HIV and where/how they would like to receive it. Our findings can help inform future HIV vaccine implementation efforts by offering insights into the factors that motivate and deter GBMSM to receive an HIV vaccine.

Implementing pathogen reduction technology while discontinuing blood donor deferral criteria for sexual risk behaviors: A simulation study.

BACKGROUND: Combining pathogen reduction technology (PRT) with blood screening may alleviate concerns over the risk of transfusion-transmitted infections (TTI) and support changes in blood donor selection to potentially increase blood availability. This study aimed to estimate the residual risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transfusion-transmission in Canada after implementing PRT, while eliminating deferrals for sexual risk behaviors. STUDY DESIGN AND METHODS: A probabilistic approach that combined Bayesian networks with Monte Carlo simulations was used to estimate the risk of transfusing HIV-, HBV-, or HCV-contaminated blood components. Different scenarios were considered to compare the current residual risk after PRT implementation, with and without donor deferral criteria for sexual risk behaviors. Donor profiles and blood component outcomes were simulated based on a literature review including the prevalence and incidence of HIV, HBV, and HCV in the Canadian blood donor population; the use of current blood screening assays; and HIV, HBV, and HCV blood donor viral loads. RESULTS: In the universal PRT scenario (i.e., with PRT/without deferral criteria), the estimated risks of HIV, HBV, and HCV transmission were significantly lower than those in the currently observed scenario (i.e., without PRT/with deferral criteria). CONCLUSIONS: This risk model suggests that PRT for platelets and plasma (and eventually for RBCs when available) significantly reduces the residual risks of HIV, HBV and HCV transfusion-transmission and could enable the removal of blood donor deferral criteria for sexual risk behaviors.

Challenges and Opportunities with at-Home Blood Collection for HIV-1 Viral Load Monitoring among Sexual Minoritized Men who use Stimulants.

Sexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants. From March-May 2022, cisgender SMM with HIV reporting moderate-to-severe stimulant use disorder and suboptimal (< 90%) past-month antiretroviral therapy (ART) adherence were recruited via a consent-to-contact participant registry. Eligible men completed teleconference-based informed consent and were mailed a HemaSpot-HD blood collection device (volume capacity 160 µL; lower limit of detection 839 copies/mL) with detailed instructions for home blood self-collection and return shipment. Implementation process measures included estimated blood volume and VL quantification. Among 24 participants, 21 (88%) returned specimens with a median duration of 23 days (range: 10-71 days) between sending devices to participants and receiving specimens. Of these, 13/21 (62%) included enough blood (≥ 40 µL) for confidence in detectable/undetectable results; 10/13 (77%) had detectable VL, with 4/10 (40%) were quantifiable at ≥ 839 copies/mL. The remaining 8/21 had low blood volume (< 40 µL), but 3/8 (38%) still had detectable VL, with 1/3 (33%) quantifiable at ≥ 839 copies/mL. Home blood collection of ≥ 40 µL using HemaSpot-HD was feasible among this high-priority population, with > 50% having a VL detected. However, interim VL monitoring using HemaSpot-HD among those experiencing difficulties with ART adherence may be strengthened by building rapport via teleconferencing and providing detailed instructions to achieve adequate sample volume.

Real Talk: Conversations on HIV with Black Heterosexual Men in Healthcare Settings.

Nearly half of heterosexually transmitted human immunodeficiency virus (HIV) infections occur among Black men in the United States. Yet Black heterosexual men (BHM) are largely ignored in HIV programming, policy implementation, and research. This study explores how masculinity, mental health, and socioeconomic factors such as income, education, and insurance (e.g., enrollment and coverage) correlate with the likelihood of BHM having important conversations surrounding HIV with their healthcare providers and family members. Conversations among social networks (e.g., peers, family, and neighbors) create an opportunity to increase comfortability while discussing HIV-related topics around condom use and testing. This study used a cross-sectional survey design and convenience sampling (N = 279) to recruit participants from a community-academic partnership involving a Federally Qualified Health Center (FQHC) in Detroit between June 1, 2020, and July 31, 2020. Descriptive statistics were used to report demographics, socioeconomic information, and sexual health-related behavior variables. Spearman's correlation test was used to report bivariate correlations between predictor and outcome variables. 49.3% of the study participants disclosed having ever talked to a healthcare provider about HIV/acquired immune deficiency syndrome (AIDS), and 40.9% disclosed having ever talked to a family member about HIV/AIDS and sexually transmitted infections (STIs). The results from this article highlight potential barriers that may inhibit BHM from engaging in conversations about HIV with their healthcare providers and family members. It is important to include BHM in future research that focuses on HIV prevention and education to support community leaders and clinicians who work to address these disparities.

HIV-related knowledge, risk perception, and minority stressors among South Asian sexual minority men in the United States.

BACKGROUND: South Asian gay, bisexual, and other men who have sex with men (GBM) in the United States have been persistently overlooked in HIV research and programming. To address this limitation, this article describes their HIV-related knowledge, risk perception, and minority stressors, with a focus on identifying variations between American-born individuals and immigrants. METHODS: Participants were recruited from April-July 2022 through social media advertising and peer referral and surveyed about their sociodemographic and HIV-related behavioral characteristics. Previously validated scales were used to assess their HIV-related knowledge, risk perception, disclosure of sexual identity, experienced homophobia, and perceived racism within the sexual and gender minority community. Mann-Whitney-Wilcoxon tests were conducted to compare those born in the United States and those born abroad. RESULTS: Of the 112 participants, 26 (23.21%) were American-born individuals and 86 (76.79%) were immigrants. Despite similar levels of sexual risk behaviors, such as having multiple male sex partners, engaging in condomless anal sex, and using alcohol or drugs immediately before or during sex, immigrants had lower levels of HIV-related knowledge (p = .0480) and risk perception (p = .0114) compared to American-born individuals. Immigrants were also less likely to have disclosed their sexual identity to family, friends, and society compared to American-born individuals (p = .0004). No differences were identified with respect to experiences of homophobia (p = .2303) or perceptions of racism (p = .4011). CONCLUSION: Comprehensive HIV prevention efforts that address the social and cultural norms of South Asian GBM in the United States are needed.