HIV transmission continues to increase for Gay men, especially for those Gay men in nonmonogamous serodiscordant relationships. As the use of PreExposure Prophylaxis (PrEP) increases, much less is known about how PrEP is creating social meaning and transforming the sexual behaviors of HIV negative, non-monogamous Gay men. Accordingly, the purpose of this study was to investigate the meaning making experiences of Gay men in nonmonogamous serodiscordant relationships. Using the Minority Stress Model, Resiliency Theory, and Queer Theory as theoretical frameworks, the research question for the study focused on how HIV negative Gay men who are on PrEP and involved in nonmonogamous serodiscordant relationships navigate their sexual lives. Interpretative Phenomenological Analysis was employed within a purposeful sample of 13 Gay men. The two themes of resiliency and reframing emerged from the descriptive coding, member checking, and triangulation of the data. Of the two themes identified, participants noted pre-PrEP resiliency strategies including looks and trust, while current PrEP strategies included strategic positioning, getting educated about HIV and PrEP, and dating undetectable men. Reframing experiences included marketability, greater feeling of sexual freedom and responsibility, new rules around nonmonogamy, increased sexual confidence, and new masculine terms for condomless anal sex. Findings and recommendations from the study may advance positive social change when researchers and practitioners combat stigma, understand perceived lower risk of HIV transmission through new resiliency techniques, and facilitate the reframing of sex within an individual, relational, and Gay cultural context.

Patients with human immunodeficiency virus (HIV)/AIDS live a far different life today compared with those who were infected in the 1980s and 1990s. Antiretroviral therapy has evolved from a once poorly tolerated, heavy pill burden to the availability of many once-daily single-tablet regimens. The improvements in therapy have necessitated the need to be cognizant of comorbidities as well as drug-drug interactions. Despite the tremendous advances in therapy, newer therapies are in the pipeline and continue to emerge, making care for patients burdened by HIV perhaps easier than it has ever been.

Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population.

Preexposure prophylaxis (PrEP) is an innovative biomedical approach that has been used over the past 6 years to avert the spread of human immunodeficiency virus (HIV). Under-prescribing of PrEP could increase the probability of HIV exposure among serodiscordant couples/partners and those who do not practice safe sex. Previous PrEP research has not assessed the association between awareness of PrEP, years of experience of providers, provider types, and the frequency of PrEP prescription among physicians. Precaution adoption model framed this study, which aimed to evaluate the bond between the independent variables relating to awareness of PrEP, years of experience, and provider types with the outcome of the frequency of PrEP prescription among physicians. A cross-sectional design was applied to survey 100 physician participants. Kendall's tau-b correlation test and Fisher's exact test were used to analyze the research questions. Eighty-seven percent of the surveyed physicians had low awareness about PrEP, and 90% never prescribed PrEP. Lack of awareness was the primary barrier to prescribing PrEP at the providers' level. Kendall's tau-b correlation test showed that higher awareness of PrEP and years of experience were associated with the frequency of PrEP prescription at 95% confidence interval. However, Fisher's exact test showed an insignificant difference between provider types and the frequency of PrEP Prescription. These findings support the notion that independent of specialty, the more physicians know about PrEP and the more years of experience they have, the more they prescribe it. The results and recommendations could enhance positive social change by providing information to develop an inclusive PrEP education curriculum for health care professionals.

Bien que le nombre annuel de nouvelles infections au VIH diminue régulièrement depuis le milieu des années 1990, celui-ci reste élevé, en particulier en Afrique sub-Saharienne. L’organisme médical international Médecins Sans Frontières (MSF) a sélectionné quatre sites à hautes incidence et prévalence, dont un situé dans le district de Ndhiwa, au Kenya. La prévalence chez l’adulte a été estimée à 24% (d’après l’enquête en population NHIPS menée en 2012 par MSF-Epicentre). MSF espère, après une combinaison d’interventions sur le terrain, observer en temps réel une baisse de l’incidence de l’infection par le VIH. Dans la première partie, différents aspects de l’infection par le VIH et les questions actuelles sont présentés. Dans la seconde partie, notre objectif était d’estimer l’incidence de l’infection par le VIH à Ndhiwa à l’aide de différentes approches sélectionnées et appliquées aux données de NHIPS. Cet indicateur est essentiel pour déterminer la dynamique de l’épidémie, identifier les groupes de la population les plus à risque, et pour planifier des interventions de santé. Dans la dernière partie, notre objectif portait sur la modélisation à court terme de l’épidémie de VIH/SIDA dans le district de Ndhiwa. Dans un premier temps, nous avons proposé une méthodologie pour la modélisation de l’épidémie de VIH/SIDA associant l’estimation des paramètres d’un modèle et la prédiction de l’évolution de l’épidémie selon celui-ci, utilisant des données locales. Cette méthodologie a ensuite été appliquée aux interventions de santé envisageables par MSF-Epicentre, à l’aide de simulations déterministes et stochastiques / Although the annual number of new HIV infections has been decreasing since the middle of the 1990s’, it remains high, and particularly in sub-Saharan Africa. Epicentre, in collaboration with “Médecins Sans Frontières”, is planning a strategy to reduce HIV incidence in several areas of high prevalence and incidence rates, such as Ndhiwa sub-county (Nyanza Province, Kenya). In this sub-county, the adult HIV prevalence was estimated at 24% in 2012 (Ndhiwa HIV Impact in Population Survey, NHIPS, 2012). In the first part of this thesis, various aspects of HIV infection as well as current issues are given. In the second part, our objective is to estimate HIV incidence in Ndhiwa sub-county using several distinct approaches. In the last part, we focus on the mathematical modeling of the spread of the HIV infection to the short term. Firstly, we develop a framework for using the same data for estimation and prediction. Secondly, the potential impacts of multiple interventions on HIV incidence in Ndhiwa sub-county are studied using our framework and performing deterministic and stochastic simulations