RESUMEN
BACKGROUND: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. OBJECTIVE: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. METHODS: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. RESULTS: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. CONCLUSIONS: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults.
Asunto(s)
Infecciones por VIH , Enfermedades de Transmisión Sexual , Envío de Mensajes de Texto , Adulto Joven , Adolescente , Humanos , Reproducibilidad de los Resultados , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/prevención & control , Atención a la Salud , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & controlRESUMEN
AIMS: To investigate the self-reported impact of COVID-19 measures on access to testing for HIV and other sexually transmitted infections (STIs) and condoms and factors associated with reduced access among adults in Sweden. METHODS: Cross-sectional data were collected in late 2020 through a web panel with adults (18-49 years) in Sweden as part of the International Sexual Health And REproductive health survey (I-SHARE) (N=1307). The primary outcome was self-reported access to HIV/STI testing and condoms during COVID-19 measures. Logistic regression was used to assess adjusted odds ratios of experiencing reduced access to HIV/STI testing and condoms in relation to sociodemographic characteristics, changes in sexual behaviours and COVID-19-related factors. RESULTS: Of the 1138 sexually active respondents, 17% wanted an HIV/STI test, and of those over half (57%) reported reduced access during the COVID-19 measures in 2020. Compared with cis-women, transgender or non-binary respondents were more likely to experience lower access to testing. Among those who usually used condoms (n=568), 23% reported hampered condom access due to COVID-19 restrictions. Reduced condom access was associated with identifying as non-cis gender and a cis-man compared with cis-woman, non-heterosexual orientation, being foreign-born and financially worried. CONCLUSIONS: Findings indicate that access to HIV/STI testing and condoms among sexually active adults of reproductive age in Sweden was disrupted during the COVID-19 pandemic in 2020 with varied impact depending on sexual orientation, gender identity or socioeconomic situation. This signals the importance of ensuring equitable access to sexual and reproductive health services and commodities in future crises response.
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COVID-19 , Condones , Infecciones por VIH , Prueba de VIH , Accesibilidad a los Servicios de Salud , Enfermedades de Transmisión Sexual , Humanos , Suecia/epidemiología , Adulto , Estudios Transversales , COVID-19/prevención & control , COVID-19/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Adolescente , Adulto Joven , Condones/estadística & datos numéricos , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Prueba de VIH/estadística & datos numéricosRESUMEN
We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.
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Trazado de Contacto/métodos , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Aplicaciones Móviles , Parejas Sexuales , Teléfono Inteligente , Sífilis/diagnóstico , Revelación de la Verdad , Adulto , Anciano , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Sífilis/prevención & control , Sífilis/psicología , Adulto JovenRESUMEN
Justice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.
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Derecho Penal , Atención a la Salud/organización & administración , Infecciones por VIH/prevención & control , Prueba de VIH/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Delincuencia Juvenil , Salud Pública , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Humanos , Tamizaje Masivo , Conducta Social , Estados UnidosRESUMEN
BACKGROUND: Justice-involved young adults (JIYA) aged 18-24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers. METHODS: MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months. DISCUSSION: This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.
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Acceptability of rapid HIV self-testing is high but potential users remain concerned about correct use, interpretation of test results, and linkage to care. This article describes user preferences for a smartphone app to mitigate these challenges and how these were integrated into the SMARTtest app to support self- and partner-testing using the INSTI Multiplex®. Sixty men and transgender women who have sex with men self-tested for HIV and syphilis while guided by a prototype app that provided a video, pictorial step-by-step instructions, and sample test results presented textually ("positive," "negative"). Subsequently, participants provided feedback on revisions and additional app content. Participants recommended offering different user modes (self, partner, both), and retaining the video, step-by-step instructions, and textual test results. They strongly favored the ability to save and send test results to sexual partners or providers. These features were integrated into the SMARTtest app to facilitate HIV/syphilis self- and partner-testing, HIV/syphilis status awareness and disclosure, and linkage to care.
Asunto(s)
Infecciones por VIH , Teléfono Inteligente , Sífilis , Adulto , Anciano , Femenino , Identidad de Género , Infecciones por VIH/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Parejas Sexuales , Sífilis/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. METHODS: We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year. We obtained information on individual demographics, clinical practice, attitudes toward MSM, and interest in contributing to MSM clinical services. We defined an MSM-competent physician as one who asked male patients about sexual orientation, sexual practices, and recommended HIV/ STI testing during a clinic visit. We conducted multivariable logistic regression to identify factors associated with MSM competency. RESULTS: In total, 501 physicians completed the survey. The most common subspecialties were dermatovenereology (33.1%), urology (30.1%), and general medicine (14.4%). Roughly half (n = 267, 53.3%) reported seeing MSM in the past 12 months. Among physicians who saw MSM in the past 12 months, 60.3% (n = 161) met criteria as MSM-competent physicians, and most (n = 234, 87.6%) MSM-competent physicians reported positive or neutral attitudes towards MSM. Over 60% of all physicians were willing to participate in activities for improving MSM services, such as training and being on a list of physicians willing to serve MSM. MSM-competent physicians showed no sociodemographic differences compared with non MSM-competent physicians. MSM-competent physicians were more willing to have their medical institution named on a public clinic list capable of serving MSM (aOR: 1.70, 95%CI: 1.01-2.86) and being on a public physician list capable of serving MSM (aOR: 1.77, 95%CI: 1.03-3.03). CONCLUSIONS: MSM-competent physicians included a broad range of individuals that practiced in diverse clinical settings. Most physicians were interested in improving and expanding MSM clinical services, despite having neutral attitudes toward same-sex behavior. Future interventions should focus on developing MSM clinical competency and expanding services that meet the needs of MSM.
Asunto(s)
Competencia Clínica/normas , Médicos/normas , Enfermedades de Transmisión Sexual/terapia , Adulto , Anciano , Actitud del Personal de Salud , China , Medicina Clínica/normas , Medicina Clínica/estadística & datos numéricos , Estudios Transversales , Atención a la Salud/normas , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/terapia , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Médicos/psicología , Sexología/normas , Sexología/estadística & datos numéricos , Conducta Sexual , Salud Sexual/normas , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/psicología , Encuestas y Cuestionarios , Urología/normas , Urología/estadística & datos numéricos , Venereología/normas , Venereología/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: To describe medical services provided to sexual assault patients in US emergency departments and to identify the percentage of hospitals always providing the 10 elements of comprehensive medical care management (CMCM). METHODS: A cross-sectional study was conducted in a national sample of US hospitals. A 26-item telephone survey assessed provision of services to sexual assault survivors in accordance with CMCM. Management included acute medical care comprising history and physical examination; acute and long-term rape crisis counseling; STI testing and prophylaxis; emergency contraception counseling and provision; and HIV testing and prophylaxis. The primary outcome was extent of provision of these elements. RESULTS: Overall, 582 emergency departments responded to the survey. The following components of CMCM were provided: acute medical care (582 [100.0%]); rape crisis counseling (234 [40.2%]); STI management (448 [77.0%]); emergency contraception (351 [60.3%]); and HIV management (380 [65.3%]). Only 101 (17.4%) hospitals provided all 10 elements of CMCM. CONCLUSION: Less than one-fifth of US hospitals provide comprehensive services to sexual assault patients. A national program incorporating clinical guidelines, checklists, and funding for sexual assault forensic/nurse examiner programs could improve the standard of care provided in emergency departments-the primary point of contact for acute care of sexual assault survivors.