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The Impact of Location on Implementation of HIV/STI Prevention Interventions Among LGBTQ Communities

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The Impact of Location on Implementation of HIV/STI Prevention Interventions Among LGBTQ Communities The impact of location on implementation of HIV/STI prevention interventions among LGBTQ communities Questions References • What is the impact of geographical location on 1. Tieu HV, Koblin BA, Latkin C, Cur- implementation of HIV/STI prevention programs or riero FC, Greene ER, Rundle A, et al. interventions among LGBTQ communities? Neighborhood and network characteris- tics and the HIV care continuum among gay, bisexual, and other men who have Key Take-Home Messages sex with men. Journal of Urban Health. 2018;29. • The characteristics of a location, including segregation, community-level stigma, and infrastructural resources, may 2. Witzel TC, Nutland W, Bourne A. influence HIV service utilization and the HIV continuum of What qualities in a potential HIV pre- care among men who have sex with men (1). exposure prophylaxis service are valued by black men who have sex with men • Implementation of HIV prevention interventions may be in London? A qualitative acceptability affected by whether a location is convenient, allows for study. International Journal of STD & anonymity, and makes one vulnerable to HIV stigma and AIDS. 2018;29(8):760–5. homophobia (2). 3. Damschroder LJ, Aron DC, Keith • Evidence-based interventions that do not “fit” a particular RE, Kirsh SR, Alexander JA, Lowery setting may be resisted by the target population (3). JC. Fostering implementation of health Therefore, researchers recommend adapting interventions to services research findings into practice: fit the local context of the communities they are serving (4). A consolidated framework for advancing implementation science. Implementa- • Structural interventions, such as those to reduce HIV stigma tion Science. 2009;4:50. and homophobia within neighbourhoods, have also been recommended by researchers to improve the social and 4. Robinson BE, Galbraith JS, Lund structural conditions of neighbourhoods with high HIV SM, Hamilton AR, Shankle MD. The prevalence (1). process of adaptation of a community- level, evidence-based intervention for HIV-positive African American men The Issue and Why It’s Important who have sex with men in two cit- ies. AIDS Education & Prevention. HIV disproportionately impacts some members of the LGBTQ 2012;24(3):206–27. community (5). For example, men who have sex with men continue to represent the greatest number and proportion of people living 5. Bourgeois AC, Edmunds M, Awan with HIV in Canada (5). A, Jonah L, Varsaneux O, Siu W. HIV in Canada-surveillance report, 2016. The use of evidence-based interventions for HIV prevention has Canada Communicable Disease Report. become a widespread approach to curbing the HIV epidemic (4). 2017;43(12):248–56. Unfortunately, significant barriers have obstructed implementation of these interventions in the real-world settings (6). Implementation, RAPID RESPONSE SERVICE | #135, APRIL 2019 1 in this review, refers to “the use of strategies to adopt and integrate 6. Norton WE, Amico KR, Cornman evidence-based health interventions and change practice patterns DH, Fisher WA, Fisher JD. An agenda within specific settings” (6). for advancing the science of implemen- tation of evidence-based HIV preven- A growing body of research connects location characteristics to HIV tion interventions. AIDS & Behavior. outcomes (1). This is in line with the well-established view in public 2009;13(3):424–9. health that health is influenced by characteristics of networks, neighbourhoods, and geographic communities (7). This influence 7. Jefferson KA, Kersanske LS, Wolfe is thought to go beyond individual risk behaviours and ultimately ME, Braunstein SL, Haardorfer R, Jarlais solidify disparities across populations (1). DCD, et al. Place-based predictors of HIV viral suppression and durable sup- Given the relationship between health and location, adapting pression among men who have sex with evidence-based interventions to unique communities and local men in New York City. AIDS & Behavior. contexts has been considered an important aspect of implementation 2017;21(10):2987–99. by researchers (3, 4). Theories of implementation science have explored the impact of tangible and intangible characteristics (such 8. Beach LB, Greene GJ, Lindeman P, as structural, political, and cultural features) of the setting in which Johnson AK, Adames CN, Thomann M, an intervention is implemented (3). This research suggests that et al. Barriers and facilitators to seeking setting can interact with individuals and intervention processes to HIV services in Chicago among young influence implementation effectiveness (3). men who have sex with men: Perspectives of HIV service providers. AIDS Patient Addressing factors that influence implementation is crucial for Care & STDs. 2018;32(11):468–76. the scale-up of HIV prevention interventions towards ending the epidemic (6). This review explores the impact of location on 9. Eberhart MG, Yehia BR, Hillier A, implementation of HIV prevention interventions among LGBTQ Voytek CD, Blank MB, Frank I, et al. populations. Behind the cascade: Analyzing spatial patterns along the HIV care continuum. Journal of Acquired Immune Deficiency What We Found Syndromes. 2013;64 Suppl 1:S42–51. Location and accessing HIV-related services 10. Eberhart MG, Yehia BR, Hillier A, Voytek CD, Fiore DJ, Blank M, et al. Indi- To guide the improvement of interventions to increase HIV care vidual and community factors associated engagement, researchers have begun to explore barriers and with geographic clusters of poor HIV facilitators that LGBTQ individuals encounter when accessing HIV care retention and poor viral suppression. services (8). Some research has found that the distance to transit, Journal of Acquired Immune Deficiency care providers, and pharmacies may act as a barrier to engagement Syndromes. 2015;69 Suppl 1:S37–43. and retention in HIV care, as well as adherence to HIV treatment (9, 10). A cross-sectional survey of 1,170 gay and bisexual men who 11. Nelson KM, Pantalone DW, Gamarel have sex with men also found that participants living in rural areas KE, Carey MP, Simoni JM. Correlates of had increased odds of never testing for HIV compared to those never testing for HIV among sexually ac- living in urban areas, as having to travel to urban settings to receive tive internet-recruited gay, bisexual, and testing in a more private manner is an option that brings with it other men who have sex with men in the transportation, financial, and other barriers (11). United States. AIDS Patient Care & STDs. 2018;32(1):9–15. In many cases, however, LGBTQ individuals reported that they deliberately travelled far from home for HIV care and services, despite inconvenience. This was mainly due to apprehension about seeking HIV services within their own neighbourhoods. For example, participants in a mixed methods study among 54 Indigenous men identifying as gay, bisexual, two spirit or who have same-sex experiences reported that stigma associated with HIV testing in RAPID RESPONSE SERVICE | #135, APRIL 2019 2 smaller towns led people to travel into their location (12). However, 12. Burks DJ, Robbins R, Durtschi a lack of transportation was cited as a barrier to HIV testing and JP. American Indian gay, bisexual and services (12). A study that conducted 66 in-depth interviews with two-spirit men: A rapid assessment transgender and gender diverse youth living with HIV from 14 of HIV/AIDS risk factors, barriers to cities across the U.S found similar results (13). A lack of personal prevention and culturally-sensitive in- transportation or money for public transportation was reported tervention. Culture, Health & Sexuality. by some participants as a barrier to HIV testing and care. Youth 2011;13(3):283–98. also reported that fear of seeing someone they knew in locations within their neighbourhoods impacted their ability to receive care 13. Harper GW, Jadwin-Cakmak LA, (13). HIV service providers participating in a qualitative interview Popoff E, Campbell BA, Granderson R, study in Chicago also reported that greater distance between home Wesp LM, et al. Transgender and other and provider, as well as complex transit routes, may lead to a lack gender-diverse youth’s progression of engagement in HIV services among young men who have sex through the HIV continuum of care: with men (8). They also reported, however, that some young men Socioecological system barriers. AIDS who have sex with men accessed their services specifically because Patient Care & STDs. 2019;33(1):32–43. their site location was far from home, and they wanted to conceal their HIV status (8). A longitudinal cohort study among young men 14. Phillips G II, Neray B, Janulis P, Felt who have sex with men and transgender youth in Chicago found D, Mustanski B, Birkett M. Utilization that proximity and convenience (e.g. “too close to my house”) were and avoidance of sexual health services reasons for not utilizing sexual health services by 9% of individuals and providers by YMSM and trans- (14). gender youth assigned male at birth in Chicago. AIDS Care. 2019:1–8. Indeed, neighbourhood-level stigma may impact many LGBTQ individuals’ engagement with HIV prevention and care, affecting 15. Wilson EC, Arayasirikul S, Johnson where they seek services. One study interviewing African American K. Access to HIV care and support ser- transwomen living with HIV in Alameda County, California, found vices for African American transwomen that barriers related to transportation and location were influenced living with HIV. International Journal of by negative experiences within their neighbourhood (15). Some Transgenderism. 2013;14(4):182–95. individuals felt unsafe when travelling to HIV care appointments, which would require taking public transportation during the day. 16. Datta J, Reid D, Hughes G, Mercer They were also reluctant to attend appointments at locations where CH, Wayal S, Weatherburn P. Places and the likelihood of seeing peers was high, due to fear that they would people: The perceptions of men who be “outed” as being HIV positive. These participants reported that have sex with men concerning STI test- they preferred attending appointments in nearby San Francisco, as it ing: A qualitative study.
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