Tim Lane - Profile on Academia.edu (original) (raw)

Papers by Tim Lane

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.

“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

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.

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.

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

There is an urgent need to develop the HIV treatment cascade for men who have sex with men (MSM) ... more There is an urgent need to develop the HIV treatment cascade for men who have sex with men (MSM) and transgender individuals in rural Mpumalanga, South Africa. Mhealth tools such as smartphone applications have the potential to support HIV self-care behaviors. We conducted an exploratory study with HIV-positive community leaders to understand their current uses of cell phones and smartphones and to assess their interest in an HIV research study that utilized a smartphone application for HIV care support. A total of 18 community leaders were recruited to complete a questionnaire and focus group. We found that a large proportion of participants had smartphone access and were interested in a research study that utilized a smartphone application with secure access measures. We conclude that smartphone applications for HIV care research are feasible based on access and interest by MSM and transgender individuals in this rural setting.

Medicine

We describe the accuracy of serial rapid HIV testing among men who have sex with men (MSM) in Sou... more We describe the accuracy of serial rapid HIV testing among men who have sex with men (MSM) in South Africa and discuss the implications for HIV testing and prevention. This was a cross-sectional survey conducted at five stand-alone facilities from five provinces. Demographic, behavioral, and clinical data were collected. Dried blood spots were obtained for HIV-related testing. Participants were offered rapid HIV testing using 2 rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using a third-generation enzyme immunoassay (EIA) and a fourth-generation EIA as confirmatory. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive, and false-negative rates were determined. Between August 2015 and July 2016, 2503 participants were enrolled. Of these, 2343 were tested by RDT on site with a further 2137 (91.2%) having definitive results on both RDT and EIA. Sensitivity, specificity, positive predictive value, negative predictive value, false-positive rates, and false-negative rates were 92.6% [95% confidence interval (95% CI) 89.6-94.8], 99.4% (95% CI 98.9-99.7), 97.4% (95% CI 95.2-98.6), 98.3% (95% CI 97.6-98.8), 0.6% (95% CI 0.3-1.1), and 7.4% (95% CI 5.2-10.4), respectively. False negatives were similar to true positives with respect to virological profiles. Overall accuracy of the RDT algorithm was high, but sensitivity was lower than expected. Post-HIV test counseling should include discussions of possible false-negative results and the need for retesting among HIV negatives. Abbreviations: ART = antiretroviral therapy, CI = confidence interval, DBS = dried blood spot, EIA = enzyme immunoassay, ELISA = enzyme-linked immunosorbent assay, HIV = human immunodeficiency virus, HTS = HIV testing services, IBBS = integrated bio-behavioural survey, IQC = internal quality control, IQR = interquartile ranges, MSM = men who have sex with men, NICD = National Institute for Communicable Diseases, NPV = negative predictive value, PPV = positive predictive value, PrEP = preexposure prophylaxis, RDT = rapid diagnostic test, SAHMS-MSM = South Africa Health Monitoring Survey with MSM, STIs = sexually transmitted infections.

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...

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;#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.

PLoS ONE, 2014

The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention interv... more The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention intervention for South African MSM. Boithato aims to increase consistent condom use, regular testing for HIV-negative MSM, and linkage to care for HIV-positive MSM. The MPMS baseline examined HIV prevalence and associated risk behaviors, and testing, care, and treatment behaviors among MSM in Gert Sibande and Ehlanzeni districts in Mpumalanga province, South Africa in order to effectively target intervention activities. We recruited 307 MSM in Gert Sibande and 298 in Ehlanzeni through respondentdriven sampling (RDS) between September 2012-March 2013. RDS-adjusted HIV prevalence estimates are 28.3% (95% CI 21.1%-35.3%) in Gert Sibande, and 13.7% (95% CI 9.1%-19.6%) in Ehlanzeni. Prevalence is significantly higher among MSM over age 25 [57.8% (95% CI 43.1%-72.9%) vs. 17.9% (95% CI 10.6%-23.9%), P,0.001 in Gert Sibande; 34.5% (95%CI 20.5%-56.0%) vs. 9.1% (95% CI 4.6%-13.9%), P,0.001 in Ehlanzeni]. In Gert Sibande, prevalence is higher among self-identified gay and transgender MSM vs. other MSM [39.3% (95%CI, 28.3%-47.9%), P,0.01], inconsistent condom users [38.1% (18.1%-64.2%), P,0.05], those with a current regular male partner [35.0% (27.1%-46.4%), P,0.05], and those with lifetime experience of intimate partner violence with men [40.4%, (95%CI 28.9%-50.9%), P,0.05]. Prevalence of previous HIV testing was 65.8% (95%CI 58.8%-74.0%) in Gert Sibande, and 69.3% (95%CI 61.9%-76.8%) in Ehlanzeni. Regular HIV testing was uncommon [(34.6%, (95%CI 27.9%-41.4%) in Gert Sibande; 31.0% (95%CI 24.9%-37.8%) in Ehlanzeni]. Among HIV-positive participants, few knew their status (28.1% in Gert Sibande and 14.5% in Ehlanzeni), or were appropriately linked to care (18.2% and 11.3%, respectively), or taking antiretroviral therapy (13.6% and 9.6% respectively). MPMS results demonstrate the importance of implementing interventions for MSM to increase consistent condom use, regular HIV testing, and linkage and engagement in care for HIV-infected MSM.

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.

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

Health Policy, 2006

In 2002, California adopted a non-name system for HIV case reporting. This study focused on the a... more In 2002, California adopted a non-name system for HIV case reporting. This study focused on the acceptability of a non-name reporting system among key stakeholders implementing the system. We conducted qualitative research during the pre-and post-implementation period of the non-name HIV reporting regulations. During both study periods we conducted key informant in-depth interviews (n = 48 and 52, respectively) with health department surveillance staff, laboratory personnel, health care providers and clinic staff; and we conducted four focus group discussions (n = 28 and 30, respectively) with representatives of community-planning group members and advocacy groups. We found that overall, California's non-name HIV reporting regulations were acceptable to most key stakeholders. Acceptability of a non-name system was highest among advocates and healthcare providers. Views of health department staff varied across the four counties, with some expressing a strong preference of a names based system and others accepting the non-name system.

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.

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)