Search

Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake. [ABSTRACT FROM AUTHOR]

For gay, bisexual, and men who have sex with men (GBMSM), sexual versatility encompasses both insertive (top) and receptive (bottom) sexual practices. By contrast, "total top" and "total bottom" roles are often marginalized by those who advocate versatile roles for GBMSM. This article explores how GBMSM "come to voice" as total tops and total bottoms on the social media platform, Reddit. Reading posts and comments as autobiographical acts, the article analyses how total tops and bottoms assert the validity of their claim to sexual knowledge as total top or total bottom while negotiating the sexual politics of versatility on Reddit and beyond. [ABSTRACT FROM AUTHOR]

Grindr is a popular geospatial networking application (GSNA) among gay, bisexual, and men who have sex with men (GBMSM); it can be used for variety of goals (e.g. finding dates, making friends, or coordinating a hookup) depending on the user's wants. These needs and wants, however, do not arise in a vacuum. Informed by uses and gratification (U&G) theory, this paper examined individual factors such as race, body image and depression as drivers of the motivations behind Grindr usage In an online cross-sectional survey (N = 102), we explored the antecedents of six different motivations (i.e. friendship, sex, entertainment, romantic partnership, social inclusion, and location-based community) for Grindr use among GBMSM. The results revealed that romance and friendship motives increased Grindr usage compared to the other four motivation categories. Across motivation categories, habitual Grindr usage was a significant driver of continued Grindr use. Individual factors such as race, sociosexuality and self-disclosure also influenced users' motivations to use Grindr. Overall, the results point to individual factors eliciting differing motivations for Grindr use, resulting in either outcome-based or passive usage of the application. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 had significant influences on everyone's lives. This study aimed to explore impacts of COVID-19 on mental and sexual health and access to health services among gay, bisexual and other men who have sex with men (GBMSM) in Singapore. Methods: This qualitative study recruited 16 self-identified GBMSM via purposive sampling and semi-structured individual interviews were conducted. Three themes and seven sub-themes were derived from analysis done using the framework method. Results: Participants shared how COVID-19 led to negative emotions and experiences at an intrapersonal level and interpersonal level (with families or partners), which were also worsened by prevailing stigma that GBMSM already face in Singapore and within their social networks. Sexual behaviours associated with HIV and other sexually transmitted infections risk and substance use were seen to be maladaptive coping methods of social isolation due to COVID-19. These dynamics were all exacerbated by the closure of "non-essential" services, which included many important services for mental and sexual health that were relevant to the GBMSM community. Conclusions: Changes in policies and community efforts should be explored to improve these areas, enhancing the psychosocial and sexual well-being of GBMSM. [ABSTRACT FROM AUTHOR]

We aimed to illuminate the challenges of treating anal diseases among gay, bisexual and other men who have sex with men (GBMSM) in a homophobic climate amid resource constraints. Building on a long-term Kenyan-Canadian collaboration, an anal healthcare intervention study, known as the WEMAH Project, was initiated in January 2022. The initial collaborative work strengthened existing anal health services provided at a community-based clinic serving GBMSM in Nairobi. The illness and treatment journey for one patient is highlighted. Prior to attending the community clinical programme, reluctance to disclose symptoms to other healthcare workers, misdiagnoses and incorrect treatment, absence of physical exam conducted, lack of access to effective medications, and self-treatment attempts not only led to late disease detection but also exacerbated the illness itself, culminating in advanced disease progression accompanied by severe pain and suffering. However, once connected to the community clinic with the enhanced anal healthcare programme, the disease was effectively managed by the clinical team. Although specialised clinics have been established throughout Kenya to meet the STI-related needs of GBMSM, the constellation of factors highlighted in one patient's journey, from illness to recovery, reveals important gaps in Kenya's existing sexual health programme for GBMSM. [ABSTRACT FROM AUTHOR]

HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identity/behavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR = 1.30, [95% CI: 1.02, 1.65]). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings. [ABSTRACT FROM AUTHOR]

HIV treatment interruptions are a major public health concern that demonstrate a lack of engagement in care and is detrimental to the health of people living with HIV. Community connectedness have demonstrated a protective effect for psychosocial health but are not well understood for HIV treatment outcomes. We explored associations between community connectedness and treatment interruptions among gay, bisexual and other men who have sex with men (gbMSM) living with HIV in Vancouver, British Columbia. We analyzed survey data from the Momentum Health Study and identified treatment interruptions through data linkages with the provincial HIV Drug Treatment Program as episodes lasting more than 60 days beyond an expected antiretroviral therapy refill date from February 2012 to July 2019. We built a mixed-effects logistic regression model, adjusting for confounders. Of 213 gbMSM living with HIV, 54 experienced treatment interruption (25.4%) over a median five-year follow-up. Multivariable results found the number gbMSM who spoken to in the past month (aOR = 0.995; 95% CI = 0.991, 1.000 (per 100-unit increase)) and attending a gay community meeting more than once per month (aOR = 0.32; 95% CI = 0.11, 0.89) were associated with lower odds of treatment interruptions. These results highlight the importance of social connections in facilitating effective HIV care. [ABSTRACT FROM AUTHOR]

A recent Supreme Court ruling that permitted LGBTQ + rights organisations to officially register as non-governmental organisations has led to rises in political homophobia in Kenya. Community leaders initiated and led a rapid agency assessment to examine the effects of this rising political homophobia on sexual health services access for gay, bisexual and other men who have sex with men (GBMSM). This survey assessment engaged directors and programme managers running 20 community-based organisations (CBOs) representing 19 Kenyan counties, serving the sexual health needs of more than >25,000 GBMSM. In addition to prevalent shutdowns of health services, respondents reported growing religious tensions, fears and threats of attack, withdrawal of local county government support, and rising religious tensions. At a moment when highly oppressive anti-LGBTQ + legislation has been drafted and debated in parliament, in the name of 'family protection', this commentary makes an appeal to allied health officials and global funding partners to make more explicit statements that call attention to the negative consequences of political homophobia on the grounds of public health and human rights. [ABSTRACT FROM AUTHOR]

Collaboration between academic researchers and community members is a cornerstone of community-based research. The success of a project's results depends on this collaboration. Currently collaborative practices are mostly documented from the researchers' perspective. Based on a case study of the development of the MyBuzz.ca online intervention for gay and bisexual men who use substances, this article aims to describe components associated with the co-construction process to identify practices that have enabled stronger collaborations with community stakeholders and led to their increased involvement in research. A thematic analysis of eight semi-structured interviews was conducted to identify participants' perceptions of their participation, their roles, and decision-making with respect to the development of the brief online intervention. Results highlight the importance of establishing prerequisites to foster a positive co-construction experience. Working on an issue that affects the community was one of the elements that encouraged participation in this project. The perspectives of stakeholders (other than academic researchers) support the importance of prerequisites and working on issues affecting the community in successfully conducting community-based research. This study also provides an opportunity to model these elements to foster the co-construction process in community-based research. It highlights facilitators and obstacles to co-construction while underscoring the benefits for various members of the community to participate in this type of study. [ABSTRACT FROM AUTHOR]

Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional 'unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19. [ABSTRACT FROM AUTHOR]

Nigerian gay, bisexual, and other men who have sex with men (GBMSM) experience social marginalisation, discrimination and violence due to their sexual orientation and same-sex attraction, which may affect mental health, substance use, and HIV sexual risk behavior. The goal of the current study was to conduct formative qualitative research to gain better understanding of these issues among GBMSM in Lagos, Nigeria. Face-to-face, semi-structured, in-depth interviews were conducted with 30 GBMSM in Lagos, Nigeria. Data were analysed using a deductive content analysis approach. We found that Nigerian GBMSM experienced both general life stressors as well as proximal and distal sexual minority identity stressors, including rejection by family members, harassment, and physical violence perpetrated by the general public and police officers. Participants described dealing with mental health problems within the context of family rejection, experienced stigma due to sexual orientation, and feelings of social isolation. Substance use was described as occurring within the context of social settings. Lastly, some participants mentioned that they engaged in risky sexual behaviour while under the influence of alcohol and drugs. These findings call for comprehensive and innovative, GBMSM-affirming behavioural healthcare, substance cessation services, and innovative HIV prevention interventions specifically designed and tailored for Nigerian GBMSM. [ABSTRACT FROM AUTHOR]

Nigerian gay, bisexual and other men who have sex with men (GBMSM) experience negative psychosocial health problems, which may increase their risk for HIV infection. Few studies have explored the syndemic effect of co-occurring psychosocial health problems on HIV sexual risk among Nigerian GBMSM. We investigated the co-occurrence of syndemic psychosocial health problems and their synergistic effect on HIV risk behaviors. We assessed depressive symptoms, post-traumatic stress disorder, alcohol dependence, tobacco use, and hard-drug use. The outcome variables were the number of male sexual partners and consistent condom use. In a multivariable model, experiencing 4 or more psychosocial health problems – compared to experience none or one psychosocial health problem – was significantly associated with increasing number of male sexual partners. We found no statistically significant association between the number of syndemic psychosocial health problems and consistent condom use. Our study findings provides evidence of a synergistic relationship between negative psychosocial health factors and HIV sexual risk behavior. These findings underscore the importance of developing HIV prevention programming aimed at reducing HIV transmission risk that incorporate substance use and mental health treatments, in order to improve the overall health and quality of life for Nigerian GBMSM. [ABSTRACT FROM AUTHOR]

Kenyan gay, bisexual, and other men who have sex with men (GBMSM) are significantly affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective biomedical approach to HIV prevention. We conducted a cross-sectional survey of 459 HIV-negative Kenyan GBMSM to assess individual and interpersonal correlates of PrEP awareness/acceptability using univariate and hierarchical logistic regression modeling. We found that 64.3% of participants had heard of PrEP and 44.9% were willing to use PrEP. In hierarchical logistic regression models for PrEP awareness, condom use with regular partners, higher condom use self-efficacy, higher perceived ability to use PrEP, history of STI, and membership in LGBT organization were significantly associated with being aware of PrEP (χ2 =69.6, p <.001). In hierarchical logistic regression models for PrEP acceptability, higher self-esteem, higher condom use self-efficacy, depression/anxiety, higher perceived ability to use PrEP, willingness to engage in PrEP follow-up visits, coercion at sexual debut, and family exclusion were significantly associated with being acceptable to PrEP (χ2 =231.8, p <.001). Individual and interpersonal factors were significantly associated with PrEP awareness and acceptability. Our findings underscore the need to promote awareness and understanding of PrEP as an effective HIV prevention tool in combination with other safer-sex methods that are appropriate given an individual's personal circumstances. [ABSTRACT FROM AUTHOR]

In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM. [ABSTRACT FROM AUTHOR]

The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08-0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03-1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area. [ABSTRACT FROM AUTHOR]