Natalie M. Leblanc

Facilitators and Barriers to HIV Screening A Qualitative Meta-Synthesis

Accomplishments in biomedical research and technology, combined with innovative community and clinically based interventions, have expanded HIV testing globally. However, HIV screening and receipt of results remains a challenge in some areas. To optimize the benefits of HIV screening, it is imperative that there is a better understanding of the barriers to and motivators of testing for HIV infection. This study is a meta-synthesis of the qualitative literature on HIV screening and receipt of results; 128 unique publications had implications for HIV screening and receipt of results. A socioecological perspective provided an appropriate approach for synthesizing the literature. Three levels of influence emerged: individual attributes, interpersonal attributes, and broader patterns of influence. Findings were reviewed and found to have implications for continued engagement in the HIV treatment cascade. Recommendations to enhance HIV screening and to ensure receipt of results are proposed and discussed.

Exploring the Perceptions of Anal Cancer Screening and Behaviors Among Gay and Bisexual Men Infected With HIV.

BACKGROUND The incidence of anal cancer is on the rise among HIV-infected men who have sex with men (MSM). Given the increasing availability of screening, this study explored anal cancer screening awareness and behaviors among MSM infected with HIV. METHODS In-depth interviews were conducted with 58 MSM infected with HIV. RESULTS Other than 2 participants treated for anal cancer and 3 treated for precancerous anal lesions, the majority of participants had never heard of anal cancer. Men reported lack of awareness and recommendations from their health care professionals as the greatest barriers to screening. Upon learning about their risk for anal cancer and the availability of screening, the men were eager to discuss screening with their physicians. Participants provided numerous recommendations for future interventions, including training health care professionals to promote screening, disseminating information pertaining to anal cancer through social networks, and creating media campaigns to raise awareness about the need to screen for this type of cancer. CONCLUSIONS Future intervention work should focus on ensuring that health care professionals, particularly among HIV/primary care specialists, promote screening for anal dysplasia. It is critical that intervention methods use a community-based approach to raise awareness about the need to screen for anal cancer, especially among MSM infected with HIV.

Negotiated safety - components, context and use: An integrative literature review.

AIM The aim of this study was to examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept. BACKGROUND There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood. DESIGN Integrative review of empirical and theoretical literature. DATA SOURCES The Cumulative Index for Nursing and Allied Health Literature (CINAHL) MEDLINE and PsychINFO electronic databases were accessed. REVIEW METHODS Articles were read to gain a historical context of the term and identify varying interpretations of the concept. Factors warranting consideration in association with NS were identified and clinical and public health implications were noted. RESULTS Forty-eight studies were reviewed. Negotiated safety included the following components: (i) HIV sero-negative concordant men within a primary relationship; (ii) joint HIV screening and mutual disclosure of their HIV status; (iii) explicit relationship boundaries which establish either nonexclusively that allows for the dispensing of condoms within the primary relationship and consistent condom use for extra-dyadic sex; or dispensing of condoms within a primary partnership and exclusivity; and (iv) a breach clause that allows communication to re-establish the agreement if needed. CONCLUSION Negotiated safety is a prescriptive approach to HIV risk reduction among couples. Researchers and practitioners could benefit from promoting this approach to HIV prevention.

An Exploration of Men's Knowledge, Attitudes, and Perceptions of HIV, HIV Risk, and Willingness to Test for HIV in Yendi District, Northern Ghana

&NA; We explored mens HIV knowledge, perceptions of HIV risk, and willingness to test for HIV in preparation for the initiation of formalized voluntary counseling and testing (VCT) services at Yendi Hospital in Yendi District, Ghana. A multi‐method approach was used, including surveys of 129 male hospital patrons, three men‐only focus group discussions, and eight interviews with clinical staff at the hospital. History of condom use, perception of risk, paying for an HIV test, and age were all significantly associated (p < .05) with willingness to test. An aversion to the hospital was the most prominent theme among participants. Aversion was due to perceived lack of confidentiality, preference for traditional healers, perceived costs, and fear of testing. Our participants (a) expressed the need for VCT services, (b) recommended that VCT target men for HIV prevention and VCT patronage, and (c) thought locations outside of hospitals should provide testing services.

Advancing the case for nurse practitioner-based models to accelerate scale-up of HIV pre-exposure prophylaxis

AIMS To explore the factors that position nurse practitioners (NPs) to lead the implementation of HIV pre-exposure prophylaxis. BACKGROUND The HIV epidemic represents a global health crisis. Reducing new HIV infections is a public health priority, especially for Black and Latino men who have sex with men (MSM). When taken as directed, co-formulated emtricitabine and tenofovir have over 95% efficacy in preventing HIV; however, substantial gaps remain between those who would benefit from pre-exposure prophylaxis (PrEP) and current PrEP prescribing practices. DESIGN This is a position paper that draws on concurrent assessments of research literature and advanced practice nursing frameworks. METHOD The arguments in this paper are grounded in the current literature on HIV PrEP implementation and evidence of the added value of nurse-based models in promoting health outcomes. The American Association of Colleges of Nursings advanced nursing practice competencies were also included as a source of data for identifying and cross-referencing NP assets that align with HIV PrEP care continuum outcomes. CONCLUSIONS There are four main evidence-based arguments that can be used to advance policy-level and practice-level changes that harness the assets of nurse practitioners in accelerating the scale-up of HIV PrEP. RELEVANCE TO CLINICAL PRACTICE Global public health goals for HIV prevention cannot be achieved without the broader adoption of PrEP as a prevention practice among healthcare providers. NPs are the best hope for closing this gap in access for the populations that are most vulnerable to HIV infection.

Providers’ perceptions of couples’ HIV testing and counseling (CHTC): Perspectives from a U.S. HIV epicenter.

Current epidemiology demonstrates the significance of couple-based HIV transmission among vulnerable U.S. populations and its contribution to health disparity in HIV prevalence. Couples’ HIV testing and counseling (CHTC) can be used to address couple-based HIV risk in the United States. Though a globally recognized service, the literature lacks U.S.-based health-care providers’ (HCPs) perspectives of CHTC. To address this research gap, a qualitative descriptive design was used to ascertain HCPs’ perceptions about CHTC. Semistructured in-depth interviews were conducted with 22 HCPs who were experienced with engaging patients or clients across the HIV care continuum. Overall, HCPs supported CHTC for different U.S. populations. Content analysis revealed that HCPs perceived CHTC to be an evolution from current HIV testing approaches and a mechanism to screen people who may not otherwise. CHTC was perceived to have biomedical and socio-behavioral merit that warranted consideration for implementation within health service settings and among populations with heightened vulnerability to HIV acquisition. This strategy was perceived to be a mechanism for introducing pre-exposure prophylaxis and conception health into one’s practice. CHTC also signaled patients reorienting perceptions of personal health as being linked to the health of another individual. Providers recognized that couples have evolved to be increasingly nonheteronormative and thought that CHTC should be offered to all couples. However, participants also noted that HCPs in the United States need to be comfortable with promoting sexual health among various populations for implementation of CHTC to be successful.

Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships

ABSTRACT Intimate partner violence (IPV) is associated with a high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP), which does not require partner knowledge or consent, is a promising HIV risk reduction option for women experiencing IPV. Drawing on semi-structured interviews with 26 women experiencing IPV within the last six months, this study explored the feasibility and acceptability of PrEP use in this population. Slightly more than half of the women in this study expressed interest in taking PrEP when in a relationship with an abusive partner. Potential barriers to PrEP, discussed regardless of womens expressed interest in PrEP, included fear of side effects and long-term health concerns, low risk perceptions, potential partner interference, and prioritizing coping with the relationship over HIV prevention. When offering PrEP counseling, providers should inquire about IPV, as women in violent relationships may require tailored counseling to address barriers and concerns specific to their situation.

The Impact of Parental Reaction to Sexual Orientation on Depressive Symptoms and Sexual Risk Behavior Among Hispanic Men Who Have Sex with Men

PURPOSE This study examined the relationship of parent reaction to sexual orientation with depressive symptoms and safer sex among Hispanic adult men who have sex with men (MSM). We also examined mens acculturation to the U.S. (Americanism) in relation with these variables. METHOD Cross‐sectional data collected from July 2011 to December 2012, from 125 MSM with a mean age of 43.02 years. Instruments included the Perceived Parent Reaction Scale, the Centers for Epidemiological Studies Depression Scale, the Safer Sex Behavior Questionnaire and the Bidimensional Acculturation Scale. Data was analyzed using Hierarchical generalized linear models (GZLM). RESULTS Among men whose parents knew of their sexual orientation, rejection of sons sexual orientation from mother (p = 0.032) and from father (p = 0.004) was related to higher number of depressive symptoms. Parent reactions were not directly related to safer sex behaviors. Americanism was associated with lower depressive symptoms (p = 0.001) but was not related to safer sex behaviors. CONCLUSIONS Current parent attitudes about their sons’ sexual orientation had an effect on the sons’ emotional wellbeing and acculturation may play a protective role. Mental health and primary care clinicians working with Hispanic MSM should assess for level of family support and provide resources to assist with disclosure and family acceptance of sexual orientation as indicated, particularly among recently immigrated men who may be at higher risk. HighlightsMSM are at an increased risk for HIV infection and major depressive disorder.Ethnic minority men such as Hispanic MSM, may experience sexual minority status related stigma and exclusion.Hispanic MSM may have difficulty disclosing sexual orientation to the family of origin.Parental reaction to disclosure of sexual orientation may impact depressive symptoms.Mental health nurses working with Hispanic MSM need awareness of the impact of parental reaction to disclosure of sexual orientation on mental health of Hispanic MSM.

Abstract B72: HPV knowledge and screening among gay men of color in South Florida

Introduction: Squamous cell carcinoma of the anus (SCCA), also known as anal cancer, is on the rise, particularly among HIV-infected gay and bisexual men. The disease is caused by persistent infection of two strains of the human papillomavirus (HPV), the most common sexually transmitted infection worldwide. Persistent infection of two cancer-causing strains (16 and 18) leads to the development of high-grade squamous intraepithelial lesions (HSIL) in the anal canal which, left untreated, can develop into SCCA. Two different strains (6 and 11) cause non-cancerous genital warts, a condition more difficult to treat among HIV-infected populations. SCCA can be prevented through timely screening for HSIL via anal Papanicolau (Pap) smear or high resolution anoscopy. However, HIV-infected gay and bisexual men are continuing to suffer disproportionate burden of this disease due to various reasons included underutilization of anal cancer screening. Therefore, this study explored what HIV-infected gay and bisexual men understand about HPV, SCCA, the need to screen for this disease, and their preferences for receiving information about SCCA screening. Methods: Authors conducted in-depth interviews with 58 HIV-infected gay and bisexual men and analyzed the data using a qualitative content analysis approach. Results: Participants9 HPV and SCCA awareness differed based on whether or not they had been diagnosed for either HSIL (n=3) or SCCA (n=3) compared to those who were never diagnosed for either condition. The men treated for HSIL (n=3) understood the relationship between HPV and the precancerous lesions while men diagnosed with SCCA (n=3) did not know this cancer was caused by HPV. On the other hand, men with no past diagnosis of HSIL or SCCA were not aware of HPV and its potential health repercussions. The few participants who had heard of HPV perceived the virus to be a women9s health issue. Screening behaviors varied based on the clinic where participants received HIV primary care. Men who regularly received care at one specific federally qualified health center were screened for HSIL within the previous two years, and they reported that provider recommendation was the greatest facilitator that led to their screening uptake. Men receiving care at other locations or who were currently out of care did not realize the need to screen for HSIL or SCCA. They reported lack of awareness about SCCA and lack of provider recommendation to be the greatest barriers to anal cancer screening. Other barriers cited include embarrassment of screening procedures and the fear of being diagnosed with cancer. However, as men learned of their risk for cancer and upon realizing the severity of this potential diagnosis, they described their desire to screen in the near future. Participants: recommended numerous health education strategies to raise awareness about the need to screen for SCCA among HIV-infected gay and bisexual men. The most common recommendation was to ensure that HIV primary care clinicians promoted screening for HSIL and SCCA. They also recommended mass media campaigns in which educational posters and informational advertisements could be posted in public locations such as bus stops or in local print media. Conclusion: Similar to past research, HIV-infected gay and bisexual men reported willingness to screen for anal cancer, and they requested more widely communicated information about the risk for anal cancer and the need to screen. Future intervention work should use a community-based approach to raise awareness about SCCA among HIV-infected gay and bisexual men. Further, it is critical to ensure that both HIV primary care providers as well as general primary care providers promote HSIL screening, particularly among HIV-infected gay and bisexual men to prevent the development of anal cancer. Citation Format: Alexis Koskan, Natalie Leblanc. HPV knowledge and screening among gay men of color in South Florida. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B72.