Preventive Medicine & Public Health

Biography

Joseph T F Lau is a Professor; Associate Director; Head of the Division of Behavioral Health and Health Promotion; and Director of the Centre for Health Behaviours Research in the J C School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong. He is also the Founding President of the Hong Kong Society of Behavioral Health (HKSBH), Convenor of the Asian Network for Behavioral Health, and Convenor for the Academic Forum of Behavioral Health. His diverse research interests include those on behavioral interventions for changing risk and preventive behaviours. He has published about 400 papers in peer-reviewed journals, and has been awarded over 60 grants as PI. He provides consultancy to WHO, the Cambodian government and various CDCs in China, and is a Member of the Governing Council and Co-Chair of the International Liaison Committee for the International Society of Behavioral Medicine (ISBM).

Abstract

Globally, the HIV epidemic among men who have sex with men (MSM) has become out of control. In addition to being disproportionately burdened by STI/HIV, MSM experience higher rates of mental health problems. HIV-positive MSM are challenged by multi-morbidity and syndemics, as their prevalence of mental health problems is 2-3 times higher than HIV-negative MSM. Such prevalence may be aggregated by stigma, prevalent illicit psychoactive substance use and chemsex, and low mental health service utilization. Mental health problems were associated with faster progression to AIDS, shorter survival and higher risk of secondary HIV transmission. Moreover, they would diminish the efficacy of the WHO recommended treatment as prevention (TasP) by affecting usage and adherence. In the past few years, the growing evidence for the effectiveness of bio-medical HIV interventions (e.g., pre-exposure prophylaxis (PrEP), TasP) has changed HIV prevention strategies substantially. Issues related to behavioral and psychological possesses are involved in the implementation of bio-medical HIV interventions. Take PrEP as an example, previous risk behaviors, cognitive variables and mental health status (e.g., anxiety) were determinants of its acceptance among MSM. Potential issues, such as non-adherence to daily dosage, risk compensation, not taking up required testing (i.e., HIV, STI, renal/liver function) regularly, and not seeking medical consultation before starting/discontinuing PrEP, should be monitored and prevented to ensure the effectiveness of PrEP and safety of PrEP users. HIV prevention for controlling HIV epidemics among MSM should understand the importance of psychological factors and consequences, as well as the interplay between biomedical and behavioral processes.