Stigma and Shame Experiences by MSM Who Take PrEP

Running Head: CRITIQUING EVALUATION Critiquing Evaluation Criteria for Quantitative Research Article XXXXXXXXXXXX Ana G. Méndez University NURS-502 Instructor: XXXXXXXXXXXXXX 2019 1 CRITIQUING EVALUATION 2 Critiquing Evaluation Criteria for Quantitative Research Article The title of the article selected is Cost/Benefit of Hepatitis C Treatment: It Does Not End with SVR the author is Kaplan, some references were used to demonstrate the veracity of this article, The author has received research support from Bayer Healthcare Inc with Affiliations with University of Pennsylvania, so the4 authors credentials to let us know more about them, and give us more credibility on the literature review. The title is clear including group of studies (older people) but not area where the research would be done. The purpose of this study is presented and discussed the importance of the problem; it is stated at the beginning of the report “to evaluate the association between loss of fat-free mass and mortality among older people.” Also shows the key points that sarcopenia is associated with functional decline in older people, and appendicular fat-free mass is a significant predictor of mortality in them. Researchers also provide an idea of what they are doing and why it can offer useful importance to evaluate the association between fat-free mass and mortality among older people. They stated that “the available prospective studies show an association between functional measures or frailty and mortality rather than muscle mass per se” and they wanted to evaluate the association between muscle mass (and fat-mass) with mortality in a cohort of healthy older people. The problem statement is clear because many factors have been evidenced to associate loss of muscle mass with loss of muscle strength and function, but not as a potential predictor of mortality, and it’s the aim to be evaluated on this work. During the study, the authors identify key research points and variables to be examined. The length of survival was tatted as dependent variable, and age, appendicular fat-free mass/height, and appendicular fat mass /height as independent variables, stratifying by sex; also were added life table analyses considering survival as a dichotomous variable, using the time of CRITIQUING EVALUATION 3 death or end of follow-up as the censoring variable, and sex-specific quartiles of appendicular fat-free mass. Sarcopenia, as stated by the researchers, “is defined as the inexorable loss of muscle mass that occurs with aging”. Available prospective studies only show the association between the functional measures or frailty and mortality rather than muscle mass per se, and the purpose of this study was to evaluate the association between muscle and fat mass, measured by DEXA and death in a cohort of healthy older people. Stigma and Shame Experiences by MSM Who Take PrEP

The study has the potential to help solve this problem that is currently faced in clinical practice. The literature review follows a logical sequence that leads to a critical analysis of previous work support and conflict, since it refers to earlier studies of the case, making comparisons and drawing the same results valid for issuing proposals for improvement of the situation. But there is not a full literature review, because, after a little introduction where references are made, the authors begin immediately with the method of study. Then they added more literature review in the Discussion section, but not too much. The need for the present study, to the authors, is to complement and further deepen existing studies. The authors did not emphasize a rationale for the conceptual framework, which supports the basis of the study. At the Discussion section they stated “these results show that the loss of appendicular fat-free mass was significantly associated with mortality among people aged over 74 years of age”, so it liked to be their hypothesis, if so, then we could say that the hypothesis was posed precisely and in a form that permits it to be rested. Regarding the methodology used, the variables are relevant, and the concepts are clearly defined as the purpose of the study. Despite not having a clear question in the study proposal, and not being sure if what stated in my paragraph before was the hypothesis on it, I think that the CRITIQUING EVALUATION 4 design used is appropriate to find answers for this theme. The methods of data collection are sufficiently described; it was the information of healthy older people between 1995 and 2005, with body composition measured by DEXA. They had to leave independently in the community and be free of disabilities diseases (cancer, cardiac or renal failure). Life table analyses were performed considering survival. One thousand four hundred thirteen participants (1001 women and 412 men) were included in the report, but there was no information about how they were recruited. The study does not refer to identified or potential threats to internal or external validity, but they reported at the end of it that they did not measure functional parameters that were associated with mortality and that there was no record regarding chronic conditions that could modify the mortality results. The methods data collection is not sufficiently described (as explained before). It did not specify if all the researchers were data collectors or one of them only was. It’s no clear for me. Both sampling methods and subjects were described in the Methods section. They explained that it was a large population of participants (1413).All participants signed informed consent at the time of examination, authorizing the authors to use the data obtained for research purposes. The Institute of Nutrition and Food Technology Ethics Committee approved the studies. The instruments for data collection used are appropriate for this study. They used body composition obtained by DEXA, body mass index, and performed a Cox proportional hazards model with the variables listed above. Also, I think the reliability and validity of the measuring instruments of the study are adequate because were performed all statistical analysis using CRITIQUING EVALUATION 5 Intercooled Stat 9.1 for Windows, numerical values with a normal distribution were expressed as mean +/- standard deviation, and with non-normal distribution were expressed as median and range. Also survival differences between participants allocated in different quartiles of body composition were compared by X 2 analysis. The results for each were clearly and objectively presented in the study. They offer the characteristics of the study population on the results, and also tables that illuminate the presentation of results, with characteristics demographics, anthropometrics and the body compositions of participants by sex, and also they presented figures showing the twelve-year survival of older people between 74 and 78 years of age, and according to sex-specific fat-free mass/height.. This makes the presentation of the subject much easier to understand, besides supporting the theoretical framework raised and affirms the bibliography even more. The conclusion on this study are based on the results and related to the hypotheses that “the loss of appendicular fat-free mass was significantly associated with mortality among people aged aver 74 years of age, but fat mass was not predictive of mortality”. The researcher stated that in previous report they showed that there was a median loss of fat-free mass among women and men, but weight remained stable as there was a simultaneous increase in fat mass, and it would be associated with a significant reduction in walking capacity, disabilities, and even death, if there’s not preventive intervention on it. Figures illuminate the presentation for results, table show demographic, anthropometric and body composition parameters of the participants. They concluded that their study “showed having a low amount of appendicular fat-free mass is a significant predictor of mortality in older people and that efforts should be made to prevent age-associated Sarcopenia”, so it’s related to the hypothesis related above. They stated that the study has two weaknesses, one of them is that there was no record of chronic conditions CRITIQUING EVALUATION 6 which could modify the mortality results, and the other one is that they did not measure functional parameters that are associated with mortality in other studies. They added that training is the only way to revert the functional effects of sarcopenia. This would help us to be more cautious when assessing these patients, since early detection of frailty or sarcopenia, would be the key to preventing aging disabilities, even death. Thus further prospective studies are needed to confirm the results obtained in other populations because there is no information about chronic conditions together with sarcopenia and its influences on mortality results. In conclusion they added that “having a low amount of appendicular fat-free mass is a significant predictor of mortality in older people, and efforts should be made to prevent age-associated sarcopenia. No doubt, after the above, we can say that the study is relevant to the practice in the health field, either to prevent the development of disease or to mitigate its consequences. Despite having addressed to a conclusion that has implications on health practice and to recommend further studies on other populations, this study is not of sufficient quality to meet the criterion of scientific merit. Stigma and Shame Experiences by MSM Who Take PrEP

There is not hypothesis or questions stated clearly, no theoretical or conceptual framework explained, the literature review was not enough, especially considering it is matter of concern to health workers, and the researchers belong to Institute of Nutrition and Food Technology (University of Chile).This study did not show risk to the participants. CRITIQUING EVALUATION 7 References Bunout, D., De la Maza, M. P., Barrera, G., Leiva, L., & Hirsch, S. (2011). Stigma and Shame Experiences by MSM Who Take PrEP

Association between Sarcopenia and Mortality in Healthy Older People. Australasian Journal of Ageing, 30 (2), 89-92. 797437 research-article2018 JMHXXX10.1177/1557988318797437American Journal of Men’s HealthDubov et al. Special section-HIV/AIDS/STIs, Original Research Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study American Journal of Men’s Health 2018, Vol. 12(6) 1832­–1843 © The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1557988318797437 DOI: 10.1177/1557988318797437 journals.sagepub.com/home/jmh Alex Dubov, PhD1 , Phillip Galbo Jr2, Frederick L. Altice, MD3, and Liana Fraenkel, MD, MPH4 Abstract Pre-exposure prophylaxis (PrEP) uptake has been extremely low among key groups. PrEP-related stigma and shaming are potential barriers to uptake and retention in PrEP programs. There is a lack of literature describing PrEP stigma. Stigma and Shame Experiences by MSM Who Take PrEP

In order to fill this gap, we recruited online 43 HIV-negative Men who have Sex with Men (MSM) who use PrEP. Semistructured interviews were conducted to explore their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin’s grounded theory and constant comparison techniques to enhance understanding of the lived experiences of MSM who use PrEP. The participants experienced PrEP stigma as rejection by potential/actual partners, stereotypes of promiscuity or chemsex, and labeling of both the user and the medication. They connected PrEP stigma with HIV stigma, generational differences, moralization of condom use, and inability to embrace one’s own sexuality. These findings point to a need to develop tailored interventions to address PrEP-related stigma and shaming for individuals, health-care professionals, and the MSM community-at-large. Keywords Pre-exposure prophylaxis, HIV prevention, MSM, stigma, shaming Received April 5, 2018; revised July 9, 2018; accepted August 3, 2018 Despite an array of evidence-based behavioral HIV prevention interventions, there has been little reduction in the ~50,000 new HIV infections annually in the United States, especially among most-at-risk populations (MARPs). The majority of these new infections in the United States are among men who have sex with men (MSM; CDC, 2012). Biomedical prevention with the combination of Emtricitabine /Tenofovir (marketed as Truvada) was approved by the Food and Drug Administration (FDA) in 2012 for prevention of HIV in high-risk persons based on the compelling data from several major studies (Baeten et al., 2012; Choopanya et al., 2013; Grant et al., 2010; Thigpen et al., 2012) and confirmed in a systematic review (Fonner et al., 2016) demonstrating that pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection by as much as 92% (Holmes, 2012). The World Health Organization (WHO, 2012) and Centers for Disease Control (CDC, 2013) have issued public health guidance on PrEP prescription. Stigma and Shame Experiences by MSM Who Take PrEP

Despite these recommendations, PrEP uptake has been extraordinarily low. The 2015 report from the CDC states that approximately one in four gay men should be taking PrEP on a daily basis to prevent HIV transmission, translating to about 1.2 million MSM in the United States. Currently, 49,158 people are taking PrEP (including about 10,000 women). This means that only about 3% of the targeted population is using this prevention method (Bush et al., 2016). PrEP uptake is low and can be explained by a number of factors, including a lack of awareness of PrEP 1 Assistant Professor, Loma Linda University School of Public Health, Sanitarium Dr. Loma Linda, CA, USA 2 Department of Neuro-Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, USA 3 Professor of Medicine and Public Health, Director of Clinical and Community Research, Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA 4 Professor of Medicine, Yale University School of Medicine, Section of Rheumatology, New Haven, CT, USA Corresponding Author: Alex Dubov, PhD, Assistant Professor, Loma Linda University School of Public Health, Sanitarium Dr. Loma Linda, CA 92354, USA. Email: adubov@llu.edu Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 1833 Dubov et al. (Eaton, Driffin, Bauermeister, Smith, & ConwayWashington, 2015; Krakower et al., 2012), a low perceived risk of HIV acquisition (Pérez-Figueroa, Kapadia, Barton, Eddy, & Halkitis, 2015), concerns regarding potential adverse effects (Golub et al., 2013), a dislike of taking medication (Rolle et al., 2017), the cost of medication (Cohen et al., 2015), the cost and inconvenience of required monitoring visits (Elopre, Kudroff, Westfall, Overton, & Mugavero, 2017), and the requirement to undergo repeat HIV testing prior to each new prescription (Mayer et al., 2015). Stigma and Shame Experiences by MSM Who Take PrEP

In addition to concerns regarding low uptake of PrEP, public health specialists and researchers are concerned with PrEP adherence among users. Adherence is a key issue in ensuring PrEP effectiveness. Inadequate adherence is a major reason for PrEP failure, as highlighted by the PrEP trials. In iPrEx, participants with drug detected in blood were estimated to have a substantially higher reduction in HIV infection risk than seen in the intention-to-treat analysis (92% vs. 44%; Grant et al., 2010). PrEP-related stigma and shaming are potential barriers to PrEP implementation and maintenance. The definition of stigma, traditionally used by many social science researchers, is taken from the seminal work by Goffman (2009). Stigma and Shame Experiences by MSM Who Take PrEP

He defines stigma as an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one.” Crocker et al. (1998) indicate that “stigmatized individuals possess (or are believed to possess) some attribute, or characteristic, that conveys a social identity that is devalued in a particular social context.” These definitions share the assumption that people who are stigmatized have an attribute that marks them as different and leads them to be devalued in the eyes of others. Stigmatizing marks may be visible or invisible, controllable or uncontrollable, and linked to appearance, behavior, or group membership. Scholars describe stigma as a social construct or a label attached by society that leads to discrimination, negative treatment, and stereotyping. The scholarship on PrEP-related stigma is limited (Eaton et al., 2017; Franks et al., 2018; Grace et al., 2018; Schwartz & Grimm, 2017). The recent PrEP demonstration project of 261 MSM in San Francisco reported that PrEP stigma poses a barrier to uptake and retention in PrEP program. The study concluded with a call for interventions aiming to combat PrEP-related stigma (Liu et al., 2014). Golub and colleagues (2017) identified two types of PrEP-related stereotypes that were reported in 80% of 160 qualitative interviews of MSM in New York City. The first stereotype was the assumption that PrEP users are actually HIV-infected and lying about it, while the second stereotype was the belief that PrEP users are highly promiscuous and resistant to condom use. In their commentary, Calabrese and Underhill (2015) call to overcome stereotypes and sex-negative messaging in guiding decision making about PrEP use. The belief that PrEP is for promiscuous people (stigma belief) was strongly associated with a lack of interest in using PrEP among 179 White and 85 Black MSM participating at a gay pride event in a large Southwestern U.S. city (Eaton et al., 2017). In a study by Biello and colleagues (2017) among MSM who recently engaged in transactional sex, anticipated PrEP stigma was the main deterrent for PrEP use. Similarly, PrEP-related stigma has been prominent in the media, with a Huffington Post article labeling PrEP adopters as “Truvada Whores.” This term was later reappropriated by a number of activists who started to use the #TruvadaWhore hashtag on social media and wore it printed on their blue T-shirts (Duran, 2012). Stigma and Shame Experiences by MSM Who Take PrEP

PrEP discourse within the MSM community has many instances of slut-shaming that are different from mere disagreement or criticism. Slut-shaming is defined as a form of social stigma applied to those who are perceived to violate traditional expectations for sexual behavior (Poole, 2013). Often this slut-shaming comes from other gay men believing that PrEP promotes reckless sexual behavior, and it is only to be used by sluts or whores. In the present study, we conducted semistructured qualitative interviews with gay men who use PrEP in order to explore their experiences with PrEP-related stigma. The main research question for this study is: What are the PrEPrelated stigma experiences of MSM living in the United States who use PrEP for HIV prevention? We examined their narratives for experiences with felt and enacted stigma, and we describe its various manifestations and potential drivers. Methods Study Design This study was part of a larger research project conducted to determine preferences for PrEP delivery among MSM in the United States (Dubov, Fraenkel, Yorick, Ogunbajo, & Altice, 2018) and Ukraine (Dubov et al., 2018) using stated preference method. From June to October 2015, purposive sampling was used to recruit a subsample of 43 MSM who use PrEP for HIV prevention and report PrEPrelated stigma to participate in this qualitative study. The study was approved by Duquesne University IRB. Recruitment and Eligibility Participants were recruited online fro …Stigma and Shame Experiences by MSM Who Take PrEP