Monthly Archives: May 2022

Background: Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal.

Methods: A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g., Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population.

Results: The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3,000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse (“chemsex”) (AOR: 3.37; 95% CI: 1.44-7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13-3.85), HIV testing in the previous six months (AOR: 3.23; 95% CI: 1.74-5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02-3.34) were associated with having taken PrEP in the past.

Conclusions: This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.

Background: Background: The growth in mobile technology access, utilization, and services holds great promise to facilitate HIV prevention efforts in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mHealth platforms to address HIV prevention needs of Malaysian gay, bisexual, and other men who have sex with men (GBMSM).

Objective: The goal of this study was to gain insights into: a) access and utilization of communication technology (e.g., landline phone, internet, cell phone); b) acceptability of mHealth-based interventions for HIV prevention services; and c) preferences regarding the format and frequency of mHealth interventions among Malaysian GBMSM.

Methods: A cross-sectional survey of 376 Malaysian GBMSM was conducted between July 2018 and March 2020. Participants were recruited using respondent-driven sampling (RDS) in the Greater Kuala Lumpur region, Malaysia. Participants completed a self-administered assessment of participant demographics, HIV risk-related behaviors, access to and frequency of use of communication technology, and acceptability of mHealth for HIV prevention.

Results: Almost all participants owned or had access to a smartphone with Internet access (97.9%) and accessed the Internet daily (99.2%), mainly on a smartphone (88.8%). Using a 5-point scale, participants on average used smartphones primarily for social networking (M=4.5; SD=0.8), followed by sending or receiving emails (M=4.0; SD=1.0) and searching for health-related information (M=3.5; SD=0.9). Further, the results indicated high acceptance of mHealth for HIV prevention (M=4.1; SD=1.5), including: receiving HIV prevention information (91.8%); receiving medication reminders (89.4%); screening and monitoring sexual activity (81.4%) and illicit drug use (74.7%); and monitoring drug cravings (74.5%). Participants overwhelmingly preferred a smartphone app over other modalities (e.g., text, phone call, email) for engaging in mHealth HIV prevention tools. Acceptance of mHealth was higher for those who were university graduates, living in a relationship with a partner, engaged in sexualized drug use, and engaged in receptive anal sex.

Conclusions: Findings from this study provide support for developing and deploying mHealth strategies for HIV prevention in GBMSM using a smartphone app, crucial for a key population with suboptimal engagement in HIV prevention and treatment.

Background: Background: Neurocognitive dysfunction is common among individuals with opioid use disorders (OUD) and can impede a range of treatment outcomes. We developed the 57-item Brief Inventory of Neuro-cognitive Impairment (BINI) to help detect and monitor neurocognitive dysfunction in the context of drug treatment settings. To date, no study has examined the possible presence of BINI subgroups among OUD patients, which could enhance our ability to tailor intervention strategies to meet individual treatment needs. The purpose of this study was to conduct a latent profile analysis to identify BINI subgroups that differ in terms of their reported and objective neurocognitive dysfunction. We hypothesized that subgroups would emerge, suggesting the potential benefit of implementing tailored strategies for optimal treatment outcomes.

Methods: Latent profile analyses included data from opioid-dependent patients (N = 177) enrolled in a methadone maintenance treatment program between July 2018 and October 2019.

Results: We found three profiles of self-reported neurocognitive symptoms, including those with 1) minimal concerns 2) moderate concerns, and 3) many concerns across multiple domains.

Conclusions: If these results are confirmed, the BINI may be used to rapidly identify persons who require specific accommodation strategies to improve their drug treatment outcomes.

The use of amphetamine-type stimulants (ATS) has been associated with increased sexual risk behaviors and HIV transmission, among other adverse health outcomes. However, ATS use among female sex workers (FSWs) in Malaysia has not yet been characterized. We examined the prevalence and correlates associated with ATS use among Malaysian FSW. Between February and December 2016, 492 FSWs, including cisgender (n=299) and transgender (n=193) women, were recruited using respondent-driven sampling in Greater Kuala Lumpur, Malaysia. A structured questionnaire was used to collect demographic characteristics, sexual behaviors, ATS and other substance use, behavioral health issues, involvement in criminal justice, and experience of physical and sexual trauma. Logistic regression analyses were conducted to determine factors associated with active ATS use, defined as ATS use in the last 30 days. Nearly one-third (32.3%) of participants reported active ATS use. In the multivariable model, ATS use was associated with drug use during sex work (aOR=17.10; 8.32-35.15), having moderate to severe level of substance use disorder (aOR=3.38; 1.48-7.70), and engaging in sex work with multiple clients per day (two clients: aOR=3.39; 1.36-8.46; three clients: aOR=5.06; 1.81-14.10). A high prevalence of ATS use was documented in our sample. The presence of moderate to severe substance use disorder, the use of drugs during sex work activity, and having multiple sex work clients per day were significantly associated with active ATS use. Given these findings, prevention and harm reduction strategies need to be tailored to address the increasing ATS use and the associated adverse health consequences among FSWs in Malaysia.