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Bränström R, van der Star A, Pachankis JE. Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality. Soc Psychiatry Psychiatr Epidemiol 2020; 55:89-99. [PMID: 31300892 DOI: 10.1007/s00127-019-01742-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration-or a lack of meaning, purpose, and belonging as derived from societal norms, goals, and attachment-have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality. The aim of this study was to examine differences in suicidal ideation and attempts between LGB and heterosexual individuals in a nationally representative sample, and to examine barriers to societal integration as a potential explanation for any observed disparities over-and-above the influence of established contributors to sexual orientation disparity in suicidality. METHODS Data come from the cross-sectional Swedish National Public Health Survey, which collected data from unrestricted random samples of individuals (16-84 years of age) living in Sweden, annually from 2010 to 2015 (n = 57,840 individuals [response rates: 48.1-51.3%]; 1281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors. RESULTS Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (adjusted odds ratio [AOR] for suicide ideation: 2.69; 95% confidence intervals [CI]: 2.09, 3.47; AOR for suicide attempts: 5.50; 95% CI: 3.42, 8.83), and bisexuals (AOR for suicide ideation: 3.83; 95% CI: 3.26, 4.51; AOR suicide attempts: 6.78; 95% CI: 4.97, 9.24). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality. CONCLUSION Our results suggest that previously under-examined factors, namely the disproportionate barriers to societal integration that LGB individuals experience, are important contributors to the substantially elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minority individuals.
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Affiliation(s)
- Richard Bränström
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. .,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - Arjan van der Star
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Storholm ED, Huang W, Siconolfi DE, Pollack LM, Carrico AW, Vincent W, Rebchook GM, Huebner DM, Wagner GJ, Kegeles SM. Sources of Resilience as Mediators of the Effect of Minority Stress on Stimulant Use and Sexual Risk Behavior Among Young Black Men who have Sex with Men. AIDS Behav 2019; 23:3384-3395. [PMID: 31273490 PMCID: PMC6919270 DOI: 10.1007/s10461-019-02572-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The greatest proportion of new HIV infections among men who have sex with men (MSM) is occurring among young Black MSM (YBMSM) ages 13-24. Consequently, research is needed to understand the psychosocial pathways that influence HIV risk and resilience in YBMSM. Minority Stress Theory proposes that the stigma, prejudice, and discrimination facing sexual and racial minorities are chronic stressors that lead to increased engagement in risk behaviors. The present study examined whether minority stress is associated with stimulant use and sexual risk behaviors by depleting psychosocial resilience. We recruited 1817 YBMSM, ages 18-29, from multiple venues in two major cities in Texas for participation in a brief survey. Results from structural equation modeling indicated that decreased resilience partially mediated the association of minority stress with sexual risk behavior. Resilience was also negatively associated with stimulant use. Interventions focused on cultivating psychosocial resilience could mitigate the deleterious consequences of minority stress and reduce stimulant use in YBMSM.
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Affiliation(s)
- Erik D Storholm
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA.
| | - Wenjing Huang
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Daniel E Siconolfi
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | | | - Wilson Vincent
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | - Gregory M Rebchook
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
| | - David M Huebner
- School of Public Health, George Washington University, Washington, DC, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, Office 5227, Santa Monica, CA, 90407, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA
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McDaid LM, Flowers P, Ferlatte O, McAloney-Kocaman K, Gilbert M, Frankis J. Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: Empirical evidence from secondary analysis of multi-national, online cross-sectional surveys. SSM Popul Health 2019; 10:100519. [PMID: 31853476 PMCID: PMC6911981 DOI: 10.1016/j.ssmph.2019.100519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022] Open
Abstract
Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level. Gay and other men who have sex with men experience syndemics in varied contexts. Some salutogenic community assets have a protective effect on syndemic ill-health. Conceptualising syndemics within a complex adaptive systems model is required.
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Affiliation(s)
- Lisa M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Olivier Ferlatte
- Department of Social and Preventative Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc (3rd Floor), Montreal, Quebec, H3N 1X9, Canada.,Community Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia, V6Z 2H2, Canada
| | | | - Mark Gilbert
- Community Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia, V6Z 2H2, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Jamie Frankis
- Department of Health & Community Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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Adia AC, Ng MJ, Quilantang MI, Restar AJ, Hernandez LI, Imperial RH, Nazareno J, Operario D. Collective Coping Strategies for HIV-Related Challenges Among Men Who Have Sex With Men in Manila, Philippines. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:479-490. [PMID: 31550192 DOI: 10.1521/aeap.2019.31.5.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Contextual factors, such as cultures of collectivism versus individualism, shape HIV coping strategies; despite this, little research regarding collective coping strategies applied to HIV exists. This may be important for the growing HIV epidemic in the Philippines, which has a collectivistic culture and where men who have sex with men (MSM) account for a majority of the cases. Fifteen semistructured, in-depth interviews with HIV-positive MSM and 6 interviews with community-based organization workers were conducted between June and August 2017. Data were analyzed using thematic framework analysis. Three strategies were identified: peer support, spirituality, and support from existing relationships. Each form of collective coping had unique mechanisms and benefits for dealing with HIV. Overall, helping MSM with HIV find a collective identity after an HIV diagnosis enables management of HIV-related challenges. Policies and research interventions that improve access to collective identities for MSM with HIV may improve management of HIV-related challenges.
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Affiliation(s)
- Alexander C Adia
- Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island
| | | | - Ma Irene Quilantang
- Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island
- University of the Philippines, Manila, Manila, Philippines
| | - Arjee J Restar
- Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Jennifer Nazareno
- Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island
| | - Don Operario
- Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island
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Painter TM, Song EY, Mullins MM, Mann-Jackson L, Alonzo J, Reboussin BA, Rhodes SD. Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South. AIDS Behav 2019; 23:251-265. [PMID: 31102108 PMCID: PMC6800592 DOI: 10.1007/s10461-019-02540-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.
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Affiliation(s)
- Thomas M Painter
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA.
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary M Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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'This is mine, this is for me': preexposure prophylaxis as a source of resilience among women in Eswatini. AIDS 2019; 33 Suppl 1:S45-S52. [PMID: 31397722 DOI: 10.1097/qad.0000000000002178] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To understand the relationship between HIV preexposure prophylaxis (PrEP) and resilience among Emaswati women. DESIGN A qualitative study using semistructured in-depth interviews. METHODS We interviewed 24 women who recently initiated PrEP at one of six public-sector primary-care clinics participating in a government demonstration project for PrEP for the general population, as well as 30 PrEP stakeholders from HIV policy, implementation and donor sectors. RESULTS PrEP clients and stakeholders described an environment marked by high HIV risk. In this context, clients felt PrEP enhanced their resilience through feelings of protection, control over HIV acquisition, choice in relation to when to take PrEP, sexual pleasure and relief from the fear and consequences of HIV infection. Those in serodiscordant relationships described improved partner communication and a shared sense of responsibility for HIV prevention. Both PrEP clients and stakeholders asserted that PrEP marketing and communication should be Emaswati-led and community-owned. CONCLUSION PrEP helps women in Eswatini envision longer, healthier and more fulfilled lives. PrEP enhances resilience through several pathways, including self-efficacy, choice, control over HIV infection and relief from the fear of HIV infection. Social marketing and information campaigns should not only focus on PrEP as an HIV-prevention method but also emphasize how PrEP has expanded choice, enhanced control and facilitated sexual enjoyment among PrEP clients.
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Chakrapani V, Willie TC, Shunmugam M, Kershaw TS. Syndemic Classes, Stigma, and Sexual Risk Among Transgender Women in India. AIDS Behav 2019; 23:1518-1529. [PMID: 30565093 DOI: 10.1007/s10461-018-2373-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Syndemic theory could explain the elevated HIV risk among transgender women (TGW) in India. Using cross-sectional data of 300 TGW in India, we aimed to: identify latent classes of four syndemic conditions (Depression-D, Alcohol use-A, Violence victimization-V, HIV-positive status), test whether syndemic classes mediate the association between stigma and sexual risk, and test whether social support and resilient coping moderate the association between syndemic classes and sexual risk. Four distinct classes emerged: (1) DAV Syndemic, (2) AV Syndemic, (3) DV Syndemic, and (4) No Syndemic. TGW in the DAV Syndemic (OR 9.80, 95% CI 3.45, 27.85, p < 0.001) and AV Syndemic classes (OR 2.74, 95% CI 1.19, 6.32, p < 0.01) had higher odds of inconsistent condom use in the past month than the No Syndemic class. Social support significantly moderated the effect of DAV Syndemic class on inconsistent condom use. DAV Syndemic was found to be a significant mediator of the effect of transgender identity stigma on sexual risk. HIV prevention programs among TGW need to: (a) incorporate multi-level multi-component interventions to address syndemic conditions, tailored to the nature of syndemic classes; (b) reduce societal stigma against TGW; and (c) improve social support to buffer the impact of syndemics on sexual risk.
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Logie CH, Wang Y, Marcus N, Levermore K, Jones N, Ellis T, Bryan N. Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica. AIDS Behav 2019; 23:1530-1540. [PMID: 30600454 DOI: 10.1007/s10461-018-2377-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | | | | | - Tyrone Ellis
- Jamaica AIDS Support for Life, Kingston, Jamaica
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Gamarel KE, Nelson KM, Heinze J, Chiaramonte DM, Miller RL. The moderating role of resilience resources in the association between crime exposure and substance use among young sexual minority men. Subst Use Misuse 2019; 54:1787-1798. [PMID: 31094618 PMCID: PMC6692916 DOI: 10.1080/10826084.2019.1610447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: Substance use is prevalent among young sexual minority men and crime exposure is linked with adverse health behaviors. Guided by the protective model of resilience, we examined the impact of crime exposure and resilience resources on substance use behaviors, and whether resilience moderated associations between crime exposure and substance use behaviors. Methods: A cross-sectional sample of young sexual minority men (n = 720) ages 15-24 participated in a one-time survey conducted in seven cities across the United States. Participants' mean age was 21.2 years; 50% self-identified as Black, and 66% self-identified as gay. Participants self-reported on sociodemographic factors, crime exposure, resilience resources, and substance use behaviors. We fit generalized estimating models to examine associations between crime exposure, resilience resources, and the interaction between crime exposure and resilience resources on substance use behaviors. Results: Overall, 31% reported heavy alcohol use, 54% monthly marijuana use, 14% drug use, and 26% reported being a victim of a crime. Crime exposure was associated with an increased odds of alcohol (AOR = 1.45, 95%CI: 1.02, 2.14), marijuana (AOR = 1.41, 95%CI: 1.07, 2.04), and drug use (AOR = 1.94, 95%CI: 1.14, 2.98). Resilience resources were associated with a reduced odds of alcohol use (AOR = 0.66, 95%CI: 0.47, 0.93), marijuana use (AOR = 0.82, 95%CI: 0.60, 0.98), and drug use (AOR = 0.85, 95%CI: 0.54, 0.96). There was a significant interaction such that resilience resources reduced associations between crime exposure and alcohol and drug use. Conclusions: Findings support the protective effects of resilience resources for young sexual minority men. Results highlight the importance of ensuring the availability of community resources to meet the needs of sexual minority youth.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Kimberly M. Nelson
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Justin Heinze
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
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Rendina HJ, López-Matos J, Wang K, Pachankis JE, Parsons JT. The Role of Self-Conscious Emotions in the Sexual Health of Gay and Bisexual Men: Psychometric Properties and Theoretical Validation of the Sexual Shame and Pride Scale. JOURNAL OF SEX RESEARCH 2019; 56:620-631. [PMID: 29634377 PMCID: PMC6179944 DOI: 10.1080/00224499.2018.1453042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Researchers have theorized about the role of sexual shame as a mechanism through which sexual minority stress manifests into mental health difficulties, such as sexual compulsivity for gay and bisexual men (GBM), and about the resilience-promoting effects of sexual pride. However, no validated measures to date have directly tapped into these constructs rather than using proxies for them, such as internalized homonegativity. We developed the Sexual Shame and Pride Scale (SSPS) and conducted a psychometric evaluation of it using a sample of 260 highly sexually active GBM. The scale had the expected structure in factor analysis and showed evidence of internal consistency and test-retest reliability. Correlational analyses demonstrated the convergent validity of sexual shame and sexual pride with relevant constructs. Regression analyses demonstrated the predictive validity of sexual shame in relation to sexual compulsivity, accounting for unique variability even after adjusting for previously demonstrated etiological factors, and the predictive validity of both shame and pride, which interacted to consistently predict four sexual behavior outcomes. Findings suggest the SSPS is a psychometrically valid and reliable measure that may be useful in future empirical work and highlight preliminary evidence for the role of these constructs in the sexual health of GBM.
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Affiliation(s)
- H Jonathon Rendina
- a Center for HIV/AIDS Educational Studies and Training, New York; Department of Psychology, Hunter College of the City University of New York; and Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York
| | - Jonathan López-Matos
- b Center for HIV/AIDS Educational Studies and Training, New York; and Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York
| | - Katie Wang
- c Department of Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
| | - John E Pachankis
- c Department of Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Jeffrey T Parsons
- a Center for HIV/AIDS Educational Studies and Training, New York; Department of Psychology, Hunter College of the City University of New York; and Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York
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Dawson EL, Mendoza MCB, Gaul Z, Jeffries IV WL, Sutton MY, Wilson PA. Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City. PLoS One 2019; 14:e0215455. [PMID: 31017944 PMCID: PMC6481831 DOI: 10.1371/journal.pone.0215455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Black men who have sex with men, who account for less than 1% of the U.S. population, account for approximately 25% of new HIV infections annually. Condomless anal sex contributes to HIV infection among black men who have sex with men. The capacity to recover quickly from difficulties (resilience) may be protective against condomless anal sex, but has been understudied among black men who have sex with men. Psychosocial factors related to resilience, i.e., condom use self-efficacy and internalized homophobia, may also affect condomless anal sex. We assessed the association between resilience, condom use self-efficacy, internalized homophobia and condomless anal sex among black men who have sex with men. Methods Data are from a 2010–2011 study examining condomless anal sex (past 60 days) among black men who have sex with men in New York City. Validated scales assessed resilience (theoretical range = 0–100), condom use self-efficacy (theoretical range = 27–135), and internalized homophobia (theoretical range = 9–36). We described continuous variables using median and interquartile range (IQR). Univariable and multivariable Poisson regression models assuming a robust variance estimator were used to compute unadjusted and adjusted prevalence ratios, respectively, and their corresponding 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) examined the association of resilience, condom use self-efficacy, and internalized homophobia with condomless anal sex, while controlling for potential confounders (e.g., having >1 sex partner). Results The median resilience score within our sample (N = 228) was 75 (IQR = 66–83). Many black men who have sex with men reported condomless anal sex (55.7%) and >1 sex partner (58.8%). Decreased condomless anal sex was associated with increased levels of condom use self-efficacy (aPR: 0.94 per 10-point increase in condom use self-efficacy score; CI: 0.90–0.97; p-value: 0.001). Condomless anal sex was not associated with resilience or internalized homophobia. Conclusions Within this sample of black men who have sex with men, condomless anal sex was prevalent. Greater resilience was not protective against condomless anal sex. Interventions that support condom use are warranted for black men who have sex with men.
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Affiliation(s)
- Erica L. Dawson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Maria C. B. Mendoza
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ICF, Atlanta, Georgia, United States of America
| | - William L. Jeffries IV
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick A. Wilson
- Mailman School of Public Health, Columbia University, New York City, New York, United States of America
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Chakrapani V, Kaur M, Newman PA, Mittal S, Kumar R. Syndemics and HIV-related sexual risk among men who have sex with men in India: influences of stigma and resilience. CULTURE, HEALTH & SEXUALITY 2019; 21:416-431. [PMID: 30025511 PMCID: PMC6430415 DOI: 10.1080/13691058.2018.1486458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Using syndemics theory as a framework, we explored the experience of men who have sex with men in India in relation to four syndemic conditions (depression, alcohol use, internalised homonegativity and violence victimisation) and to understand their resilience resources. Five focus groups were conducted among a purposive sample of diverse men along with seven key informant interviews with HIV service providers. Participants' narratives suggested various pathways by which syndemic conditions interact with one another to sequentially or concurrently increase HIV risk. Experiences of discrimination and violence from a range of perpetrators (family, ruffians and police) contributed to internalised homonegativity and/or depression, which in turn led some men to use alcohol as a coping strategy. Stigma related to same-sex sexuality, gender non-conformity and sex work contributed to the production of one or more syndemic conditions. While rejection by family and male regular partners contributed to depression/alcohol use, support from family, regular partners and peers served as resources of resilience. In India, HIV prevention and health promotion efforts among men who have sex with men could be strengthened by multi-level multi-component interventions to reduce intersectional/intersecting stigma, address syndemic conditions and foster resilience - especially by promoting family acceptance and peer support.
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Affiliation(s)
- Venkatesan Chakrapani
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Corresponding Author: Manmeet Kaur
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Sandeep Mittal
- Chandigarh State AIDS Control Society, Chandigarh, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zhang J, O’Leary A, Jemmott JB, Icard LD, Rutledge SE. Syndemic conditions predict lower levels of physical activity among African American men who have sex with men: A prospective survey study. PLoS One 2019; 14:e0213439. [PMID: 30865694 PMCID: PMC6415907 DOI: 10.1371/journal.pone.0213439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/21/2019] [Indexed: 01/15/2023] Open
Abstract
African American men are disproportionately affected by, not only HIV/AIDS, but also chronic non-communicable diseases. Despite the known benefits of physical activity for reducing chronic non-communicable diseases, scant research has identified factors that may influence physical activity in this population. A growing literature centers on the syndemic theory, the notion that multiple adverse conditions interact synergistically, contributing to excess morbidity. This secondary data analysis examined two primary questions: whether syndemic conditions prospectively predicted physical activity, and whether, consistent with the syndemic theory, syndemic conditions interacted to predict physical activity. Participants were 595 African American men who have sex with men (MSM), a population underrepresented in health research, enrolled in a health-promotion intervention trial from 2008-2011. We used generalized-estimating-equations models to test the associations of syndemic conditions and resilience factors measured pre-intervention to self-reported physical activity 6 and 12 months post-intervention. As hypothesized, reporting more syndemic conditions pre-intervention predicted reporting less physical activity 6 and 12 months post-intervention, adjusting for the intervention. However, contrary to the syndemic theory, we did not find evidence for the interaction effects of syndemic conditions in predicting physical activity. Receiving high school education and having greater social network diversity predicted more physical activity whereas older age predicted less physical activity. To our knowledge, this is the first study to examine the syndemic theory in relation to physical activity. Although reporting a greater number of syndemic conditions was related to reduced physical activity, there was no evidence for synergy among syndemic conditions.
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Affiliation(s)
- Jingwen Zhang
- Department of Communication, University of California, Davis, Davis, California, United States of America
| | - Ann O’Leary
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John B. Jemmott
- Annenberg School for Communication and Department of Psychiatry of Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Larry D. Icard
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Scott E. Rutledge
- School of Social Work, Temple University, Philadelphia, Pennsylvania, United States of America
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Barry MC, Threats M, Blackburn NA, LeGrand S, Dong W, Pulley DV, Sallabank G, Harper GW, Hightow-Weidman LB, Bauermeister JA, Muessig KE. "Stay strong! keep ya head up! move on! it gets better!!!!": resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men. AIDS Care 2019; 30:S27-S38. [PMID: 30632775 PMCID: PMC6430674 DOI: 10.1080/09540121.2018.1510106] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Overlapping stigmas related to sexual minority-, race/ethnicity-, and HIV-status pose barriers to HIV prevention and care and the creation of supportive social networks for young, Black, gay, bisexual, and other men who have sex with men (GBMSM). A risk-based approach to addressing the HIV epidemic focuses on what is lacking and reinforces negative stereotypes about already-marginalized populations. In contrast, a strengths-based approach builds on Black GBMSM’s existing strengths, recognizing the remarkable ways in which they are overcoming barriers to HIV prevention and care. HealthMpowerment (HMP) is an online, mobile phone optimized intervention that aimed to reduce condomless anal intercourse and foster community among young Black GBMSM (age 18–30). Applying a resilience framework, we analyzed 322 conversations contributed by 48 HMP participants (22/48 living with HIV) on the intervention website. These conversations provided a unique opportunity to observe and analyze dynamic, interpersonal resilience processes shared in response to stigma, discrimination, and life challenges experienced by young Black GBMSM. We utilized an existing framework with four resilience processes and identified new subthemes that were displayed in these online interactions: (1) Exchanging social support occurred through sharing emotional and informational support. (2) Engaging in health-promoting cognitive processes appeared as reframing, self-acceptance, endorsing a positive outlook, and agency and taking responsibility for outcomes. (3) Enacting healthy behavioral practices clustered into modeling sex-positive norms, reducing the risk of acquiring or transmitting HIV, and living well with HIV. (4) Finally, empowering other gay and bisexual youth occurred through role modeling, promoting self-advocacy, and providing encouragement. Future online interventions could advance strengths-based approaches within HIV prevention and care by intentionally building on Black GBMSM’s existing resilience processes. The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience among young Black GBMSM.
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Affiliation(s)
- Megan C Barry
- a Department of Maternal and Child Health, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Megan Threats
- b School of Information and Library Science , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Natalie A Blackburn
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Sara LeGrand
- d Duke Global Health Institute , Duke University , Durham , USA
| | - Willa Dong
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Deren V Pulley
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Greg Sallabank
- e Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , USA
| | - Gary W Harper
- f Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , USA
| | - Lisa B Hightow-Weidman
- g Institute for Global Health and Infectious Diseases , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Jose A Bauermeister
- h Department of Family and Community Health , University of Pennsylvania , Philadelphia , USA
| | - Kathryn E Muessig
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
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Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, Hogan JW, Carey MP, Howe CJ. Resilience and HIV: a review of the definition and study of resilience. AIDS Care 2019; 30:S6-S17. [PMID: 30632778 DOI: 10.1080/09540121.2018.1515470] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.
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Affiliation(s)
- Akilah J Dulin
- a Center for Health Equity Research, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Sannisha K Dale
- b Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Valerie A Earnshaw
- c Department of Human Development and Family Sciences , University of Delaware , Newark , DE , USA
| | - Joseph L Fava
- d Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Michael J Mugavero
- e Division of Infectious Diseases, Department of Medicine, Center for AIDS Research , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sonia Napravnik
- f Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joseph W Hogan
- g Center for Statistical Sciences, Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Michael P Carey
- h Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior , The Miriam Hospital, Alpert Medical School of Brown University , Providence , RI , USA
| | - Chanelle J Howe
- i Centers for Epidemiology and Environmental Health, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
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Meanley S, Tingler R, Chittamuru D, Bauermeister JA. Applying resilience theory models to contextualize economic-dependent partnerships as a risk factor for HIV among young men who have sex with men. AIDS Care 2019; 30:42-50. [PMID: 30626200 DOI: 10.1080/09540121.2018.1493185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Economic-dependent partnerships (EDP) are an understudied HIV risk correlate among young men who have sex with men (YMSM) in the U.S. We explored whether YMSM's psychological resilience buffered against the effect of socioeconomic disadvantage on EDPs, after accounting for other psychosocial risks. Data come from an observational study assessing YMSM's HIV vulnerabilities. We developed indices for socioeconomic disadvantage, psychosocial profiles, and cumulative promotive factors. Multivariable logistic regressions tested the main associations of these indices on EDPs. Protective models tested whether psychosocial profiles exacerbated and cumulative promotive factors buffered the effects of socioeconomic disadvantage on EDPs. 31% and 23% of YMSM reported EDPs with main and casual partners, respectively. For both outcomes, we found support for adjusted compensatory models. Socioeconomic disadvantage was associated with increased odds of EDPs with main (AOR = 1.45, p < .001) and casual (AOR = 1.47, p < .001) partners. Psychosocial profiles were also associated with increased odds of EDPs with main (AOR = 1.53, p = .001) and casual (AOR = 1.67, p < .001) partners. Cumulative promotive factors was associated with decreased odds of EDPs with main (AOR = 0.66, p = .003) and casual (AOR = 0.72, p = .035) partners. Our findings elucidate the need for multilevel interventions that provide opportunities for socioeconomic advancement and improve psychosocial/psychological functioning for at-risk YMSM.
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Affiliation(s)
- Steven Meanley
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Ryan Tingler
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Deepti Chittamuru
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Jose A Bauermeister
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
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67
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Hussen SA, Jones M, Moore S, Hood J, Smith JC, Camacho-Gonzalez A, Del Rio C, Harper GW. Brothers Building Brothers by Breaking Barriers: development of a resilience-building social capital intervention for young black gay and bisexual men living with HIV. AIDS Care 2019; 30:51-58. [PMID: 30626207 DOI: 10.1080/09540121.2018.1527007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Young Black gay/bisexual and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV/AIDS. Novel intervention strategies are needed to optimize engagement in HIV care for this population. We sought to develop a group-level intervention to enhance resilience by augmenting social capital (defined as the sum of resources in an individual's social network) among YB-GBMSM living with HIV, with the ultimate goal of improving engagement in HIV care. Our multiphase, community-based participatory research (CBPR) intervention development process included: (1) Development and maintenance of a youth advisory board (YAB) comprised of YB-GBMSM living with HIV; (2) Qualitative in-depth interviews with YB-GBMSM living with HIV; (3) Qualitative in-depth interviews with care and service providers at clinics and community-based organizations; and (4) Collaborative development of intervention modules and activities with our YAB, informed by social capital theory and our formative research results. The result of this process is Brothers Building Brothers By Breaking Barriers, a two-day, 10-module group-level intervention. The intervention does not focus exclusively on HIV, but rather takes a holistic approach to supporting youth and enhancing resilience. Intervention modules aim to develop resilience at the individual level (exploration of black gay identity, development of critical self-reflection and coping skills), social network level (exploring strategies for navigating family and intimate relationships) and community level (developing strategies for navigating clinical spaces and plans for community participation). Most intervention activities are interactive, in order to facilitate new social network connections - and accompanying social capital - within intervention groups. In summary, our intensive CBPR approach resulted in a novel, culturally-specific intervention designed to enhance HIV care engagement by augmenting resilience and social capital among YB-GBMSM living with HIV.
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Affiliation(s)
- Sophia A Hussen
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Marxavian Jones
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Shamia Moore
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Jasper Hood
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Justin C Smith
- b Department of Behavioral Science and Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Andres Camacho-Gonzalez
- c Department of Pediatrics, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA
| | - Carlos Del Rio
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Gary W Harper
- d Department of Health Behavioral and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
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68
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Kapadia F, D’Avanzo PA, Cook SH, Barton S, Halkitis SN, Halkitis PN. Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort Study. Behav Med 2019; 45:304-313. [PMID: 30657441 PMCID: PMC6639145 DOI: 10.1080/08964289.2018.1536644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18-22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development-the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.
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Affiliation(s)
- F Kapadia
- College of Global Public Health, New York University, NY,Department of Population Health, Division of General Internal Medicine, Langone School of Medicine, New York University, NY,Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ
| | - PA D’Avanzo
- Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ
| | - SH Cook
- College of Global Public Health, New York University, NY,Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ
| | - S Barton
- Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ
| | - SN Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ
| | - PN Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies, Rutgers University, Piscataway, NJ,School of Public Health, Rutgers University, Piscataway, NJ,Rutgers RWJ Medical School,Graduate School of Applied and Professional Psychology,School of Public Affairs and Administration
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69
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Drumhiller K, Nanín JE, Gaul Z, Sutton MY. The Influence of Religion and Spirituality on HIV Prevention Among Black and Latino Men Who Have Sex with Men, New York City. JOURNAL OF RELIGION AND HEALTH 2018; 57:1931-1947. [PMID: 29696488 DOI: 10.1007/s10943-018-0626-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The influence of religion and spirituality (R/S) on HIV prevention has been understudied, especially for Black and/or Latino men who have sex with men (BLMSM), who bear a disproportionate burden of HIV, and who are part of racial/ethnic communities with high engagement in R/S. The specific aim of this study was to explore perspectives about R/S among BLMSM to inform HIV prevention strategies and reduce HIV-related health disparities. Data from 105 qualitative interviews with BLMSM were analyzed; 58 (55%) stated that R/S had no personal influence on HIV prevention. For those reporting any R/S influence, main themes were: (1) R/S positively influenced decision-making and self-respect, (2) perceived judgment and stigma by religious communities, (3) belief in a higher power, and (4) altruism. These findings can inform faith-based HIV prevention interventions for BLMSM.
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Affiliation(s)
- Kathryn Drumhiller
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA.
- Chenega Professional and Technical Services, Chesapeake, VA, USA.
| | - José E Nanín
- Community Health Program/Department of Health, Physical Education, and Recreation, Kingsborough Community College, Brooklyn, NY, USA
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA
- ICF, Atlanta, GA, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA
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70
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Shuper PA, MacLachlan DJ, Joharchi N, Guimond TH, Maxwell J, Adam BD. HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride. AIDS Behav 2018; 22:2797-2806. [PMID: 29680936 DOI: 10.1007/s10461-018-2117-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48-69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70-48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23-0.93) and social support (AOR = 0.08, 95% CI 0.01-0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Narges Joharchi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Tim H Guimond
- St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
- Ontario HIV Treatment Network, Toronto, Canada
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71
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Graham SM, Micheni M, Secor A, van der Elst EM, Kombo B, Operario D, Amico KR, Sanders EJ, Simoni JM. HIV care engagement and ART adherence among Kenyan gay, bisexual, and other men who have sex with men: a multi-level model informed by qualitative research. AIDS Care 2018; 30:S97-S105. [PMID: 30668136 PMCID: PMC6430645 DOI: 10.1080/09540121.2018.1515471] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) are highly stigmatized and male-male sex is often criminalized in sub-Saharan Africa, impeding access to quality care for sexual health, HIV prevention, and treatment. To better understand HIV care engagement and antiretroviral therapy (ART) adherence among GBMSM in this context, a conceptual model incorporating sociocultural factors is needed. We conducted a qualitative study of barriers to and facilitators of HIV care engagement and ART adherence among Kenyan GBMSM, informed by a conceptual model based on an access, information, motivation, and behavioral skills (access-IMB) model, with trust in providers and stigma and discrimination as a priori factors of interest. We conducted 30 semi-structured interviews with HIV-positive Kenyan GBMSM, of whom 20 were taking ART and 10 had not yet initiated treatment. A deductive approach was used to confirm the relevance of basic concepts of the access-IMB model, while an inductive approach was used to identify content that emerged from men's lived experiences. Access-related information, motivation, and behavioral skills appeared relevant to HIV care engagement and ART adherence, with stigma and discrimination appearing consistently across discourse exploring facilitators and barriers. Trusted providers and supportive family and friends helped many men, and resilience-related concepts such as selective disclosure of GBMSM status, connection to lesbian, gay, bisexual, and transgender (LGBT) organizations, self-acceptance, goal-setting, social identity and altruism emerged as important facilitators. Findings suggest a need to increase support from providers and peers for Kenyan GBMSM living with HIV infection. In addition, they point toward the potential value of interventions that provide opportunities to build or enhance one's sense of community belonging in order to improve HIV care engagement and promote ART adherence for this vulnerable population.
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Affiliation(s)
- Susan M. Graham
- Departments of Medicine, University of Washington, Seattle, WA, USA
- Departments of Global Health, University of Washington, Seattle, WA, USA
- Departments of Epidemiology, University of Washington, Seattle, WA, USA
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Andrew Secor
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - Don Operario
- Department of Behavior and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - K. Rivet Amico
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Eduard J. Sanders
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jane M. Simoni
- Departments of Global Health, University of Washington, Seattle, WA, USA
- Departments of Psychology, University of Washington, Seattle, WA, USA
- Departments of Gender, Women and Sexuality Studies, University of Washington, Seattle, WA, USA
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72
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Kunzweiler CP, Bailey RC, Mehta SD, Okall DO, Obondi E, Djomand G, Nyunya BO, Otieno FO, Graham SM. Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men. AIDS Care 2018; 30:S76-S88. [PMID: 30897938 PMCID: PMC10669762 DOI: 10.1080/09540121.2018.1510109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/01/2018] [Indexed: 10/27/2022]
Abstract
The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08-0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03-1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area.
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Affiliation(s)
- Colin P. Kunzweiler
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Supriya D. Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Eve Obondi
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Gaston Djomand
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Boaz Otieno Nyunya
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Susan M. Graham
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA
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73
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Quinn KG, Reed SJ, Dickson-Gomez J, Kelly JA. An Exploration of Syndemic Factors That Influence Engagement in HIV Care Among Black Men. QUALITATIVE HEALTH RESEARCH 2018; 28:1077-1087. [PMID: 29478406 PMCID: PMC5962406 DOI: 10.1177/1049732318759529] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Syndemic theory seeks to understand the interactions and clustering of disease and social conditions and explain racial disparities in HIV. Traditionally applied to HIV risk, this study characterizes the syndemic challenges of engagement in care among Black men living with HIV and provides insight into potential HIV treatment interventions to retain vulnerable individuals in care. Interviews were conducted with 23 HIV-positive men who were either out-of-care or nonadherent to antiretroviral therapy (ART). Interviews were audio recorded, transcribed verbatim, and coded using MAXQDA qualitative software. Researchers analyzed data using thematic content analysis to identify syndemic factors associated with disengagement in care or suboptimal ART adherence among Black men. Analyses revealed the syndemic nature of four themes: intersectional stigma, depression, substance use, and poverty. Findings from this study offer numerous opportunities for intervention including social and structural-level interventions to address syndemic processes and the influence of stigma and poverty on engagement in care.
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Affiliation(s)
- Katherine G Quinn
- 1 Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah J Reed
- 1 Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julia Dickson-Gomez
- 1 Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey A Kelly
- 1 Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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74
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Martin EG, Rosenberg ES, Holtgrave DR. Economic and Policy Analytic Approaches to Inform the Acceleration of HIV Prevention in the United States: Future Directions for the Field. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:199-207. [PMID: 29969310 DOI: 10.1521/aeap.2018.30.3.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The fields of economic and policy analysis have long played a role in quantifying the burden of the HIV epidemic and informing how to best deploy interventions and policies aimed at maximizing HIV care and reducing transmission. Looking towards the ultimate goal of ending the AIDS epidemic, we describe five areas for further development and application towards HIV policies: (1) setting measurable objectives to create a vision and monitor progress, (2) taking a health and wellness approach to goal-setting, (3) using impact matrices to inform quantitative analysis to explicitly address health disparities, (4) conducting budget impact analyses to project annual program costs and benefits, and (5) advancing the public health systems and services research agenda.
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Affiliation(s)
- Erika G Martin
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany-SUNY, Albany, New York
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, SUNY, Rensselaer, New York
| | - David R Holtgrave
- Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, SUNY
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75
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Dangerfield DT, Smith LR, Anderson JN, Bruce OJ, Farley J, Bluthenthal R. Sexual Positioning Practices and Sexual Risk Among Black Gay and Bisexual Men: A Life Course Perspective. AIDS Behav 2018; 22:1919-1931. [PMID: 29079948 PMCID: PMC5924576 DOI: 10.1007/s10461-017-1948-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Increased attention has highlighted the role of age and sexual development on HIV risk among Black MSM (BMSM); limited focus has been given to the relationship of sexual positioning to HIV risk along the life course. This study examined BMSM's life course sexual positioning practices and accompanying HIV/STI risks. Twenty-six Black gay and bisexual men ages 24-61 completed life history interviews in Los Angeles, California, between September and November 2015. Thematic analysis evaluated domains including major life events, substance use, social support, and partner selection. Varying exposure to HIV treatment and prevention options and venues to meet male partners revealed generational differences in sexual risks. Childhood sexual abuse and internalized homonegativity impacted personal development, sexual positioning, and condom negotiation. BMSM also assumed sexual positioning using masculinity stereotypes and body language. Clarifying the sexual development and HIV/STI risk contexts among BMSM could better inform current treatment and prevention needs.
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Affiliation(s)
- Derek T Dangerfield
- The REACH Initiative, Johns Hopkins School of Nursing, Baltimore, MD, 2120532, USA.
| | - Laramie R Smith
- Division of Global Public Health, University of California, La Jolla, San Diego, CA, USA
| | - Janeane N Anderson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Omar J Bruce
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jason Farley
- The REACH Initiative, Johns Hopkins School of Nursing, Baltimore, MD, 2120532, USA
- Department of Community Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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76
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Cook SH, Pruessner JC, Lupien SJ, Juster RP. Sexual orientation moderates the association between parental overprotection and stress biomarker profiles. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1470105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Stephanie H. Cook
- College of Global Public Health, New York University, New York, NY, USA
| | - Jens C. Pruessner
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Psychology, University of Constance, Constance, Germany
| | - Sonia J. Lupien
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
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77
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The Associations of Resilience and HIV Risk Behaviors Among Black Gay, Bisexual, Other Men Who Have Sex with Men (MSM) in the Deep South: The MARI Study. AIDS Behav 2018; 22:1679-1687. [PMID: 28856456 DOI: 10.1007/s10461-017-1881-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Resilience is an understudied intrapersonal factor that may reduce HIV risk among men who have sex with men (MSM). Multivariable Poisson regression models were used to estimate the prevalence ratio (PR) of sexual risk behaviors, HIV prevalence, and history of sexually transmitted infections (STIs) with resilience scores in a population-based study among 364 black MSM in the Deep South. Participants with higher resilience scores had a lower prevalence of condomless anal sex with casual sexual partners in past 12 months (PR = 0.80, p value = 0.001) and during their last sexual encounter (PR = 0.81; p value = 0.009). Resilience was inversely associated with a lower prevalence of condomless anal sex with main sexual partners, participating in a sex party/orgy and having a STI in the past 12 months. Resilience may have a protective effect on HIV among black MSM, especially in the Deep South, and should be further explored in studies with prospective designs.
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78
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Sexual Stigma Patterns Among Nigerian Men Who Have Sex with Men and Their Link to HIV and Sexually Transmitted Infection Prevalence. AIDS Behav 2018; 22:1662-1670. [PMID: 29168069 DOI: 10.1007/s10461-017-1982-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual stigma facilitates the spread of HIV and sexually transmitted infections (STIs) but little is known about stigma affecting Nigerian men who have sex with men (MSM). We assessed patterns of sexual stigma across Nigerian MSM and their relationship to HIV and STIs. Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 Nigerian MSM enrolled from March 2013 to February 2016 using respondent driven sampling. Structural equation modeling was utilized to assess the association between stigma classes and HIV and STI prevalence, adjusting for participants' characteristics. A dose-response association was found between stigma class and HIV prevalence (27, 40, 55%, overall χ2 p < 0.001) and STI prevalence (15, 21, 24%, overall χ2 p = 0.011). These data suggest that stigma mitigation strategies, combined with increased engagement of MSM and retention in the HIV care continuum, need to be a component of interventions focused on reducing HIV transmission risks among MSM in Nigeria.
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79
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Hart TA, Noor SW, Adam BD, Vernon JRG, Brennan DJ, Gardner S, Husbands W, Myers T. Number of Psychosocial Strengths Predicts Reduced HIV Sexual Risk Behaviors Above and Beyond Syndemic Problems Among Gay and Bisexual Men. AIDS Behav 2017; 21:3035-3046. [PMID: 28050650 DOI: 10.1007/s10461-016-1669-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR = 1.51, 95% CI 1.18-1.92; p = 0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR = 0.67, 95% CI 0.53-0.86; p = 0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Syed W Noor
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Julia R G Vernon
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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80
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Woodward EN, Walsh JL, Senn TE, Carey MP. Positive social interaction offsets impact of low socioeconomic status on stress. J Natl Med Assoc 2017; 110:371-377. [PMID: 30126563 DOI: 10.1016/j.jnma.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Stress is associated with unhealthy behaviors and premature morbidity and mortality, especially among those of low socioeconomic status (SES). Clarifying the roles of stress-related risk and protective factors can guide interventions designed to reduce stress and improve health among socioeconomically disadvantaged populations. PURPOSE (1) Replicate prior research showing that lower SES is associated with higher stress in a predominantly racial minority, socioeconomically disadvantaged sample, and (2) test the hypothesis that different types of social support (a protective factor) mitigate the deleterious effects of SES on self-reported perceived stress. METHODS Low-income patients (N = 508, 54% male, 68% African American, Mage = 28) from a publicly-funded clinic provided demographic information and then completed measures of perceived stress and social support. Four types of social support were assessed (viz., affectionate, emotional/informational, positive social interaction, and tangible). Structural equation modeling tested the hypothesized associations among SES, social support, and stress. RESULTS Individuals of lower SES, β = -0.27 (0.08), p < 0.01, and lower overall social support, β = -0.47 (0.05), p < 0.001, reported higher stress. Social support moderated associations between SES and stress, with participants with lower SES benefitting the most from social support. Of the four types of social support that were measured, positive social interaction was the strongest moderator, β = 0.20 (0.08), p = 0.01. CONCLUSIONS The associations among SES, stress, and social support corroborate prior research. Positive social interaction was particularly important for decreasing stress among socioeconomically disadvantaged persons.
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Affiliation(s)
- Eva N Woodward
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Brown University, Box G-BH, Providence, RI 02912, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA; Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Theresa E Senn
- School of Nursing, University of Rochester, Box SON, Helen Wood Hall, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA; Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
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81
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Hussen SA, Harper GW, Rodgers CRR, van den Berg JJ, Dowshen N, Hightow-Weidman LB. Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV. LGBT Health 2017; 4:275-282. [PMID: 29792564 DOI: 10.1089/lgbt.2016.0135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE HIV/AIDS disproportionately affects young gay, bisexual, and other men who have sex with men (Y-GBMSM). Resilience remains understudied among Y-GBMSM living with HIV, but represents a potentially important framework for improving HIV-related outcomes in this population. We sought to explore cognitive and behavioral dimensions of resilience and their correlates among Y-GBMSM to gain insights to inform future interventions. METHODS Our study sample consisted of 200 Y-GBMSM living with HIV enrolled in a multisite study of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants completed a one-time, self-administered structured questionnaire, including validated scales capturing a range of cognitive, behavioral, demographic, and psychosocial data. Utilizing these data, we examined cognitive and behavioral dimensions of resilience and their potential psychosocial correlates using linear regression modeling. RESULTS Multiple regression analyses demonstrated that education, stigma, social support, ethnic identity, internalized homonegativity, and behavioral resilience were statistically significant predictors of cognitive resilience (P < 0.001, R2 = 0.678). Social support satisfaction and cognitive resilience were significant predictors of behavioral resilience (P < 0.001, R2 = 0.141). CONCLUSIONS Our findings point to potential strategies for incorporating resilience-promoting features into future interventions to support Y-GBMSM living with HIV. Specifically, strengths-based interventions in this population should seek to enhance social support, promote positive identity development, and encourage education. Future research can also seek to utilize and refine our measures of resilience among youth.
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Affiliation(s)
- Sophia A Hussen
- 1 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia
- 2 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia
| | - Gary W Harper
- 3 Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, Michigan
| | - Caryn R R Rodgers
- 4 Department of Pediatrics, Albert Einstein College of Medicine , Bronx, New York
| | - Jacob J van den Berg
- 5 Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Nadia Dowshen
- 6 Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Lisa B Hightow-Weidman
- 7 Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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82
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Mustanski B, Swann G, Newcomb ME, Prachand N. Effects of Parental Monitoring and Knowledge on Substance Use and HIV Risk Behaviors Among Young Men Who have Sex with Men: Results from Three Studies. AIDS Behav 2017; 21:2046-2058. [PMID: 28417252 PMCID: PMC5804483 DOI: 10.1007/s10461-017-1761-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Young men who have sex with men (YMSM) are disproportionately impacted by HIV/AIDS and have elevated rates of substance use. Parenting practices, such as knowledge of child whereabouts and monitoring of behavioral rules, protect against these outcomes among heterosexual youth. This article examined the relationship between these parenting practices and substance use and HIV risk behaviors among YMSM. Data are reported from three similar studies of YMSM: ChiGuys (ages 14-18), Crew 450 (ages 16-22), and RADAR (ages 16-29). The ChiGuys and RADAR studies report cross-sectional analyses, whereas Crew 450 reports latent growth curve analyses. In ChiGuys and Crew 450, participants reported significantly higher scores for parental knowledge of general activities than parental knowledge of gay-specific activities. Parental knowledge of general activities was significantly associated with less binge drinking in both samples and with condomless sex in the ChiGuys sample. Parental monitoring was significantly associated with less marijuana use and condomless sex in younger RADAR participants (16-18 years) and with less drug use in older participants (>18 years). Findings support the need for further research on the influences of parents on YMSM health risk behaviors and the value of exploring family- and parent-interventions to address YMSM health.
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Affiliation(s)
- Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Northwestern University, Feinberg School of Medicine, 625 N Michigan Ave Suite 1400, Chicago, IL, 60611, USA.
| | - Gregory Swann
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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83
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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84
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Parsons JT, Millar BM, Moody RL, Starks TJ, Rendina HJ, Grov C. Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a U.S. national sample. Health Psychol 2017; 36:695-703. [PMID: 28541070 DOI: 10.1037/hea0000509] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The syndemics framework has been used to explain the high rates of HIV infection among gay and bisexual men. However, most studies have relied primarily on urban or otherwise limited (e.g., single location) samples. We evaluated the prevalence of syndemics-here, depression, polydrug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity-among gay and bisexual men from across the United States, including nonurban areas. METHOD Using data from a national sample of 1,033 HIV-negative gay and bisexual men, demographic differences in the prevalence of each syndemic condition and associations with HIV transmission risk behavior were examined. RESULTS More than 62% of men reported at least 1 syndemic condition. Prevalence did not vary by U.S. region-however, a larger proportion of nonurban men and those with lower income and education levels were above the median number of syndemic conditions. In bivariate analyses, HIV transmission risk behavior was associated with each syndemic condition except for childhood sexual abuse, whereas in multivariate analyses, it was associated with polydrug use, sexual compulsivity, being Latino, and being single and was highest among those reporting 3 or more syndemic conditions. CONCLUSIONS Rates of syndemic conditions among this national sample of gay and bisexual men were generally comparable to previous studies, however elevated rates in nonurban men suggest the need for targeted intervention and support. Links observed between syndemics and HIV transmission risk behavior highlight the ongoing need to address psychosocial concerns among gay and bisexual men in order to reduce their disproportionately high rates of HIV infection. (PsycINFO Database Record
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Affiliation(s)
- Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Department of Psychology, Hunter College of the City University of New York
| | - Brett M Millar
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York
| | - Raymond L Moody
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York
| | - Tyrel J Starks
- Center for HIV/AIDS Educational Studies & Training, Department of Psychology, Hunter College of the City University of New
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Department of Psychology, Hunter College of the City University of New
| | - Christian Grov
- Department of Community Health and Social Science, City University of New York Graduate School of Public Health and Health Policy
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85
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Szymanski DM, Mikorski R, Carretta RF. Heterosexism and LGB Positive Identity: Roles of Coping and Personal Growth Initiative. COUNSELING PSYCHOLOGIST 2017. [DOI: 10.1177/0011000017697195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To combat the prevailing deficit and dysfunction paradigm, scholars have called for research focusing on LGB individuals from a positive psychology perspective. Thus, we examined the mediating roles of coping with discrimination via resistance and education/advocacy in the relations between heterosexist discrimination and positive LGB identity among 356 LGB persons. We also examined the potential moderating role of personal growth initiative between (a) heterosexist discrimination and five positive LGB identity dimensions, (b) heterosexist discrimination and engagement coping, and (c) engagement coping and the LGB identity dimensions. Findings revealed that coping with discrimination via education/advocacy mediated the relationships between heterosexist discrimination and belonging to the LGB community, commitment to social justice, self-awareness, authenticity, and relationship intimacy links. We also found coping via education/advocacy predicted both commitment to social justice and self-awareness for LGB persons with low and high personal growth initiative, with stronger relations for those with low personal growth initiative.
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86
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Friedman MR, Coulter RW, Silvestre AJ, Stall R, Teplin L, Shoptaw S, Surkan PJ, Plankey MW. Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study. AIDS Care 2017; 29:469-480. [PMID: 27456040 PMCID: PMC5571899 DOI: 10.1080/09540121.2016.1211614] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert W.S. Coulter
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Teplin
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Pamela J. Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
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87
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Abram KM, Stokes ML, Welty LJ, Aaby DA, Teplin LA. Disparities in HIV/AIDS Risk Behaviors After Youth Leave Detention: A 14-Year Longitudinal Study. Pediatrics 2017; 139:e20160360. [PMID: 28115541 PMCID: PMC5260145 DOI: 10.1542/peds.2016-0360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine changes in the prevalence of 15 HIV/AIDS sex and drug risk behaviors in delinquent youth during the 14 years after they leave detention, focusing on sex and racial/ethnic differences. METHODS The Northwestern Juvenile Project, a prospective longitudinal study of 1829 youth randomly sampled from detention in Chicago, Illinois, recruited between 1995 and 1998 and reinterviewed up to 11 times. Independent interviewers assessed HIV/AIDS risk behaviors using the National Institutes on Drug Abuse Risk Behavior Assessment. RESULTS Fourteen years after detention (median age, 30 years), one-quarter of males and one-tenth of females had >1 sexual partner in the past 3 months. One-tenth of participants reported recent unprotected vaginal sex with a high-risk partner. There were many sex and racial/ethnic differences. For example, African American males had 4.67 times the odds of having >1 partner than African American females (95% confidence interval [CI], 3.22-6.76). Over time, compared with non-Hispanic white males, African American males had 2.56 times the odds (95% CI, 1.97-3.33) and Hispanic males had 1.63 times the odds (95% CI, 1.24-2.12) of having multiple partners, even after adjusting for incarceration and age. Non-Hispanic white females were more likely to have multiple partners than racial/ethnic minority females. CONCLUSIONS Although rates decrease over time, prevalence of sex risk behaviors are much higher than the general population. Among males, racial/ethnic minorities were at particular risk. The challenge for pediatric health is to address how disproportionate confinement of racial/ethnic minority youth contributes to disparities in the HIV/AIDS epidemic.
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Affiliation(s)
- Karen M Abram
- Departments of Psychiatry and Behavioral Sciences, and
| | | | - Leah J Welty
- Departments of Psychiatry and Behavioral Sciences, and
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Departments of Psychiatry and Behavioral Sciences, and
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88
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Coleman TA, Bauer GR, Pugh D, Aykroyd G, Powell L, Newman R. Sexual Orientation Disclosure in Primary Care Settings by Gay, Bisexual, and Other Men Who Have Sex with Men in a Canadian City. LGBT Health 2016; 4:42-54. [PMID: 27996376 DOI: 10.1089/lgbt.2016.0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Sexual orientation affects individuals' health histories and is fundamental to providers' understanding of patients as a whole. Gay, bisexual, and other men who have sex with men (GB-MSM) are vulnerable to certain health conditions, including HIV. The aim of this exploratory analysis was to examine factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues and to discuss implications. METHODS We conducted a cross-sectional internet survey of GB-MSM (n = 202) in London-Middlesex, Ontario, Canada; analyses were limited to those with a regular primary care provider (n = 173). Blockwise regression models explored demographic, psychosocial, and healthcare-related factors associated with sexual orientation disclosure and physician-patient communication about GB-MSM-related health. RESULTS Just over seventy-one percent (71.1%) of participants reported that their primary care provider (PCP) knew their sexual orientation, and 44.5% had talked to them about GB-MSM health. Overt negative comments or being refused care based on sexual orientation occurred infrequently, although 26.6% reported their provider had assumed they were heterosexual. Being married to or living common-law with another man, more frequent experiences of homosexual prejudice, and higher quality assessment of provider's communication skills were associated with the PCP knowing respondents' sexual orientation. Greater internalized homonegativity was associated with not talking to a PCP about GB-MSM-related health issues. More frequent experiences of homosexual prejudice, higher assessment of provider communication, and having prior negative experiences with a PCP were significantly associated with talking to a PCP about GB-MSM health. CONCLUSION The majority of our sample disclosed their sexual orientation; however, not all patients voluntarily disclose. Medical training and education in Canada, where specific rights protections exist for sexual orientation minority populations, should emphasize awareness of essential patient health information. Training should include information about GB-MSM health and building a foundation on how to speak with GB-MSM patients nonjudgmentally.
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Affiliation(s)
- Todd A Coleman
- 1 Department of Psychology, Ryerson University , Toronto, Canada .,2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Greta R Bauer
- 2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Daniel Pugh
- 3 Gay Men's Sexual Health Alliance , Toronto, Canada
| | - Gloria Aykroyd
- 4 St. Joseph's Infectious Diseases Care Program , London, Canada
| | | | - Rob Newman
- 6 Regional HIV/AIDS Connection , London, Canada
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89
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Klein C, Lomonaco C. Real Talk: Developing a Computer-Delivered Sexual Health Program for Black Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:455-471. [PMID: 27925486 PMCID: PMC6261286 DOI: 10.1521/aeap.2016.28.6.455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
HIV disproportionately affects Black men who have sex with men (MSM), yet there are few evidence-based programs that respond to the diverse realities of Black MSM communities. This article examines the development of Real Talk, a new harm reduction-based, sexual health intervention for Black MSM. We first analyze the key themes from our formative research: (1) stigma, discrimination, and intersectionalities in the lives of Black MSM, (2) the importance of safe spaces and community provided by health promotion programs, and (3) moving beyond condoms in sexual health messaging. We then describe our agile design product development process and present an overview of the intervention's components and how they respond to the issues identified in the formative research. In conclusion, we discuss dissemination opportunities and challenges in an age of decreased prevention funding, pre-exposure prophylaxis (PrEP), and the increased use of e-health promotion modalities.
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Affiliation(s)
| | - Carmela Lomonaco
- Office of the President, University of California, Oakland, California
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90
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Abstract
Rates of depression and anxiety are disproportionately high among lesbians and gay men, and stigma-related stress is thought to be a major factor. While reducing stigma remains a priority, developing ways to assist lesbians and gay men to build resilience to stigma-related stress is also a growing priority among policymakers and health professionals. This article summarizes major conceptual work and research on resilience among lesbians and gay men, including key findings from a nationwide online survey involving 2,793 Australian lesbians and gay men aged 16 years and older that examined demographic and psychosocial factors related to resilience. Research on resilience in gay and lesbian populations is currently a small field but appears to be growing. As recommended in this article, further work is needed to identify circumstances in which lesbians and gay men display resilience to stigma-related stress and to systematically test resilience training programmes that help to prevent depression and anxiety in these at-risk populations.
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Affiliation(s)
- Anthony Lyons
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne, Victoria , Australia
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91
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Cowden RG, Meyer-Weitz A, Oppong Asante K. Measuring resilience in competitive tennis players: psychometric properties of the Resilience Scale for Adults. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/0081246316644151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Resilience Scale for Adults is considered a valid and reliable measure of resilience resources and has received validation support across several populations. This study attempted to validate and examine the psychometric properties of the instrument in a sample of competitive tennis players to prospectively appropriate the inventory for use among athletes. The tennis athletes ( n = 365) completed the Resilience Scale for Adults, the Sports Mental Toughness Questionnaire, and the stress items included on the Recovery-Stress Questionnaire for Athletes. Confirmatory factor analysis model fit indices revealed an acceptable level of fit for the original six-factor structure. The Resilience Scale for Adults scale and subscales were negatively associated with stress and correlated positively with mental toughness, providing evidence of the convergent validity of the Resilience Scale for Adults. Collectively, the findings offer initial support for using the Resilience Scale for Adults to assess a broad range of protective factors among competitive tennis players. Further research is required to explore the adaptation or refinement of the Resilience Scale for Adults for use in multiple sporting contexts.
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Affiliation(s)
- Richard G Cowden
- Institute of Psychology and Wellbeing, North-West University, South Africa
- Discipline of Psychology, University of KwaZulu-Natal, South Africa
| | - Anna Meyer-Weitz
- Discipline of Psychology, University of KwaZulu-Natal, South Africa
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92
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Lyons A, Heywood W, Rozbroj T. Psychosocial Factors Associated with Resilience in a National Community-Based Cohort of Australian Gay Men Living with HIV. AIDS Behav 2016; 20:1658-66. [PMID: 26884311 DOI: 10.1007/s10461-016-1338-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV-positive gay men may experience multiple sources of adversity and stress, related both to their HIV diagnosis and sexual identity. Most of these men, however, do not experience mental health problems. Little is known about factors that help them achieve resilience in the face of life challenges. This study examined psychosocial factors associated with resilience in a national community-based sample of 357 Australian HIV-positive gay men. Resilience was measured using the Connor-Davidson Resilience Scale. Higher levels of resilience were linked with experiencing low or no internalized HIV-related stigma, having no previous history of mental health problems, and a number of socioeconomic indicators. In addition to providing a more complete picture of the mental health of HIV-positive gay men, findings from this study can be used to inform strength-based approaches to mental health prevention and support.
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93
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White Hughto JM, Hidalgo AP, Bazzi AR, Reisner SL, Mimiaga MJ. Indicators of HIV-risk resilience among men who have sex with men: a content analysis of online profiles. Sex Health 2016; 13:SH16023. [PMID: 27248854 PMCID: PMC5135650 DOI: 10.1071/sh16023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 03/23/2016] [Indexed: 01/13/2023]
Abstract
Background: HIV-risk resilience, or positive adaptation in the face of risk, is increasingly being recognised as an important characteristic among men who have sex with men (MSM). However, resilience in the context of online partner seeking remains underexplored among MSM. Methods: Using content analysis methodology, this study operationalised indicators of HIV-risk resilience in the profiles of 933 MSM using a sexual networking website. HIV-risk resilience included endorsing foreplay only (non-penetrative sex) or a versatile sexual position; being "out" (e.g. disclosed sexual orientation), having a profile photo, seeking friendship, seeking a relationship, serosorting, not endorsing alcohol or drug use, safer sexual adventurism (e.g. role playing, bondage), and safer sex. Results: The majority of men were between 18 and 35 years old (76.0%) and 73.3% were racial/ethnic minorities. The mean number of resilience components endorsed was 5.2 (s.d. = 1.5; range 0-9). Nearly half (48.0%) reported being "out" and 68.7% had a profile photo. The majority of men were seeking relationships (66.5%) and/or friendships (69.7%), were sexually versatile (53.3%), and preferred safer sex only (76.3%). The majority did not endorse drug use (82.0%) and 25.4% did not endorse alcohol use. Nearly one-quarter (21.4%) endorsed sexual adventurism and 2.5% were serosorting by partner's HIV negative status. Conclusion: HIV-risk resilience may be common among MSM using sexual networking websites and may manifest in safer sex intentions. Rather than exclusively focusing on sexual risk reduction, health promotion efforts targeting MSM online should acknowledge, measure, and leverage existent HIV-risk resilience strategies in this group.
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Affiliation(s)
- Jaclyn M. White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
- Yale School of Public Health, Department of Epidemiology, 60 College Street, New Haven, CT 06510, USA
| | - Anna P. Hidalgo
- Columbia University, Department of Sociology, 606 West 122nd Street, New York, NY 10027, USA
| | - Angela R. Bazzi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
- Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA 02118, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
- Boston Children’s Hospital/Harvard Medical School, Division of General Pediatrics, 300 Longwood Avenue, Boston, MA 02115, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Boston, MA 02115, USA
- Brown University, Institute for Community Health Promotion, 21 South Main Street, 8th Floor Providence, RI 02912, USA
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94
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Fumaz CR, Ayestaran A, Perez-Alvarez N, Muñoz-Moreno JA, Moltó J, Ferrer MJ, Clotet B. Resilience, ageing, and quality of life in long-term diagnosed HIV-infected patients. AIDS Care 2016; 27:1396-403. [PMID: 26679268 DOI: 10.1080/09540121.2015.1114989] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Resilience is a predictor of emotional well-being and psychological adjustment in people living with HIV infection. We report the results of a cross-sectional study in which we evaluated resilience and its association with perception of ageing, coping strategies, quality of life, and emotional status in a group of long-term diagnosed HIV-infected patients. The analysis included 151 consecutive participants (57.6% men). Resilience was moderately high to high in 65 (43%) participants, moderately low to moderate in 57 (37.7%), and very low in 29 (19.2%). Univariate and multivariate analyses were performed. Two factors of perception of ageing (good cognitive self-concept and good subjective perception of social relationships), the use of positive reframing as a coping strategy and better emotional status remained associated with high resilience. Our findings suggest that successful ageing is possible in people living with HIV infection. Resilience seems to play a key role in the ageing process.
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Affiliation(s)
- Carmina R Fumaz
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Aintzane Ayestaran
- c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain.,d Statistics and Operations Research Department - Universitat Politècnica de Barcelona , Barcelona , Spain
| | - Nuria Perez-Alvarez
- c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain.,d Statistics and Operations Research Department - Universitat Politècnica de Barcelona , Barcelona , Spain
| | - Jose A Muñoz-Moreno
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Jose Moltó
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Maria Jose Ferrer
- b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain
| | - Bonaventura Clotet
- e AIDS Research Institute IrsiCaixa-HIVACAT , Badalona , Barcelona , Spain
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95
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Colpitts E, Gahagan J. The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health. Int J Equity Health 2016; 15:60. [PMID: 27048319 PMCID: PMC4822231 DOI: 10.1186/s12939-016-0349-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health. METHODS We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health. RESULTS The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens. CONCLUSIONS While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.
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Affiliation(s)
- Emily Colpitts
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, P.O. Box 15000, 6230 South Street, Halifax, N.S, B3H 4R2, Canada
| | - Jacqueline Gahagan
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, P.O. Box 15000, 6230 South Street, Halifax, N.S, B3H 4R2, Canada.
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96
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Gahagan J, Colpitts E. Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research. JOURNAL OF HOMOSEXUALITY 2016; 64:95-121. [PMID: 27043161 DOI: 10.1080/00918369.2016.1172893] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.
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Affiliation(s)
- Jacqueline Gahagan
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Emily Colpitts
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
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97
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Wilson PA, Meyer IH, Antebi-Gruszka N, Boone MR, Cook SH, Cherenack EM. Profiles of Resilience and Psychosocial Outcomes among Young Black Gay and Bisexual Men. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 57:144-57. [PMID: 27217318 DOI: 10.1002/ajcp.12018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Young Black gay/bisexual men (YBGBM) are affected by contextual stressors-namely syndemic conditions and minority stress-that threaten their health and well-being. Resilience is a process through which YBGBM achieve positive psychosocial outcomes in the face of adverse conditions. Self-efficacy, hardiness and adaptive coping, and social support may be important resilience factors for YBGBM. This study explores different profiles of these resilience factors in 228 YBGBM in New York City and compares profiles on psychological distress, mental health, and other psychosocial factors. Four profiles of resilience were identified: (a) Low self-efficacy and hardiness/adaptive coping (23.5%); (b) Low peer and parental support (21.2%); (c) High peer support, low father support (34.5%); and (d) High father and mother support, self-efficacy, and hardiness/adaptive coping (20.8%). YBGBM in profile 1 scored markedly higher on distress (d = .74) and lower on mental health functioning (d = .93) compared to men in the other profiles. Results suggest that self-efficacy and hardiness/adaptive coping may play a more important role in protecting YBGBM from risks compared to social support and should be targeted in interventions. The findings show that resilience is a multidimensional construct and support the notion that there are different patterns of resilience among YBGBM.
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Affiliation(s)
- Patrick A Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ilan H Meyer
- Williams Institute, University of California - Los Angeles, Los Angeles, CA, USA
| | - Nadav Antebi-Gruszka
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Melissa R Boone
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephanie H Cook
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Emily M Cherenack
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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98
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Grov C, Cain D, Whitfield THF, Rendina HJ, Pawson M, Ventuneac A, Parsons JT. Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and Opportunities. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2016; 13:1-21. [PMID: 26858776 PMCID: PMC4743043 DOI: 10.1007/s13178-015-0212-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups.
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99
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Matthews DD, Smith JC, Brown AL, Malebranche DJ. Reconciling Epidemiology and Social Justice in the Public Health Discourse Around the Sexual Networks of Black Men Who Have Sex With Men. Am J Public Health 2016; 106:808-14. [PMID: 26890175 DOI: 10.2105/ajph.2015.303031] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM.
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Affiliation(s)
- Derrick D Matthews
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - Justin C Smith
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - Andre L Brown
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - David J Malebranche
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
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Blosnich JR, Nasuti LJ, Mays VM, Cochran SD. Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2016; 86:69-78. [PMID: 26752446 DOI: 10.1037/ort0000112] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly six-fold increased risk of lifetime suicide attempts than heterosexual women (RR = 5.88, 95%CI: 3.89-8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR = 6.93, 95%CI: 3.65-13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR = 1.48 and RR = 1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 vs. 19.6 years of age, respectively). Healthcare professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments.
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Affiliation(s)
- John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Laura J Nasuti
- Department of Epidemiology, UCLA Fielding School of Public Health
| | - Vickie M Mays
- Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Susan D Cochran
- Department of Epidemiology, UCLA Fielding School of Public Health
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