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      Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention

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          Abstract

          Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM ( n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.

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          Most cited references36

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          The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities.

          This study assessed the relation between experiences of social discrimination (homophobia, racism, and financial hardship) and symptoms of psychologic distress (anxiety, depression, and suicidal ideation) among self-identified gay and bisexual Latino men in the United States. Data were collected from a probability sample of 912 men (self-identified as both Latino and nonheterosexual) recruited from the venues and public social spaces identified as both Latino and gay in the cities of Miami, Los Angeles, and New York. The study showed high prevalence rates of psychologic symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). In both univariate and multivariate analyses, experiences of social discrimination were strong predictors of psychologic symptoms. The mental health difficulties experienced by many gay and bisexual Latino men in the United States are directly related to a social context of oppression that leads to social alienation, low self-esteem, and symptoms of psychologic distress.
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            Towards an improved investment approach for an effective response to HIV/AIDS.

            Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults.

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                Author and article information

                Journal
                J Sex Transm Dis
                J Sex Transm Dis
                JSTD
                Journal of sexually transmitted diseases
                Hindawi Publishing Corporation
                2090-7893
                2090-7958
                2013
                8 July 2013
                : 2013
                : 953123
                Affiliations
                1The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA
                2Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
                3San Francisco Department of Public Health, San Francisco, CA, USA
                4Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
                5Mailman School of Public Health, Columbia University, New York, NY, USA
                6Urban Health Program, RTI International, San Francisco, CA, USA
                Author notes

                Academic Editor: Mark R. Dybul

                Author information
                http://orcid.org/0000-0003-2255-7582
                http://orcid.org/0000-0001-6526-6860
                Article
                10.1155/2013/953123
                4437423
                26316968
                d15f70a2-c690-4aac-afba-4fea299ac816
                Copyright © 2013 George Ayala et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 January 2013
                : 30 May 2013
                : 6 June 2013
                Categories
                Research Article

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