scholarly journals Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco

10.2196/13241 ◽  
2019 ◽  
Vol 7 (5) ◽  
pp. e13241 ◽  
Author(s):  
Caitlin M Turner ◽  
Sean Arayasirikul ◽  
Dillon Trujillo ◽  
Victory Lê ◽  
Erin C Wilson
Keyword(s):  
San Francisco ◽  
Young Men ◽  
Structural Barriers ◽  
Social Inequity ◽  
Women Living With Hiv ◽  
Trans Women ◽  
Ecological Momentary Assessments ◽  
Sex With Men ◽  
Ecological Momentary ◽  
Living With Hiv

scholarly journals Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco (Preprint)

2018 ◽  
Author(s):  
Caitlin M Turner ◽  
Sean Arayasirikul ◽  
Dillon Trujillo ◽  
Victory Lê ◽  
Erin C Wilson
Keyword(s):  
San Francisco ◽  
Basic Needs ◽  
Young Men ◽  
Structural Barriers ◽  
Social Inequity ◽  
Young Msm ◽  
Sex With Men ◽  
Ecological Momentary ◽  
Living With Hiv

BACKGROUND Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. OBJECTIVE We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. METHODS A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. RESULTS Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. CONCLUSIONS Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV.

Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study

Sexual Health ◽  
2019 ◽  
Vol 16 (4) ◽  
pp. 367 ◽  
Author(s):  
Ashley Lacombe-Duncan ◽  
Peter A. Newman ◽  
Greta R. Bauer ◽  
Carmen H. Logie ◽  
Yasmeen Persad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Providers ◽  
Structural Barriers ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Trans Women ◽  
Living With Hiv

Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.

scholarly journals Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study (Preprint)

2020 ◽  
Author(s):  
Caitlin Marie Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson ◽  
Sean Arayasirikul
Keyword(s):  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Targeted Interventions ◽  
Young Msm ◽  
Trans Women ◽  
Sex With Men ◽  
Living With Hiv

BACKGROUND Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. OBJECTIVE The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. METHODS Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. RESULTS Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. CONCLUSIONS Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study

10.2196/22733 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e22733
Author(s):  
Caitlin Marie Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson ◽  
Sean Arayasirikul
Keyword(s):  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Targeted Interventions ◽  
Young Msm ◽  
Trans Women ◽  
Sex With Men ◽  
Living With Hiv

Background Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. International Registered Report Identifier (IRRID) RR2-10.2196/16406

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

(Dis)integrated Care: Barriers to Health Care Utilization for Trans Women Living With HIV

2017 ◽  
Vol 28 (5) ◽  
pp. 708-722 ◽  
Author(s):  
Lauren Munro ◽  
Zack Marshall ◽  
Greta Bauer ◽  
Rebecca Hammond ◽  
Caleb Nault ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Integrated Care ◽  
Care Utilization ◽  
Barriers To Health Care ◽  
Women Living With Hiv ◽  
Trans Women ◽  
Living With Hiv ◽  
Barriers To Health

Resilience, Physical Activity, and Depression in Women Living With HIV in the San Francisco Bay Area

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Patricia R. Ambrose ◽  
Yvette P. Cuca ◽  
Glenda N. Baguso ◽  
Thomas J. Hoffmann ◽  
Carol Dawson-Rose
Keyword(s):  
Physical Activity ◽  
San Francisco ◽  
San Francisco Bay ◽  
San Francisco Bay Area ◽  
Bay Area ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Acceptability of ecological momentary assessment among young men who have sex with men

2017 ◽  
Vol 14 (4) ◽  
pp. 436-444 ◽  
Author(s):  
Dustin T. Duncan ◽  
Farzana Kapadia ◽  
Thomas R. Kirchner ◽  
William C. Goedel ◽  
William J. Brady ◽  
...  
Keyword(s):  
Ecological Momentary Assessment ◽  
Young Men ◽  
Sex With Men ◽  
Ecological Momentary ◽  
Momentary Assessment
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