Findings from the First Year of a Federally Funded, Direct-to-Consumer HIV Self-Test Distribution Program - United States, March 2023-March 2024.

In September 2022, CDC funded a nationwide program, Together TakeMeHome (TTMH), to expand distribution of HIV self-tests (HIVSTs) directly to consumers by mail through an online ordering portal. To publicize the availability of HIVSTs to priority audiences, particularly those disproportionately affected by HIV, CDC promoted this program through established partnerships and tailored resources from its Let's Stop HIV Together social marketing campaign. The online portal launched March 14, 2023, and through March 13, 2024, distributed 443,813 tests to 219,360 persons. Among 169,623 persons who answered at least one question on a postorder questionnaire, 67.9% of respondents were from priority audiences, 24.1% had never previously received testing for HIV, and 24.8% had not received testing in the past year. Among the subset of participants who initiated a follow-up survey, 88.3% used an HIVST themselves, 27.1% gave away an HIVST, 11.7% accessed additional preventive services, and 1.9% reported a new positive HIVST result. Mailed HIVST distribution can quickly reach large numbers of persons who have never received testing for HIV or have not received testing as often as is recommended. TTMH can help to achieve the goal of diagnosing HIV as early as possible and provides a path to other HIV prevention and care services. Clinicians, community organizations, and public health officials should be aware of HIVST programs, initiate discussions about HIV testing conducted outside their clinics or offices, and initiate follow-up services for persons who report a positive or negative HIVST result.

Message Framing Strategies to Promote the Uptake of PrEP: Results from Formative Research with Diverse Adult Populations in the United States.

There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.

RESUMEN: No existen recommendaciones basadas en evidencia para comunicar sobre la profilaxis prexposición (PrEP) como parte de un efoque más amplio de mensajes de prevención del VIH. Para informar el desarrollo de mansajes relacionados con el consumo de la PrEP, entrevistamos a 235 personas en 10 ubicaciones en los EE.UU. para explorar su comprensión y percepciones de los borradores de mensajes de prevención del VIH y evaluar sus preferencias generales por un enfoque de mensajeria amplio o centrado en la PrEP. Los participantes respondieron favorablemente y relacionadoscon ambos barradores de mensajes. Los participantes que no conocían la PrEP tenían más probabilidades de decir que el mansaje general de prevención amplia de VIH era personalmente relevent que aquellos que conocían la PrEP. No existe differencias significativas en la relevancia personal percibida para el mensaje centrado en la PrEP. Los hallazgos cualitativos sugieren que los mensajes de prevención del VIH deben utilizar términos especificos bien definidos, incluir enlaces a información adicional y utilizar un lenguaje que mejore las opciones, que enfatice la agencia personal y enmarque el llamado a la acción como una decisión informada entre una variedad de opciones de prevención efectivas.

Effectively Communicating About HIV and Other Health Disparities: Findings From a Literature Review and Future Directions.

Despite significant progress in the prevention and treatment of HIV, disparities in rates of infection remain among key groups in the United States, including blacks and African Americans; Hispanics/Latinos; and men who have sex with men (MSM). The U.S. Department of Health and Human Services' initiative, Ending the HIV Epidemic: A Plan for America, calls for addressing HIV-related disparities and reducing stigma and discrimination associated with HIV. The goal of this literature review was to identify approaches for effectively communicating about health disparities across the HIV care continuum. We reviewed the literature to investigate strategies used to communicate health disparities and to identify potential unintended adverse effects resulting from this messaging. Messages about health disparities often target subgroups at higher risk and can be framed in a variety of ways (e.g., social comparison, progress, impact, etiological). Studies have examined the effects of message framing on the risk perceptions, emotional reactions, and behaviors of individuals exposed to the messaging. The evidence points to several potential unintended adverse effects of using social comparison framing and individual responsibility framing to communicate about health disparities, and visual images and exemplars to target messages to higher-risk subgroups. There is not yet a clear evidence-based approach for communicating about health disparities and avoiding potential unintended effects. However, we offer recommendations for communicating about HIV-related disparities based on our findings. Because we found limited literature that addressed our research questions in the context of HIV, we propose a research agenda to build an evidence base for developing effective messages about HIV-related disparities.

Testing Makes Us Stronger™: Evaluating the correlation between exposure and intermediate outcomes targeted by the campaign's messages.

OBJECTIVES: To examine whether self-reported exposure to Testing Makes Us Stronger™ (TMUS), an HIV testing health communication campaign for black gay, bisexual, and other men who have sex with men (BMSM), was associated with key intermediate outcomes targeted by the campaign's messages. METHODS: Data from sexually active, HIV-negative or unknown status BMSM aged 18-44 (N = 590) were collected through an anonymous Web-based survey that measured sociodemographics, campaign exposure, attitudinal beliefs, normative beliefs, self-efficacy, and HIV testing intentions, among other variables. The association between exposure to TMUS and intermediate outcomes was evaluated using propensity-score weight adjusted correlations. RESULTS: Exposure to TMUS was high (43%) among the priority audience. Exposure to the campaign was correlated with 8 of 11 intermediate outcomes measured, including key attitudinal beliefs about the accessibility of the test and benefits to the individual, injunctive norms, self-efficacy, and HIV testing intention. CONCLUSION: Adhering to principles of effective campaign design, such as using theory as a conceptual foundation for message design, can increase a campaign's chances for successfully meeting its goals and objectives. PRACTICE IMPLICATIONS: Findings from this study can be used to inform message design for other communication efforts to promote HIV testing among BMSM.

HIV information needs of transgender people and their healthcare providers.

Despite the disproportionate burden of HIV among transgender people in the United States, few HIV-related communication materials exist for transgender people or their healthcare providers. Our goal was to understand the barriers and facilitators transgender people face in accessing HIV prevention, testing, and care services and the potential implications for message development and dissemination. We reviewed the literature and interviewed nine key informants representing healthcare and service providers, researchers, and transgender advocates. Healthcare providers who care for transgender patients often demonstrate a lack of transgender competent care strategies. In addition, transgender people face many barriers to accessing HIV services. Although communication materials cannot address many of these barriers, materials specifically developed for transgender people and their healthcare providers would fill a gap and may increase uptake of HIV services. Materials for transgender people should include gender-affirming messaging and imagery, be framed in terms of resiliency, and present HIV information tailored to the needs of transgender people. Materials for healthcare providers should provide basic information to increase transgender competency and provision of comprehensive healthcare for transgender patients, inclusive of gender-affirming and HIV prevention, testing and care services. Channels for disseminating materials to transgender people and healthcare providers are described.

An Interrupted Time Series Evaluation of the Testing Makes Us Stronger HIV Campaign for Black Gay and Bisexual Men in the United States.

Black gay, bisexual, and other men who have sex with men (BMSM) are the subpopulation most disproportionately affected by HIV in the United States. Testing Makes Us Stronger (TMUS), a communication campaign designed to increase HIV testing rates among BMSM ages 18 to 44, was implemented in the United States from December 2011 through September 2015. We used interrupted time series analysis (ITSA) to compare pre- and post-campaign trends in monthly HIV testing events among the priority audience in six of the implementation cities from January 2011 through December 2014. In the 11 months prior to the launch of TMUS, HIV testing events among BMSM in the six campaign implementation cities decreased by nearly 35 tests per month (p = .021). After the introduction of TMUS, the number of HIV testing events among BMSM in the same cities increased by more than 6 tests per month (p = .002). ITSA represents a quasi-experimental technique for investigating campaign effects beyond underlying time trends when serial outcome data are available. Future evaluations can be further strengthened by incorporating a comparison group to account for the effects of history and maturation on pre- and post-campaign trends.

Differences Between Florida and the Rest of the United States in Response to Local Transmission of the Zika Virus: Implications for Future Communication Campaigns.

For those at risk for Zika virus infection, prevention requires an approach that includes individual, interpersonal, and community-level support for behavior change. In August 2016, the announcement of local Zika transmission in Florida provided an opportunity to determine whether Zika-related knowledge, attitudes, and behaviors might be affected differentially in Florida compared to the rest of the nation. From August 8-October 3, 2016, we conducted nationally representative weekly surveys (N = 12,236), oversampling Florida residents, measuring Zika virus news exposure, knowledge about transmission and prevention of the infection, and attitudes and behaviors toward prevention. We tested two classes of models: those focused on individual Zika risk perceptions (e.g., protection motivation theory) and one focused on community action beyond those directly at risk (social consensus model). Analyses assessed differences between Florida and the rest of the nation by survey week. Consistent with both models, Floridians demonstrated significantly higher levels of perceived susceptibility and knowledge, more positive attitudes toward Zika virus prevention, and higher likelihood of engaging in protective behavior than non-Floridians. Consistent with theories of individual risk perception, response was greater among respondents who saw themselves at risk of infection. However, consistent with the SCM, irrespective of personal risk, response was greater among Floridians. Nevertheless, more than half of the public took no direct action to prevent the spread of Zika. Communities at increased risk for a novel infection such as Zika may quickly acquire Zika-related knowledge, attitudes, and behavior, but large-scale community-wide response might be difficult without further community-level public education.

Swipe Right: Dating Website and App Use Among Men Who Have Sex With Men.

This study explored the frequency of dating website and app usage among MSM to understand sub-group differences in use. Web-based survey data (N = 3105) were analyzed to assess the use of dating websites and apps. More than half (55.7%) of MSM in this sample were frequent users of dating websites and apps. Two-thirds (66.7%) of frequent users had casual partners only in the past 12 months and reported a high average number of casual sexual partners in the past 12 months (Mdn = 5.0) compared to never users (Mdn = 0.0; χ 2(2) = 734.94, adj. p < .001). The most frequently used dating website or app was Grindr, with 60.2% of the sample reporting some or frequent use. Adam4Adam (23.5%), Jack'd (18.9%) and Scruff (18.7%) were also frequently used. Dating websites and apps may be effective channels to reach a diverse group of MSM with HIV prevention messages.

CDC'S Testing Makes Us Stronger (TMUS) Campaign: Was Campaign Exposure Associated With HIV Testing Behavior Among Black Gay and Bisexual Men?

This study assessed exposure among Black gay, bisexual, and other men who have sex with men (BMSM) to a communication campaign, Testing Makes Us Stronger (TMUS), and its association with HIV testing to determine campaign effectiveness. Data from an online survey (N = 3,105) were analyzed using propensity score weight-adjusted logistic regression to examine the effect of exposure on HIV testing. Among BMSM aged 18-44 (n = 702), 43.2% reported TMUS exposure. The majority of those exposed were aged 25-34 (54%), HIV-negative (65%), and had some college education (87%). TMUS exposure was associated with reported increased HIV testing behaviors at 6- and 12-month frequencies. Communication campaigns with clear implementation strategies, focused objectives, and online and event presence can be associated with longer-term outcomes such as HIV testing.

PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States, 2009-2015.

OBJECTIVES: As trials were assessing the safety and efficacy of daily oral antiretroviral preexposure prophylaxis (PrEP) for the prevention of HIV infection, there was a clear need to understand the evolution of knowledge of, and attitudes toward, PrEP among primary care clinicians. METHODS: Physicians and nurse practitioners were surveyed in 2009 (n = 1500), 2010 (n = 1504), 2012 (n = 1503), 2013 (n = 1507), 2014 (n = 1508) and 2015 (n = 1501) to assess their awareness of PrEP, willingness to prescribe PrEP, and whether they support use of public funds to pay for PrEP. Pharmacists (n = 251) were surveyed about PrEP in 2012 only. Descriptive statistics were computed for physician demographics and PrEP-related questions. Prevalence ratios for willingness to prescribe PrEP were computed using Poisson regression analysis. RESULTS: Awareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 66%). Following a description of PrEP with an estimated effectiveness of 75%, across 6 of the study years 91% of clinicians indicated a willingness to prescribe PrEP to at least one group at high risk of HIV acquisition. A smaller majority of clinicians indicated support for public funding of PrEP in 2009: 59%, 2010: 53%, and 2013: 63%. CONCLUSIONS: In surveys conducted before and after the release of PrEP trial results, primary care clinicians were largely unaware of PrEP. They indicated high levels of willingness to prescribe it for patients at high risk of HIV acquisition and expressed interest in education about how to deliver this new clinical HIV prevention method. It will be important to continue monitoring clinician knowledge, attitudes, and practices as the use of PrEP increases in the US.

Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus--United States, 2016.

CDC issued interim guidance for the prevention of sexual transmission of Zika virus on February 5, 2016. The following recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners. These recommendations replace the previously issued recommendations and are updated to include time intervals after travel to areas with active Zika virus transmission or after Zika virus infection for taking precautions to reduce the risk for sexual transmission. This guidance defines potential sexual exposure to Zika virus as any person who has had sex (i.e., vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who has traveled to or resides in an area with active Zika virus transmission. This guidance will be updated as more information becomes available.

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus - United States, 2016.

Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (1,2). Infection with Zika virus is asymptomatic in an estimated 80% of cases (2,3), and when Zika virus does cause illness, symptoms are generally mild and self-limited. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly (4,5), as well as a possible association with Guillain-Barré syndrome. Currently, no vaccine or medication exists to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites (http://www.cdc.gov/zika/prevention/).

Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015.

BACKGROUND: In 2014, approximately 40,000 persons in the United States received a diagnosis of human immunodeficiency virus (HIV) infection. Preexposure prophylaxis (PrEP) with daily oral antiretroviral medication is a new, highly effective intervention that could reduce the number of new HIV infections. METHODS: CDC analyzed nationally representative data to estimate the percentages and numbers of persons in the United States, by transmission risk group, with indications for PrEP consistent with the 2014 U.S. Public Health Service's PrEP clinical practice guideline. RESULTS: Approximately 24.7% of sexually active adult men who have sex with men (MSM) (492,000 [95% confidence interval {CI} = 212,000-772,000]), 18.5% of persons who inject drugs (115,000 [CI = 45,000-185,000]), and 0.4% of heterosexually active adults (624,000 [CI = 404,000-846,000]), had substantial risks for acquiring HIV consistent with PrEP indications. CONCLUSIONS: Based on current guidelines, many MSM, persons who inject drugs, and heterosexually active adults have indications for PrEP. A higher percentage of MSM and persons who inject drugs have indications for PrEP than heterosexually active adults, consistent with distribution of new HIV diagnoses across these populations. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Clinical organizations, health departments, and community-based organizations should raise awareness of PrEP among persons with substantial risk for acquiring HIV infection and their health care providers. These data can be used to inform scale-up and evaluation of PrEP coverage. Increasing delivery of PrEP and other highly effective HIV prevention services could lower the number of new HIV infections occurring in the United States each year.

Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015.

BACKGROUND: In 2014, approximately 40,000 persons in the United States received a diagnosis of human immunodeficiency virus (HIV) infection. Preexposure prophylaxis (PrEP) with daily oral antiretroviral medication is a new, highly effective intervention that could reduce the number of new HIV infections. METHODS: CDC analyzed nationally representative data to estimate the percentages and numbers of persons in the United States, by transmission risk group, with indications for PrEP consistent with the 2014 U.S. Public Health Service's PrEP clinical practice guideline. RESULTS: Approximately 24.7% of sexually active adult men who have sex with men (MSM) (492,000 [95% confidence interval {CI} = 212,000-772,000]), 18.5% of persons who inject drugs (115,000 [CI = 45,000-185,000]), and 0.4% of heterosexually active adults (624,000 [CI = 404,000-846,000]), had substantial risks for acquiring HIV consistent with PrEP indications. CONCLUSIONS: Based on current guidelines, many MSM, persons who inject drugs, and heterosexually active adults have indications for PrEP. A higher percentage of MSM and persons who inject drugs have indications for PrEP than heterosexually active adults, consistent with distribution of new HIV diagnoses across these populations. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Clinical organizations, health departments, and community-based organizations should raise awareness of PrEP among persons with substantial risk for acquiring HIV infection and their health care providers. These data can be used to inform scale-up and evaluation of PrEP coverage. Increasing delivery of PrEP and other highly effective HIV prevention services could lower the number of new HIV infections occurring in the United States each year.

The changing marketing of smokeless tobacco in magazine advertisements.

INTRODUCTION: Concerns about secondhand smoke, increasing indoor smoking bans, and health concerns regarding cigarettes are contributing to the development of new smokeless tobacco (ST) products by the tobacco industry and the repositioning of traditional ST products. The objective of this research was to systematically document the changing advertising strategies and themes of the ST industry. METHODS: Using descriptive content analysis, this study analyzed 17 nationally circulated magazines for ST advertisements (ads) from 1998-1999 and 2005-2006, recording both magazine and advertisement characteristics (e.g., themes, selling proposition, people portrayed, and setting/surroundings.) Ninety-five unique ads were found during the two time periods-occurring with total frequency of 290 ad placements in 816 issues. One hundred ninety-one ads were found in the 2005-2006 sample, while 99 were found in the 1998-1999 magazines. RESULTS: Significant differences in ST ads were identified between time periods and magazine types. A greater percentage of ads were found in the latter time period, and the average number of ads per issue increased (0.24 in 1998-1999 and 0.49 in 2005-2006, p < .001). More recent magazines and general adult magazines contained a greater proportion of flavored products, "alternative to cigarette" messages, and indoor settings when compared with earlier magazines and men's magazines, respectively. CONCLUSIONS: While continuing to advertise in men's magazines with themes appealing to men and "traditional" ST users, the ST industry appears to be simultaneously changing its message placement and content in order to include readers of general adult magazines who may not currently use ST.

Making sense of cancer news coverage trends: a comparison of three comprehensive content analyses.

Cancer stories (N = 5,327) in the top 50 U.S. newspapers were analyzed by a team of four coders and the results were compared with the earliest analyses of this type (from 1977 and 1980). Using cancer incidence rates as a comparison, three cancers were found to be consistently underreported (male reproductive, lymphatic/Hodgkin's, and thyroid) and four cancers were found to be consistently overreported (breast, blood/Leukemia, pancreatic, and bone/muscle). In addition, cancer news coverage consistently has focused on treatment rather than on other aspects of the cancer continuum (e.g., prevention), portrayed lifestyle choices (e.g., diet, smoking) as the most common cancer risk factor, and rarely reported incidence or mortality data. Finally, the data were compatible with the idea that personalization bias (e.g., celebrity profiles, event coverage) may explain some news coverage distortions.

An exploratory study of factors influencing glaucoma treatment adherence.

PURPOSE: To understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping to develop an intervention for a specific population. PATIENTS AND METHODS: In-depth interviews were conducted with 80 individuals diagnosed with open-angle glaucoma, glaucoma suspect, or ocular hypertension. Additional eligibility requirements were that all participants were: between the ages of 18 to 80; white or African American; spoke and understood English; and were taking daily doses of topical glaucoma treatments for at least the past year. Cross-tabulations and chi2 tests were conducted to compare adherent and nonadherent individuals, classified as such based on self-report and medical chart/pharmacy data. RESULTS: Compared with adherent participants, nonadherent participants were less likely to: believe their eye doctors spent sufficient time with them; ask their eye doctor if they had any questions; know of benefits to taking their glaucoma medication regularly; and have someone help them take their glaucoma medications or drive them to eye appointments. Conversely, compared with adherent individuals, nonadherent participants were more likely to have difficulty remembering to take their medications and to believe their glaucoma would affect their eye sight in the future. CONCLUSIONS: Nonadherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care. Interventions are needed to address these modifiable factors related to glaucoma treatment adherence.

Frequently cited sources in cancer news coverage: a content analysis examining the relationship between cancer news content and source citation.

The media are a frequent and sometimes sole source of cancer information for many people. News coverage of cancer can be influential to cancer-related practices such as prevention or detection behaviors, and sources cited by journalists may be influential in shaping this coverage. A content analysis (n = 3,656 stories) revealed that the most frequently cited sources in cancer news articles-research institutions and medical journals-receive disproportionately more attention compared to the National Cancer Institute (NCI), the American Cancer Society (ACS), and pharmaceutical companies. Research institutions were cited twice as frequently as medical journals, and more than three times as frequently as pharmaceutical companies. Most clinical trial stories were optimistic or neutral in tone, and tone was significantly related to citations of pharmaceutical companies and medical journals. Implications for effects of cancer coverage on behaviors, and the influence of sources such as research institutions and pharmaceutical companies, are discussed.

Cancer risk communication in mainstream and ethnic newspapers.

INTRODUCTION: We wanted to understand how cancer risks are communicated in mainstream and ethnic newspapers, to determine whether the 2 kinds of newspapers differ and to examine features of news stories and sources that might predict optimal risk communication. METHODS: Optimal risk communication was defined as presenting the combination of absolute risk, relative risk, and prevention response efficacy information. We collected data by conducting a content analysis of cancer news coverage from 2003 (5,327 stories in major newspapers, 565 stories in ethnic newspapers). Comparisons of mainstream and ethnic newspapers were conducted by using cross-tabulations and Pearson chi2 tests for significance. Logistic regression equations were computed to calculate odds ratios and 95% confidence intervals for optimal risk communication. RESULTS: In both kinds of newspapers, cancer risks were rarely communicated numerically. When numeric presentations of cancer risks were used, only 26.2% of mainstream and 29.5% of ethnic newspaper stories provided estimates of both absolute and relative risk. For both kinds of papers, only 19% of news stories presented risk communication optimally. Cancer risks were more likely to be communicated optimally if they focused on prostate cancer, were reports of new research, or discussed medical or demographic risks. CONCLUSION: Research is needed to understand how these nonnumeric and decontextualized presentations of risk might contribute to inaccurate risk perceptions among news consumers.

Effects of newspaper coverage on public knowledge about modifiable cancer risks.

This study explores the relationship between cancer newspaper coverage and public knowledge about cancer prevention, confirming self-reported associations between news exposure and cancer prevention knowledge with descriptions of newspaper coverage of modifiable cancer risks. Content analyses (N = 954) revealed that newspapers pay relatively little attention to cancer prevention. However, there is greater newspaper attention to tobacco and diet than to exercise, sun, and alcohol. Survey analysis (the National Cancer Institute's Health Information National Trends Survey) revealed that after controlling for differences based on gender, race, age, income, and education, attention to health news was significantly associated with knowledge about cancer risks associated with food and smoking but not for knowledge about exercise, sun, or alcohol. These findings conform to the findings of the content analysis data and provide a validation of a self-reported measure of media exposure, as well as evidence suggesting a threshold below which news coverage may not generate public knowledge about cancer prevention.