Acceptability of Three Novel HIV Prevention Methods among Young Male and Transgender Female Sex Workers in Puerto Rico

Sex workers need HIV-prevention methods they can control and incorporate easily in their work. We studied the acceptability of three methods: HIV self-test use with clients, oral pre-exposure prophylaxis (PrEP), and rectal microbicide gel. 

Four male and eight transgender female (TGF) sex workers in Puerto Rico completed a baseline survey with a quantitative measure of likelihood of use. From them, one male and four TGF also completed a 12-week study of rectal microbicide placebo gel use prior to receptive anal intercourse with male clients and evaluated via qualitative in-depth interviews and follow-up quantitative assessments how each method could be incorporated into their work. 

Most were interested in a rectal microbicide gel and able to use it covertly with clients. Challenges to using the HIV self-test with clients included the potential for both breach of confidentiality and confronting violent situations. Participants also expressed interest in oral PrEP, but raised concerns about side effects.

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By:  Giguere R1, Frasca T2, Dolezal C2, Febo I3, Cranston RD4, Mayer K5, McGowan I4, Carballo-Diéguez A2.

• 1Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA. giguere@nyspi.columbia.edu.
• 2Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
• 3Department of Pediatrics, Gama Project, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA.
• 4School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
• 5Fenway Health, Fenway Institute, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
• AIDS Behav. 2016 Apr 5. 

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HIV-Related Stigma and HIV Prevention Uptake among Young Men Who Have Sex with Men and Transgender Women in Thailand

HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. 

From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). 

Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. 

Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. 

Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention.

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By:  Logie CH1, Newman PA1, Weaver J1, Roungkraphon S2, Tepjan S1.

• 1 Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada .
• 2 Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon , Bangkok, Thailand .

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Perceptions among Dutch Men Who Have Sex with Men & Their Willingness to Use Rectal Microbicides & Oral Pre-Exposure Prophylaxis to Reduce HIV Risk

Oral pre-exposure prophylaxis (PrEP) with antiretroviral (ARV) tablets and topical PrEP or microbicides containing ARV drugs could help to reduce HIV incidence. These methods hold promise for men who have sex with men (MSM) who are at higher risk of acquiring HIV. 

This mixed-methods study in the Netherlands explored perceptions of MSM and their willingness to use oral PrEP and rectal microbicides (RM) if made available. Recruited through social media (Facebook and Twitter), 108 MSM completed online questionnaires. Seven of them consented to discuss the survey results in semi-structured interviews. 

Survey participants preferred a RM that could be applied before and after anal intercourse (60.8%) to daily oral PrEP (20.3%). This preference was based on anticipated user friendliness, hypothetically fewer expected adverse events, and perceptions that RM would be less likely to be confused with ARVs for treatment. 

Those who preferred oral PrEP had stronger beliefs in the effectiveness of pills, perceived its use as easy, and viewed not requiring sexual partner awareness as advantages. No predictive factors were found for the choice of one prevention method over the other. Although Dutch MSM perceive both oral and topical PrEP positively, many barriers exist to the introduction of these products in the Netherlands. These include lack of regulatory approval of oral PrEP, no proven efficacy as yet for RM, and strong HIV stigma within the MSM population. 

In-depth qualitative research is needed to further explore the perceptions of MSM to inform implementation of programmes should these HIV prevention methods become available.

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By:   Marra E1, Hankins CA1,2.

• 1a Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands.
• 2b London School of Hygiene and Tropical Medicine , Amsterdam , The Netherlands. 

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Using Conjoint Analysis to Determine the Impact of Product & User Characteristics on Acceptability of Rectal Microbicides for HIV Prevention among Peruvian Men Who Have Sex with Men

OBJECTIVES:

Men who have sex with men (MSM) are in need of novel and acceptable HIV prevention interventions. In Peru, a Phase II clinical trial was recently completed evaluating rectally applied tenofovir gel among Peruvian MSM and transgender women. If deemed safe and acceptable, the product could move into efficacy testing, but acceptability data for similar products are needed now in order to prepare for future implementation. Peru is in need of expanded, national acceptability data among likely users.

METHODS:

Using conjoint analysis of an online cross-sectional survey taken by 1008 Peruvian MSM and transgender women, we tested the acceptability of eight hypothetical rectal microbicide (RM) products comprising six, dual-value attributes. We also assessed the relationship of select product attributes with sample characteristics.

RESULTS:

Highest acceptability was found for a RM that was 90% effective, used before and after sex, without side effects, costing approximately $0.30, had no prescription requirement and had a single-use applicator. Product effectiveness and presence of side effects were the factors most likely to drive RM acceptance and use. Education, sexual orientation, sexual role and concern for HIV infection were also related to aspects of RM acceptability.

CONCLUSION:

RM acceptability was high, confirming the results of earlier, smaller studies and placing confidence in the acceptability of RMs. Analysis of the relationships with product attributes and sample characteristics underscore the need to consider the impact of factors such as sexual orientation, sexual role, level of education and concern for HIV acquisition on RM acceptability.

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Sex Transm Infect doi:10.1136/sextrans-2015-052028

By:  Tang EC1, Galea JT2, Kinsler JJ3, Gonzales P4, Sobieszczyk ME5, Sanchez J6, Lama JR6.

• 1Columbia University College of Physicians & Surgeons, New York, New York, USA.
• 2Epicentro Salud, Lima, Peru Socios En Salud, Lima, Peru.
• 3Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
• 4Asociación Civil Impacta Salud y Educación, Lima, Peru.
• 5Columbia University College of Physicians & Surgeons, New York, New York, USA Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York, USA.
• 6Asociación Civil Impacta Salud y Educación, Lima, Peru Department of Global Health, University of Washington, Seattle, Washington, USA.

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Anal Douche Practices and Willingness to Use a Rectal Microbicide Enema for HIV Prevention and Associated Factors among an Internet Sample of HIV-Negative and HIV-Discordant Male Couples in the US

A significant proportion of MSM acquire HIV from their primary relationship partners. Rectal microbicides are currently being studied to determine their efficacy for HIV prevention, yet willingness to use rectal microbicides among male couples is largely unknown. 

Dyadic data from 333 HIV-negative and HIV-discordant male couples, representing 631 HIV-negative men, were used to assess anal douching practices and willingness to use a rectal microbicide for HIV prevention. 17 % of men douched 100 % of the time before having anal sex within their primary partner. 

Among those who had sex outside of their relationship, 36% had douched 100% of the time before having anal sex with a casual MSM partner. Most men (63 %) indicated a willingness to use a theoretically effective rectal microbicide prior to anal sex for HIV prevention. 

If found effective, rectal microbicides delivered as an anal douche may be an acceptable format for HIV prevention to some MSM who already engage in anal douching. Understanding current douching practices will be important in successfully promoting the uptake of rectal microbicides.

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By:  Mitchell JW1, Sophus AI2, Lee JY3, Petroll AE4.

• 1Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 1021, Miami, FL, 33136, USA. jwm35@med.miami.edu.
• 2Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 1021, Miami, FL, 33136, USA. axs840@miami.edu.
• 3Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 1021, Miami, FL, 33136, USA. jxl636@miami.edu.
• 4Division of Infectious Diseases, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA. apetroll@mcw.edu. 

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Condoms, Lubricants & Rectal Cleansing: Practices Associated with Heterosexual Penile-Anal Intercourse amongst Participants in an HIV Prevention Trial in South Africa, Uganda & Zimbabwe

We investigated condom and lubricant use, rectal cleansing and rectal gel use for penile-anal intercourse (PAI), during in-depth interviews with women from South Africa, Uganda and Zimbabwe who formerly participated in VOICE, a five-arm HIV prevention trial of two antiretroviral tablets and a vaginal gel. 

Few studies have addressed practices related to PAI among women; existing data from Africa on condom and lubricant use for PAI, as well as preparatory practices of PAI such as rectal cleansing, are limited to men who have sex with men. Women demonstrated a lack of awareness of HIV transmission risks of PAI and none of the participants reported using condom-compatible lubricants for PAI. 

Participants described a variety of preparatory rectal cleansing practices. Some participants disclosed rectal use of the vaginal study gel. Understanding practices related to PAI in Africa is critical to microbicide development, as these practices are likely to influence the acceptability, feasibility, and use of both vaginal and rectal microbicide products.

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By: Duby Z1, Hartmann M, Montgomery ET, Colvin CJ, Mensch B, van der Straten A.

• 1Department of Medicine, Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa, zoe.duby@gmail.com.  

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