Tim Lane | University of California, San Francisco (original) (raw)

Papers by Tim Lane

Research paper thumbnail of Rural school experiences of South African gay and transgender youth

Journal of LGBT Youth

Abstract Low educational attainment, often a lack of a high school diploma or matriculation degre... more Abstract Low educational attainment, often a lack of a high school diploma or matriculation degree, has been linked to negative health outcomes and lower quality of life for sexual and gender minorities globally. However, optimism and resiliency have been demonstrated to provide buffering effects on school dropout. We conducted a study in a South African rural setting to understand the school experiences of gay men, drag queens, and transgender women in Mpumalanga, South Africa. We recruited 35 HIV-positive participants using a purposive sampling method and then conducted a series of focus group discussions. A semi-structured focus group protocol was used, which covered three main domains: educational attainment and goals, experiences as a gender or sexual minority in school before matriculation, and personal and social values placed on education. Through a constant comparison analytical approach, we identified four themes to include school violence and discrimination, dropping out or staying silent to cope, competition between drag queens and girls, and education is social power. Our study suggests that sexual and gender minority youth navigate harassment and discrimination, which negatively impacts their educational attainment, but there is opportunity to support their academic achievement and leadership in society by building upon their acts of resiliency.

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Research paper thumbnail of “Booze is the main factor that got me where I am today”: alcohol use and HIV risk for MSM in rural South Africa

AIDS Care

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Research paper thumbnail of How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

Global health promotion, 2017

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV socia... more There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

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Research paper thumbnail of Modelling the UNAIDS 90-90-90 treatment cascade for gay, bisexual and other men who have sex with men in South Africa: using the findings of a data triangulation process to map a way forward

AIDS and Behavior

A data triangulation exercise was carried out between 2013 and 2015 to assess the HIV epidemic an... more A data triangulation exercise was carried out between 2013 and 2015 to assess the HIV epidemic and response among gay, bisexual and other men who have sex with men (GBMSM) in South Africa. We used the findings to assess progress in achieving the UNAIDS 90-90-90 goals for GBMSM in the country. Three scenarios were developed using different GBMSM population factors (2.0, 3.5 and 5.0% of males aged ≥15) to estimate the population size, HIV prevalence of 13.2-49.5%, and 68% of GBMSM knowing their status. Due to data gaps, general population data were used as estimates of GBMSM on antiretroviral therapy (ART) and virologically suppressed (25.7 and 84.0%, respectively). The biggest gap is access to ART. To address the data gap we recommend developing data collection tools, indicators, and further quantification of HIV cascades. Targeted testing, linkage to services and scaled-up prevention interventions (including pre-exposure prophylaxis) are also required.

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Research paper thumbnail of Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa

Journal of the International Association of Providers of AIDS Care (JIAPAC)

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Research paper thumbnail of The accuracy of HIV rapid testing in integrated bio-behavioral surveys of men who have sex with men across 5 Provinces in South Africa

Medicine

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Research paper thumbnail of This will not enter me": painful anal intercourse among black men who have sex with men in South african townships

Archives of sexual behavior, 2015

Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk a... more Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk and protective behaviors among men who have sex with men (MSM). The purpose of this study was to identify attributions for and responses to painful RAI among Black MSM in South African townships. In-depth interviews were conducted with 81 Black MSM (ages 20-39 years) who were purposively recruited from four townships. The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex. Pain during RAI was brought up by many participants without specific prompting from the interviewer. Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. The main strategies participants used to address pain during RAI were setting sexual bou...

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Research paper thumbnail of HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

AIDS and Behavior, 2014

While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those ... more While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those already infected know their status. Effectively promoting frequent HIV testing-of increasing importance with the expanding accessibility of antiretroviral treatment-requires an understanding of the testing practices in this population. To understand men's HIV testing practices, including their behavior, experiences, and perceptions, we conducted in-depth interviews with 81 black South African MSM (ages 20-39), purposively recruited from four townships. Many men in the sample had tested for HIV. While ever having tested seemed to facilitate repeat testing, men still expressed a high level of discomfort with testing. It was common to test after having engaged in risky behavior, thus increasing anxiety about testing that was already present. Fear that they might test HIV positive caused some men to avoid testing until they were clearly sick, and others to avoid testing completely. HIV testing may increase in this population if it becomes a routine practice, instead of being driven by anxiety-inducing incidents. Mobilization through social support might facilitate frequent testing while education about current treatment options is needed.

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Research paper thumbnail of The Mpumalanga Men's Study (MPMS): Results of a Baseline Biological and Behavioral HIV Surveillance Survey in Two MSM Communities in South Africa

PLoS ONE, 2014

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Research paper thumbnail of Men Who Have Sex with Men in Mozambique: Identifying a Hidden Population at High-risk for HIV

AIDS and behavior, Jan 19, 2014

The population of men who have sex with men (MSM) has been largely ignored in HIV-related policie... more The population of men who have sex with men (MSM) has been largely ignored in HIV-related policies and programming in Mozambique and there is little information about the contribution of MSM to the HIV epidemic. An integrated biological and behavioral study among MSM using respondent-driven sampling was conducted in 2011 in Maputo, Beira and Nampula/Nacala. Men who reported engaging in oral or anal sex with other men in the last 12 months answered a questionnaire and provided a blood sample for HIV testing. The prevalence of HIV was 8.2 % (Maputo, n = 496), 9.1 % (Beira, n = 584) and 3.1 % (Nampula/Nacala, n = 353). Prevalence was higher among MSM ≥ 25 vs. 18-24 years: 33.8 % vs. 2.4 % (p < 0.001), 32.1 vs. 2.8 % (p < 0.001), and 10.3 vs. 2.7 % (p < 0.06), in each city respectively. The difference in prevalence demonstrates the need to increase prevention for younger MSM at risk for HIV and ensure care and treatment for older HIV-infected MSM.

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Research paper thumbnail of Removing Barriers to Knowing HIV Status

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006

Objectives: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were ... more Objectives: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. Methods: We provided

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Research paper thumbnail of HIV surveillance in theory and practice: Assessing the acceptability of California's non-name HIV surveillance regulations

Health Policy, 2006

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Research paper thumbnail of Using Participatory Mapping to Inform a Community-Randomized Trial of HIV Counseling and Testing

Field Methods, 2009

Participatory mapping and transect walks were used to inform the research and intervention design... more Participatory mapping and transect walks were used to inform the research and intervention design and to begin building community relations in preparation for Project Accept, a community-randomized trial sponsored by the National Institute of Mental Health. Project Accept is being conducted at five sites in four countries: Thailand, Zimbabwe, South Africa, and Tanzania. Results from the mapping exercises informed decisions such as defining community boundaries and identifying appropriate criteria for matching community pairs for the trial as well as where to situate the services. The mapping also informed intervention-related decisions such as where to situate the services. The participatory methods enabled researchers at each site to develop an understanding of the communities that could not have been derived from existing data or data collected through standard data collection techniques. Furthermore, the methods lay the foundation for collaborative community research partnerships.

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Research paper thumbnail of Response to Harrison et al. ‘Young menʼs HIV risks in South Africa: the importance of multiple risk behaviors’

AIDS, 2006

We are grateful to Harrison et al. for sharing the insights on early sexual debut and HIV risk am... more We are grateful to Harrison et al. for sharing the insights on early sexual debut and HIV risk among young men from their own work and for their constructive engagement with our letter. In the National Youth Survey respondents were asked three separate questions about sexual debut: age of first vaginal sex (for men mean 16 years) age of first oral sex and age of first anal sex (both mean 18 years). After recategorizing the age of sexual debut for men as vaginal sex at less than 15 years of age or 15 years and older early sexual debut was associated with a reduced although not statistically significant risk of ever engaging in anal intercourse in bivariate analyses (odds ratio 0.5 95% confidence interval 0.2--1.0). (excerpt)

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Research paper thumbnail of Rural school experiences of South African gay and transgender youth

Journal of LGBT Youth

Abstract Low educational attainment, often a lack of a high school diploma or matriculation degre... more Abstract Low educational attainment, often a lack of a high school diploma or matriculation degree, has been linked to negative health outcomes and lower quality of life for sexual and gender minorities globally. However, optimism and resiliency have been demonstrated to provide buffering effects on school dropout. We conducted a study in a South African rural setting to understand the school experiences of gay men, drag queens, and transgender women in Mpumalanga, South Africa. We recruited 35 HIV-positive participants using a purposive sampling method and then conducted a series of focus group discussions. A semi-structured focus group protocol was used, which covered three main domains: educational attainment and goals, experiences as a gender or sexual minority in school before matriculation, and personal and social values placed on education. Through a constant comparison analytical approach, we identified four themes to include school violence and discrimination, dropping out or staying silent to cope, competition between drag queens and girls, and education is social power. Our study suggests that sexual and gender minority youth navigate harassment and discrimination, which negatively impacts their educational attainment, but there is opportunity to support their academic achievement and leadership in society by building upon their acts of resiliency.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of “Booze is the main factor that got me where I am today”: alcohol use and HIV risk for MSM in rural South Africa

AIDS Care

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Research paper thumbnail of How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

Global health promotion, 2017

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV socia... more There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Modelling the UNAIDS 90-90-90 treatment cascade for gay, bisexual and other men who have sex with men in South Africa: using the findings of a data triangulation process to map a way forward

AIDS and Behavior

A data triangulation exercise was carried out between 2013 and 2015 to assess the HIV epidemic an... more A data triangulation exercise was carried out between 2013 and 2015 to assess the HIV epidemic and response among gay, bisexual and other men who have sex with men (GBMSM) in South Africa. We used the findings to assess progress in achieving the UNAIDS 90-90-90 goals for GBMSM in the country. Three scenarios were developed using different GBMSM population factors (2.0, 3.5 and 5.0% of males aged ≥15) to estimate the population size, HIV prevalence of 13.2-49.5%, and 68% of GBMSM knowing their status. Due to data gaps, general population data were used as estimates of GBMSM on antiretroviral therapy (ART) and virologically suppressed (25.7 and 84.0%, respectively). The biggest gap is access to ART. To address the data gap we recommend developing data collection tools, indicators, and further quantification of HIV cascades. Targeted testing, linkage to services and scaled-up prevention interventions (including pre-exposure prophylaxis) are also required.

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Research paper thumbnail of Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa

Journal of the International Association of Providers of AIDS Care (JIAPAC)

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Research paper thumbnail of The accuracy of HIV rapid testing in integrated bio-behavioral surveys of men who have sex with men across 5 Provinces in South Africa

Medicine

Bookmarks Related papers MentionsView impact

Research paper thumbnail of This will not enter me": painful anal intercourse among black men who have sex with men in South african townships

Archives of sexual behavior, 2015

Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk a... more Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk and protective behaviors among men who have sex with men (MSM). The purpose of this study was to identify attributions for and responses to painful RAI among Black MSM in South African townships. In-depth interviews were conducted with 81 Black MSM (ages 20-39 years) who were purposively recruited from four townships. The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex. Pain during RAI was brought up by many participants without specific prompting from the interviewer. Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. The main strategies participants used to address pain during RAI were setting sexual bou...

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Research paper thumbnail of HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

AIDS and Behavior, 2014

While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those ... more While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those already infected know their status. Effectively promoting frequent HIV testing-of increasing importance with the expanding accessibility of antiretroviral treatment-requires an understanding of the testing practices in this population. To understand men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s HIV testing practices, including their behavior, experiences, and perceptions, we conducted in-depth interviews with 81 black South African MSM (ages 20-39), purposively recruited from four townships. Many men in the sample had tested for HIV. While ever having tested seemed to facilitate repeat testing, men still expressed a high level of discomfort with testing. It was common to test after having engaged in risky behavior, thus increasing anxiety about testing that was already present. Fear that they might test HIV positive caused some men to avoid testing until they were clearly sick, and others to avoid testing completely. HIV testing may increase in this population if it becomes a routine practice, instead of being driven by anxiety-inducing incidents. Mobilization through social support might facilitate frequent testing while education about current treatment options is needed.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of The Mpumalanga Men's Study (MPMS): Results of a Baseline Biological and Behavioral HIV Surveillance Survey in Two MSM Communities in South Africa

PLoS ONE, 2014

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Men Who Have Sex with Men in Mozambique: Identifying a Hidden Population at High-risk for HIV

AIDS and behavior, Jan 19, 2014

The population of men who have sex with men (MSM) has been largely ignored in HIV-related policie... more The population of men who have sex with men (MSM) has been largely ignored in HIV-related policies and programming in Mozambique and there is little information about the contribution of MSM to the HIV epidemic. An integrated biological and behavioral study among MSM using respondent-driven sampling was conducted in 2011 in Maputo, Beira and Nampula/Nacala. Men who reported engaging in oral or anal sex with other men in the last 12 months answered a questionnaire and provided a blood sample for HIV testing. The prevalence of HIV was 8.2 % (Maputo, n = 496), 9.1 % (Beira, n = 584) and 3.1 % (Nampula/Nacala, n = 353). Prevalence was higher among MSM ≥ 25 vs. 18-24 years: 33.8 % vs. 2.4 % (p < 0.001), 32.1 vs. 2.8 % (p < 0.001), and 10.3 vs. 2.7 % (p < 0.06), in each city respectively. The difference in prevalence demonstrates the need to increase prevention for younger MSM at risk for HIV and ensure care and treatment for older HIV-infected MSM.

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Research paper thumbnail of Removing Barriers to Knowing HIV Status

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006

Objectives: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were ... more Objectives: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. Methods: We provided

Bookmarks Related papers MentionsView impact

Research paper thumbnail of HIV surveillance in theory and practice: Assessing the acceptability of California's non-name HIV surveillance regulations

Health Policy, 2006

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Using Participatory Mapping to Inform a Community-Randomized Trial of HIV Counseling and Testing

Field Methods, 2009

Participatory mapping and transect walks were used to inform the research and intervention design... more Participatory mapping and transect walks were used to inform the research and intervention design and to begin building community relations in preparation for Project Accept, a community-randomized trial sponsored by the National Institute of Mental Health. Project Accept is being conducted at five sites in four countries: Thailand, Zimbabwe, South Africa, and Tanzania. Results from the mapping exercises informed decisions such as defining community boundaries and identifying appropriate criteria for matching community pairs for the trial as well as where to situate the services. The mapping also informed intervention-related decisions such as where to situate the services. The participatory methods enabled researchers at each site to develop an understanding of the communities that could not have been derived from existing data or data collected through standard data collection techniques. Furthermore, the methods lay the foundation for collaborative community research partnerships.

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Response to Harrison et al. ‘Young menʼs HIV risks in South Africa: the importance of multiple risk behaviors’

AIDS, 2006

We are grateful to Harrison et al. for sharing the insights on early sexual debut and HIV risk am... more We are grateful to Harrison et al. for sharing the insights on early sexual debut and HIV risk among young men from their own work and for their constructive engagement with our letter. In the National Youth Survey respondents were asked three separate questions about sexual debut: age of first vaginal sex (for men mean 16 years) age of first oral sex and age of first anal sex (both mean 18 years). After recategorizing the age of sexual debut for men as vaginal sex at less than 15 years of age or 15 years and older early sexual debut was associated with a reduced although not statistically significant risk of ever engaging in anal intercourse in bivariate analyses (odds ratio 0.5 95% confidence interval 0.2--1.0). (excerpt)

Bookmarks Related papers MentionsView impact