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Jadwin-Cakmak L, Jauregui JC, McDowell H, Davis K, LaBoy R, Johnson GL, Hosek S, Harper GW. "They're not feeling the love they need to feel": HIV stigma and other intersecting stigmas among Black gay and bisexual men and transgender women in House and Ball Communities. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2023; 28:424-451. [PMID: 39301481 PMCID: PMC11410368 DOI: 10.1080/19359705.2023.2200375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/21/2023] [Indexed: 09/22/2024]
Abstract
Introduction Stigma negatively influences engagement in HIV prevention and care. This study explores how young Black gay and bisexual men and transgender women (GBT) in the House and Ball Community (HBC) experience HIV and other intersecting stigmas. Method We conducted phenomenological analysis of interviews with 60 young Black GBT HBC members and 30 older leaders of the HBC. Result Participants described experiences of enacted, perceived, and internalized HIV stigma and intersecting stigmas related to race, ethnicity, sexuality, gender identity, gender expression, and body size, as well as their responses to HIV stigma. Intersecting stigmas shaped and reinforced one another, leading to isolation and increased HIV vulnerability. Conclusion Interventions to ameliorate intersectional stigma and its effects are needed to improve primary and secondary HIV prevention in the HBC.
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Affiliation(s)
- Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Juan C Jauregui
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hyuri McDowell
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kortez Davis
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Richard LaBoy
- Adolescent Initiative, Philadelphia Children's Hospital, Philadelphia, PA, USA
| | - Gabriel L Johnson
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Gary W Harper
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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2
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Harper GW, Cherenack EM, Slye N, Jadwin-Cakmak L, Hudgens M. Pilot Trial of a Critical Consciousness-Based Intervention for Black Young Gay and Bisexual Men Living with HIV: Mobilizing Our Voices for Empowerment (MOVE). J Racial Ethn Health Disparities 2023; 10:64-82. [PMID: 35048310 PMCID: PMC9296697 DOI: 10.1007/s40615-021-01197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 02/03/2023]
Abstract
HIV in the USA disproportionately affects Black young gay and bisexual men (Y-GBM). This article presents outcomes of a pilot randomized controlled trial comparing Mobilizing our Voices for Empowerment (MOVE), a culturally and developmentally tailored critical consciousness-based intervention for Black Y-GBM living with HIV (ages 16-24), with a comparison health promotion intervention. Black Y-GBM (n = 54) from four cities participated. Mixed effects models across four assessment points revealed participants in MOVE showed greater increases over time in perceived stress of HIV disclosure, self-efficacy for limiting HIV risk behavior, and condom use self-efficacy. Examining mean difference scores separately, participants in MOVE demonstrated increases in self-efficacy for HIV disclosure, perceived policy control, and self-efficacy for limiting HIV risk behavior. Immediately post-intervention, MOVE participants reported greater decreases in condomless intercourse with negative/unknown partners. MOVE may have potential to improve the health of Black Y-GBM living with HIV and reduce further transmission.
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Affiliation(s)
- Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Emily M Cherenack
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Nicole Slye
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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3
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Drab R, Wolfe JR, Chavanduka TMD, Bonar EE, Guest JL, Hightow-Weidman L, Castel AD, Horvath KJ, Sullivan PS, Stephenson R, Bauermeister J. Constructing a web-based health directory for adolescent men who have sex with men: Strategies for development and resource verification. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1597-1615. [PMID: 34716596 PMCID: PMC8916971 DOI: 10.1002/jcop.22738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Online health directories are increasingly used to locate health services and community resources, providing contact and service information that assists users in identifying resources that may meet their health and wellness needs. However, service locations require additional vetting when directories plan to refer vulnerable populations. As a tool included as part of a trial of a mobile life skills intervention for cisgender adolescent men who have sex with men (AMSM; ages 13-18), we constructed and verified resources for an online resource directory focused on linking young people to LGBTQ+ friendly and affirming local health and community social services resources. We collected information for 2301 individual directory listings through database and internet searches. To ensure the listings aligned with the project's focus of supporting young sexual minority men, we developed multiple data verification assessments to ensure community appropriateness resulting in verification of 1833 resources suitable for inclusion in our locator tool at project launch (March 2018). We offer lessons learned and future directions for researchers and practitioners who may benefit from adapting our processes and strategies for building culturally-tailored resource directories for vulnerable populations.
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Affiliation(s)
- Ryan Drab
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - James R. Wolfe
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Tanaka MD Chavanduka
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
| | - Erin E. Bonar
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
- Department of Psychiatry, School of Medicine, Addiction Center, Ann Arbor, Michigan, US
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, US
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, US
- Emory University School of Medicine, Emory University, Atlanta, Georgia, US
| | | | - Amanda D. Castel
- Milken Institute School of Public Health, George Washington University, Washington, D.C., US
| | | | | | - Rob Stephenson
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
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4
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Fernandez MI, Harper GW, Hightow-Weidman LB, Kapogiannis BG, Mayer KH, Parsons JT, Rotheram-Borus MJ, Seña AC, Sullivan PS. Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint. JMIR Res Protoc 2021; 10:e22279. [PMID: 33393918 PMCID: PMC7813632 DOI: 10.2196/22279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN’s research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.
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Affiliation(s)
- M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | | | | | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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5
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Higa DH, Crepaz N, McDonald CM, Adegbite-Johnson A, DeLuca JB, Kamitani E, Sipe TA. HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988-2017. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:1-S7. [PMID: 32073309 DOI: 10.1521/aeap.2020.32.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health.
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Affiliation(s)
- Darrel H Higa
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Nicole Crepaz
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Christina M McDonald
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Julia B DeLuca
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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Hosek S, Castillo M, Hotton A, Balthazar C, Gwiazdowski B, Laboy R, Davis K, Lemos D, Harper GW, Bell M. Comparison of Two Distinct House Ball Communities Involved in an HIV Prevention Study: Baseline Data from the POSSE Project. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2019; 18:399-416. [PMID: 33013233 PMCID: PMC7531774 DOI: 10.1080/15381501.2019.1673868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 06/11/2023]
Abstract
For many Black/African American gay, bisexual, and other young men who have sex with men (B-GBMSM), the House/Ball Community (HBC) offers a social network where they can be free to express diverse sexual and gender identities, but HIV prevalence and stigma are high. The POSSE project is an effectiveness-implementation trial of a popular opinion leader intervention designed to address HIV prevention in the Chicago and Philadelphia HBCs. In June 2016 baseline behavioral data were collected along with HIV, gonorrhea and Chlamydia testing. Eligible participants were sexually-active YMSM or transgender women (TGW), between the ages of 15-24, who self-identified as Black. One-third participants (32.5%) met or exceeded the clinical cut-off for depressive symptoms. Approximately 18% of the participants across both cities reported that they were HIV-positive. Overall, the baseline data establishes the need for HIV and STI prevention interventions across both cities, as well as interventions to address other co-occurring epidemics.
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Affiliation(s)
- Sybil Hosek
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, IL USA
| | - Marne Castillo
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Anna Hotton
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
| | | | - Bevin Gwiazdowski
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Richard Laboy
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kortez Davis
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, IL USA
| | | | - Gary W. Harper
- School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Margo Bell
- Division of Adolescent Medicine, John Stroger Hospital of Cook County, Chicago, IL USA
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7
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Flores D, Docherty SL, Relf MV, McKinney RE, Barroso JV. "It's Almost Like Gay Sex Doesn't Exist:" Parent-Child Sex Communication According to Gay, Bisexual, and Queer Adolescent Sons. JOURNAL OF ADOLESCENT RESEARCH 2019; 34:528-562. [PMID: 34054207 PMCID: PMC8159159 DOI: 10.1177/0743558418757464] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sex communication interventions facilitate positive sexual health outcomes with heterosexual adolescents. The same has yet to be established for male youth with same-sex attractions, behaviors, and identities. Our study describes the experiences of gay, bisexual and queer-identifying adolescent males with parent-child sex communication. We conducted 30 in-depth semi-structured interviews with a diverse group of 15 to 20 year-old gay, bisexual, and queer (GBQ) males. Interview transcripts were coded and themes were identified using thematic and content analysis. Narratives revealed that sex communication with parents occurs rarely, is heteronormative in content prior to adolescent males' disclosure as GBQ, and after disclosure is reactionary and based on stereotypes that associate this population with negative health outcomes. Parents were rated poorly as sex educators by adolescent males and the findings are mixed regarding perception of parents' knowledge about GBQ-specific information. Parents and healthcare providers were identified as preferred sources of sex information by GBQ adolescent males. Sex communication with parents throughout adolescence that excludes GBQ males' same-sex concerns is a missed opportunity for targeted sexual risk reduction. There are multiple ways healthcare providers can assist parents to plan age-appropriate, sexuality-inclusive, home-based discussions about sex for this group.
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Affiliation(s)
- Dalmacio Flores
- University of Pennsylvania School of Nursing, Philadelphia PA
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8
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Flores D, Abboud S, Barroso J. Hegemonic Masculinity during Parent-Child Sex Communication with Sexual Minority Male Adolescents. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2019; 14:417-439. [PMID: 32099538 PMCID: PMC7041507 DOI: 10.1080/15546128.2019.1626312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Dalmacio Flores
- School of Nursing, University of Pennsylvania (Philadelphia, PA, 19104)
| | - Sarah Abboud
- College of Nursing, University of Illinois at Chicago (Chicago, IL, 60612)
| | - Julie Barroso
- College of Nursing, Medical University of South Carolina (Charleston, SC, 29425)
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9
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Whiteley L, Mena L, Craker LK, Healy MG, Brown LK. Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game. JMIR Serious Games 2019; 7:e11861. [PMID: 30916652 PMCID: PMC6456850 DOI: 10.2196/11861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP's safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. OBJECTIVE This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. METHODS Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. RESULTS A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors' visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. CONCLUSIONS We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM.
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, United States
| | - Lacey K Craker
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Garver Healy
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
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10
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Harper GW, Jadwin-Cakmak L, Cherenak E, Wilson P. Critical Consciousness-Based HIV Prevention Interventions for Black Gay and Bisexual Male Youth. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2018; 14:109-133. [PMID: 30956625 PMCID: PMC6448792 DOI: 10.1080/15546128.2018.1479668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2018] [Accepted: 05/18/2018] [Indexed: 06/09/2023]
Abstract
Black gay/bisexual male youth are one of the groups most affected by HIV in the U.S., but few behavioral interventions have been created specifically to address this health inequity. Oppression related to these youths' multiple social identities - including racism, heterosexism, and HIV stigma - contribute to increased health risks. Primary and secondary HIV prevention interventions created specifically for Black gay/bisexual male youth that address the negative impact of oppression are urgently needed. We present empowerment as a framework for understanding how oppression affects health, and critical consciousness as a tool to be utilized in behavioral interventions. This approach helps to move Black gay/bisexual male youth from a place of oppression and powerlessness that leads to elevated health risks to a position of empowerment that promotes feelings of control and participation in healthy behaviors. Finally, we present a case example of our own critical consciousness-based secondary HIV prevention intervention created specifically for Black gay/bisexual male youth.
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Affiliation(s)
- Gary W Harper
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, School of Public Health I, Room 2272, Ann Arbor, MI 48109, ; 734-647-9778
| | - Laura Jadwin-Cakmak
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Center for Sexuality & Health Disparities, 400 North Ingalls St., Ann Arbor, MI 48109, ; 734-763-2884
| | - Emily Cherenak
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, 5th Floor, New York NY USA 10032, ; 908-303-0786
| | - Patrick Wilson
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, 5th Floor, New York NY USA 10032, ; 212-305-1852
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11
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Fisher CB, Mustanski B. Reducing Health Disparities and Enhancing the Responsible Conduct of Research Involving LGBT Youth. Hastings Cent Rep 2018; 44 Suppl 4:S28-31. [PMID: 25231783 DOI: 10.1002/hast.367] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although there is clearly a need for evidenced-based behavioral or biomedical prevention or treatment programs for suicide, substance abuse, and sexual health targeted to members of the LGBT population under the age of eighteen, few such programs exist, due in substantial part to limited research knowledge. Ambiguities in regulations that govern human subjects protections and the related inconsistencies in institutional review board (IRB) interpretations of regulatory language are the key reason for the lack of rigorous clinical trial evidence to support treatment choices and prevention approaches to reducing health disparities for this population. Given the socially sensitive nature of suicide, substance abuse, and HIV and STI research in general and LGBT research specifically, in the absence of empirical data to guide their decisions, IRBs must often rely on subjective judgments of minimal risk, which can lead to overestimation of the magnitude and probability of psychological, social, and informational harms that might arise from LGBT youth participation in clinical trials. In addition, more than other youth, LGBT adolescents whose families are unaware of their sexual orientation or gender identity or whose families have victimized them on account of it may be reluctant to participate in studies that require guardian permission. This, in turn, intensifies problems of recruitment and unbiased sampling. However, many IRBs are reluctant to apply federal regulations permitting waiver of guardian permission under conditions in which such permission is clearly not "feasible" or "reasonable" to require. Consequently, many investigators have excluded LGBT individuals under eighteen years of age in health intervention research proposals because of anticipated or actual difficulties obtaining IRB approval. This situation is in conflict with current ethical discourse focusing on the right of youths to participate in trials that will protect them from receiving developmentally untested, inappropriate, and unsafe treatments. In this article, we describe these barriers and recommendations for providing LGBT youth safe and fair access to health research.
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12
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Bauermeister JA, Golinkoff JM, Horvath KJ, Hightow-Weidman LB, Sullivan PS, Stephenson R. A Multilevel Tailored Web App-Based Intervention for Linking Young Men Who Have Sex With Men to Quality Care (Get Connected): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10444. [PMID: 30072358 PMCID: PMC6096165 DOI: 10.2196/10444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background HIV epidemic among young men who have sex with men (YMSM) is characterized by strong racial disparities and concerns about the availability and access to culturally appropriate HIV prevention and care service delivery. Get Connected, a Web-based intervention that employs individual- and system-level tailoring technology to reduce barriers to HIV prevention care (eg, HIV or sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP]), was developed for YMSM (age 15-24 years). This protocol details the design and procedures of a 2-phase project that includes mystery shopping and a randomized controlled trial (RCT) to test the efficacy of Get Connected among YMSM in Philadelphia, Atlanta, and Houston. Objective The objective of mystery shopping is to examine the quality of HIV test counseling and PrEP-related referrals for YMSM within local HIV or STI testing sites. The objective of the RCT is to test the efficacy of Get Connected for increasing HIV-negative or HIV-unknown YMSM’s successful uptake of HIV prevention services (eg, routine HIV or STI testing), PrEP awareness, and likelihood to start PrEP (PrEP willingness), compared with those in the control condition, over a 12-month period. Methods For Phase 1, we will create a master list of HIV and STI testing sites in each city. We will enroll and train 10-15 mystery shoppers per city; each testing site will be separately visited and assessed by 2 mystery shoppers. After each site visit, the mystery shoppers will complete a site evaluation to record their perceptions of various measures including lesbian, gay, bisexual, transgender, queer visibility and inclusivity, privacy and confidentiality, provider-patient interactions, and clinic environment. For Phase 2, we will enroll 480 YMSM for 12 months across the 3 iTech cities into a 2-arm prospective RCT. Participants randomized to the control condition are directed to the AIDSVu.org testing site locator. Participants randomized to the intervention condition will be granted access to a Web app with content tailored to their specific demographic characteristics (eg, age, race or ethnicity, location, and relationship status), HIV and STI risk behaviors (eg, HIV and STI testing history, substance use, communication with partners regarding status) and sociocultural context (eg, homelessness, incarceration). Study assessments will occur at enrollment and at 1, 3, 6, 9, and 12 months postenrollment. Results Get Connected research activities began in September 2016 and are ongoing. To date, institutional review board (IRB) submission is complete and IRB authorization agreements are pending at several other universities. Conclusions The deployment of Get Connected through a mobile-optimized Web app seeks to optimize the intervention’s acceptability, accessibility, availability, and long-term affordability among YMSM. Trial Registration ClinicalTrials.gov (NCT03132415); https://clinicaltrials.gov/ct2/show/NCT03132415 (Archived by WebCite at http://www.webcitation.org/70j4gSFbZ) Registered Report Identifier RR1-10.2196/10444
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Affiliation(s)
- José A Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith J Horvath
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
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Bauermeister J, Sullivan PS, Gravens L, Wolfe J, Countryman K, Smith-Bankhead N, Drab RA, Sallabank G, Helms JD, Khatibi K, Filipowicz R, Horvath KJ, Bonar E, Castel A, Hightow-Weidman L, Guest J, Stephenson R. Reducing HIV Vulnerability Through a Multilevel Life Skills Intervention for Adolescent Men (The iREACH Project): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10174. [PMID: 29991470 PMCID: PMC6058092 DOI: 10.2196/10174] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few HIV interventions have demonstrated efficacy in reducing HIV risk among adolescent men who have sex with men (AMSM), and fewer still have recognized the unique needs of AMSM based on race/ethnicity or geographical setting. Recognizing that youths' HIV vulnerability is intricately tied to their development and social context, delivering life skills training during adolescence might delay the onset or reduce the consequences of risk factors for HIV acquisition and equip AMSM with the skills to navigate HIV prevention. This protocol describes the development and testing of iREACH, an online multilevel life skills intervention for AMSM. OBJECTIVE This randomized controlled trial (RCT) aims to test the efficacy of an online-delivered life skills intervention, iREACH, on cognitive and behavioral HIV-related outcomes for AMSM. METHODS iREACH is a prospective RCT of approximately 600 cisgender adolescent males aged 13 to 18 years who report same-sex attractions. The intervention will be tested with a racial/ethnically diverse sample (≥50% racial/ethnic minority) of AMSM living in four regions in the United States: (1) Chicago to Detroit, (2) Washington, DC to Atlanta, (3) San Francisco to San Diego, and (4) Memphis to New Orleans. RESULTS This project is currently recruiting participants. Recruitment began in March 2018. CONCLUSIONS iREACH represents a significant innovation in the development and testing of a tailored life skills-focused intervention for AMSM, and has the potential to fill a significant gap in HIV prevention intervention programming and research for AMSM. REGISTERED REPORT IDENTIFIER RR1-10.2196/10174.
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Affiliation(s)
- Jose Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Laura Gravens
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James Wolfe
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Ryan A Drab
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Gregory Sallabank
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jordan D Helms
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kristie Khatibi
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rebecca Filipowicz
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Keith Joseph Horvath
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Erin Bonar
- School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Jodie Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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14
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Flores D, McKinney R, Arscott J, Barroso J. Obtaining waivers of parental consent: A strategy endorsed by gay, bisexual, and queer adolescent males for health prevention research. Nurs Outlook 2018; 66:138-148. [PMID: 28993074 PMCID: PMC5857413 DOI: 10.1016/j.outlook.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Requiring parental consent in studies with sexual minority youth (SMY) can sometimes be problematic as participants may have yet to disclose their sexual orientation, may not feel comfortable asking parents' permission, and may promote a self-selection bias. PURPOSE We discuss rationale for waiving parental consent, strategies to secure waivers from review boards, and present participants' feedback on research without parents' permission. METHODS We share our institutional review board proposal in which we made a case that excluding SMY from research violates ethical research principles, does not recognize their autonomy, and limits collection of sexuality data. DISCUSSION Standard consent policies may inadvertently exclude youth who are at high risk for negative health outcomes or may potentially put them at risk because of forced disclosure of sexual orientation. Securing a waiver addresses these concerns and allows for rich data, which is critical for providers to have a deeper understanding of their unique sexual health needs. CONCLUSION To properly safeguard and encourage research informed by SMY, parental consent waivers may be necessary.
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Affiliation(s)
| | - Ross McKinney
- Association of American Medical Colleges, Washington, DC
| | | | - Julie Barroso
- Medical University of South Carolina School of Nursing, Charleston, SC
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15
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Macapagal K, Birkett M, Janulis P, Garofalo R, Mustanski B. HIV Prevention Fatigue and HIV Treatment Optimism Among Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:289-301. [PMID: 28825861 PMCID: PMC5734058 DOI: 10.1521/aeap.2017.29.4.289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
HIV prevention fatigue (the sense that prevention messages are tiresome) and being overly optimistic about HIV treatments are hypothesized to increase HIV risk behavior. Little research has examined these constructs and their correlates among young men who have sex with men (YMSM), who are at high risk for HIV. YMSM (N = 352; Mage = 20; 50% Black) completed measures of prevention fatigue, treatment optimism, HIV risk behaviors, and HIV-related knowledge and attitudes during a longitudinal study. Overall, YMSM reported low levels of HIV prevention fatigue and treatment optimism. Path analysis (n = 307) indicated that greater prevention fatigue and treatment optimism predicted higher rates of condomless sex, but condomless sex did not predict later increases in prevention fatigue or treatment optimism. Results are inconsistent with the hypothesis of high prevention fatigue and treatment optimism among YMSM and point to potential causal relationships among these variables and condomless sex.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Michelle Birkett
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Patrick Janulis
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Third Coast Center for AIDS Research, Northwestern University
| | - Robert Garofalo
- Third Coast Center for AIDS Research, Northwestern University
| | - Brian Mustanski
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Ann and Robert H. Lurie Children’s Hospital of Chicago
- Third Coast Center for AIDS Research, Northwestern University
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16
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Reed SJ, Miller RL. Thriving and Adapting: Resilience, Sense of Community, and Syndemics among Young Black Gay and Bisexual Men. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 57:129-43. [PMID: 27217317 DOI: 10.1002/ajcp.12028] [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
We examined resilience associated with the avoidance of psychosocial health conditions (i.e., syndemics) that increase vulnerability for HIV among young Black gay and bisexual men. We used analytic induction to compare a sample of 23 men who showed no evidence of syndemic conditions to a sample of 23 men who experienced syndemic conditions. The men who avoided syndemics reported supportive relationships with people who helped them to develop a strong sense of identity, provided them with opportunities to give back to their communities, and promoted positive norms about health. In contrast, the men experiencing syndemic conditions described numerous instances of trauma and oppression that infringed upon their desire to form positive relationships. Among these men, experiences of oppression were associated with shame, identity incongruence, social isolation, relational disconnection, mistrust of men, and expectations of further marginalization. We examined participants' experiences through the framework of the psychosocial sense of community. Results of this study provide evidence for using strength-based intervention strategies to prevent syndemic conditions. Findings suggest that to attenuate socio-structural barriers to health and comorbid psychosocial health concerns, interventions must address young men's social isolation and promote positive identity and sense of community.
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Affiliation(s)
- Sarah J Reed
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robin Lin Miller
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Fisher CB, Arbeit MR, Dumont MS, Macapagal K, Mustanski B. Self-Consent for HIV Prevention Research Involving Sexual and Gender Minority Youth: Reducing Barriers Through Evidence-Based Ethics. J Empir Res Hum Res Ethics 2016; 11:3-14. [PMID: 26956988 PMCID: PMC4842126 DOI: 10.1177/1556264616633963] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project examined the attitudes of sexual and gender minority youth (SGMY) toward guardian permission for a pre-exposure prophylaxis (PrEP) adherence trial and their preparedness to provide informed, rational, and voluntary self-consent. Sixty sexually active SGMY (ages 14-17) participated in online survey and asynchronous focus group questions after watching a video describing a PrEP adherence study. Youth responses highlighted guardian permission as a significant barrier to research participation, especially for those not "out" to families. Youth demonstrated understanding of research benefits, medical side effects, confidentiality risks, and random assignment and felt comfortable asking questions and declining participation. Reasoning about participation indicated consideration of health risks and benefits, personal sexual behavior, ability to take pills every day, logistics, and post-trial access to PrEP. Results demonstrate youth's ability to self-consent to age- and population-appropriate procedures, and underscore the value of empirical studies for informing institutional review board (IRB) protections of SGMY research participants.
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18
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DuBois LZ, Macapagal KR, Rivera Z, Prescott T, Ybarra M, Mustanski B. To have sex or not to have sex? An online focus group study of sexual decision making among sexually experienced and inexperienced gay and bisexual adolescent men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2027-40. [PMID: 25925896 PMCID: PMC4561008 DOI: 10.1007/s10508-015-0521-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 05/03/2023]
Abstract
Adolescent gay and bisexual men (AGBM) are at disproportionately high risk for HIV and other sexually transmitted infections, yet healthy sexuality and HIV prevention programs grounded in experiences unique to AGBM (e.g., coming out) are lacking, as is the formative work necessary to inform such programs. A richer understanding of factors informing AGBM's decisions to have or not have sex is needed. To fill this gap in the literature, we conducted qualitative and mixed-methods analyses of data collected in online focus groups with 75 ethnically diverse 14-18-year-old AGBM across the United States. Findings suggest that many reasons why AGBM choose to have or abstain from sex mirror those noted in the previous literature as influential for heterosexual adolescents (e.g., temptation, "horniness"). AGBM conveyed additional experiences/concerns that appeared unique to their sexual identity, particularly fears about pain during anal sex, and difficulties safely and accurately identifying same-sex partners. Both sexually experienced and inexperienced youth voiced reasons to wait or stop having sex. Sexually inexperienced youth said their motivations centered on wanting to avoid STIs and HIV, a desire to wait for the right partner, and the specialness of sex. On the other hand, sexually experienced AGBM said they stopped having sex if there was not an available partner they had interest in, or to improve their romantic relationship. Thus, while our findings suggest that there may be common factors across sexual identities that impact youth's sexual decision making, healthy sexuality programs for AGBM also need to address issues specific to being gay and bisexual.
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Affiliation(s)
| | | | - Zenaida Rivera
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tonya Prescott
- Center for Innovative Public Health Research, San Clemente, CA
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, CA
| | - Brian Mustanski
- Northwestern University Feinberg School of Medicine, Chicago, IL
- To whom correspondence should be addressed at Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL 60611; phone: 312-503-5421; fax: 312-503-4800;
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19
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Birkett M, Kuhns LM, Latkin C, Muth S, Mustanski B. The sexual networks of racially diverse young men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1787-97. [PMID: 26201650 PMCID: PMC4560982 DOI: 10.1007/s10508-015-0485-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 05/26/2023]
Abstract
Young men who have sex with men are at increased risk for HIV. Research with older men and high-risk populations suggests that network dynamics may contribute to the spread of infectious disease and HIV, but little is known about the sexual networks of young men who have sex with men. Utilizing a unique dataset, this study presents novel descriptive data about the sexual networks of racially diverse 17- to 23-year-old young men who have sex with men. Additionally, individual, partner, and network characteristics of these young men who have sex with men were examined as potential drivers of HIV, STI, and unprotected intercourse. Results indicated several partner- and network-level factors associated with HIV and associated outcomes.
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Affiliation(s)
- Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA,
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20
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Arrington-Sanders R, Morgan A, Ogunbajo A, Trent M, Harper GW, Fortenberry JD. The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:597-608. [PMID: 25677334 PMCID: PMC4408764 DOI: 10.1007/s10508-014-0416-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/15/2014] [Accepted: 09/27/2014] [Indexed: 05/12/2023]
Abstract
Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.
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Affiliation(s)
- Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, 2063, Baltimore, MD 21287, USA
| | - Anthony Morgan
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, 2063, Baltimore, MD 21287, USA
| | - Adedotun Ogunbajo
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, 2063, Baltimore, MD 21287, USA
| | - Maria Trent
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, 2063, Baltimore, MD 21287, USA
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
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21
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Pettifor A, Nguyen NL, Celum C, Cowan FM, Go V, Hightow-Weidman L. Tailored combination prevention packages and PrEP for young key populations. J Int AIDS Soc 2015; 18:19434. [PMID: 25724507 PMCID: PMC4344537 DOI: 10.7448/ias.18.2.19434] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/16/2014] [Accepted: 01/02/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations. OBJECTIVE In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages. METHODS We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular. RESULTS AND DISCUSSION Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations' practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure. CONCLUSIONS Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission.
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Affiliation(s)
- Audrey Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;
| | - Nadia L Nguyen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connie Celum
- International Clinical Research Center, University of Washington, Seattle, WA, USA
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Vivian Go
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Hightow-Weidman
- Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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23
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Earlier anal sexarche and co-occurring sexual risk are associated with current HIV-related risk behaviors among an online sample of men who have sex with men in Asia. AIDS Behav 2014; 18:2423-31. [PMID: 24920344 DOI: 10.1007/s10461-014-0821-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Studies of heterosexual populations across the globe and men who have sex with men (MSM) in a few developed countries showed that earlier sexual debut (sexarche) was associated with higher levels of co-occurring and subsequent HIV risk behaviors. We examined the relationships between earlier anal sexarche, unprotected earlier anal sexarche and current HIV risks among MSM from Asia. A cross-sectional online survey was conducted among MSM (N = 10,826) in Asia in 2010. Bivariate and multivariable logistic regressions were used to identify co-occurring (i.e., sexual experiences during sexarche) and current HIV-related risk factors (i.e., past 6 months) associated with earlier anal sexarche (before the age of 18) and unprotected earlier anal sexarche, respectively. Earlier anal sexarche was significantly associated with lack of condom use, being anal receptive or both receptive and insertive, and having a partner who were older during sexarche. It was also associated with current HIV-related risk behaviors including having multiple male sexual partners, having been paid for sex, and increased frequencies of recreational drug use. Unprotected earlier anal sexarche was significantly associated with inconsistent condom use in the past the 6 months. Improved and culturally sensitive sex education at schools should be included in national and regional HIV/AIDS prevention programming and policies in Asia. Such sex education programs should incorporate curriculum that address sexuality, sexual orientation, and sexual behaviors beyond those related to reproductive health.
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Ashton LM, Hutchesson MJ, Rollo ME, Morgan PJ, Collins CE. A scoping review of risk behaviour interventions in young men. BMC Public Health 2014; 14:957. [PMID: 25224717 PMCID: PMC4177699 DOI: 10.1186/1471-2458-14-957] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/08/2014] [Indexed: 01/01/2023] Open
Abstract
Background Young adult males commonly engage in risky behaviours placing them at risk of acute and chronic health conditions. The purpose of this scoping review was to provide an overview of existing literature, describing the interventions targeting risk behaviours in young adult males. Methods A search of seven electronic databases, grey literature and relevant journals reported in English language until May 2013 was conducted. All interventions that promoted healthy behaviours or reductions in risky behaviours to treat or prevent an associated health issue(s) in young adult males (17-35 years) in upper-middle and high-income countries were included. For inclusion the appropriate age range had to be reported and the sample had to be young adult male participants only or the outcomes reported with stratification by age and/or sex to include young adult males. Risk behaviours included: physical inactivity, poor diet, alcohol use, tobacco smoking, recreational drug use, unsafe sexual behaviours, tanning/sun exposure, violence, unsafe vehicle driving, gambling and self-harm. Results The search strategy identified 16,739 unique citations and the full-text of 1149 studies were retrieved and screened with 100 included studies focussed on: physical inactivity (27%), alcohol use (25%), unsafe sexual behaviour (21%), poor diet (5%), unsafe vehicle driving (5%), tobacco smoking (4%), recreational drug use (2%), and tanning/sun exposure (1%) with no relevant studies targeting violence, gambling or self-harm. Also 10% of the studies targeted multiple risk behaviours. The most common study design was randomized controlled trials (62%). Face-to-face was the most common form of intervention delivery (71%) and the majority were conducted in university/college settings (46%). There were 46 studies (46%) that included young adult male participants only, the remaining studies reported outcomes stratified by age and/or sex. Conclusion Risk behaviours in young men have been targeted to some extent, but the amount of research varies across risk behaviours. There is a need for more targeted and tailored interventions that seek to promote healthy behaviours or decrease risky behaviours in young men. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-957) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle, Australia.
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25
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Pingel ES, Thomas L, Harmell C, Bauermeister J. Creating comprehensive, youth centered, culturally appropriate sex education: What do young gay, bisexual and questioning men want? SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2013; 10:10.1007/s13178-013-0134-5. [PMID: 24348222 PMCID: PMC3862289 DOI: 10.1007/s13178-013-0134-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
We examined young gay, bisexual and questioning men's (YGBQM) experiences with school-based sex education as they sought to learn about sex and sexual health, and their suggestions for improving same-sex education resources. Thematic analysis of 30 in-depth interviews with YGBQM (ages 18-24) underscored the discrepancies between the existing school-based sex education curricula and YGBQM's perceived sex education needs. Our results show that many youths' sexuality and same-sex sexual behaviors are excluded in sex education lessons; however, YGBQM noted that they sought out other resources (e.g., websites) to answer their questions. We discuss YGBQM's ideas for the creation of a sex and sexual health website that would be tailored for youth like themselves, including topics and features that an ideal website would contain. In addition, we present recommended changes to existing school-based sexual education curricula.
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Affiliation(s)
- Emily Sweetnam Pingel
- The Center for Sexuality & Health Disparities, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Laura Thomas
- The Center for Sexuality & Health Disparities, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - Chelsea Harmell
- The Center for Sexuality & Health Disparities, University of Michigan, School of Public Health, Ann Arbor, Michigan
| | - José Bauermeister
- The Center for Sexuality & Health Disparities, University of Michigan, School of Public Health, Ann Arbor, Michigan
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26
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Torres H, Delonga K, Lee S, Gladstone KA, Barrad A, Huckaby S, Koopman C, Gore-Felton C. Socio-Contextual Factors: Moving Beyond Individual Determinants of Sexual Risk Behavior among Gay and Bisexual Adolescent Males. JOURNAL OF LGBT YOUTH 2013; 10:10.1080/19361653.2013.799000. [PMID: 24187600 PMCID: PMC3810983 DOI: 10.1080/19361653.2013.799000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study investigated factors associated with sexual behavior that confers the greatest risk for HIV transmission (i.e., unprotected anal intercourse; UAI) among 52 sexually active gay and bisexual adolescent males in a Midwestern city ages 15-19. A logistic regression model found that ethnicity other than African American, more sexual partners in the past year, greater stigma towards homosexuality, and greater perceived peer sexual norms for risky behavior were significantly associated with UAI (x2 =27.96, df=5, p<.001; Nagelkerke R2 = 0.56). Implications for prevention interventions are discussed.
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Affiliation(s)
| | | | - Susanne Lee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, ( .)
| | | | - Alex Barrad
- PGSP-Stanford PsyD Consortium, Palo Alto University ()
| | - Scott Huckaby
- PGSP-Stanford PsyD Consortium, Palo Alto University ()
| | - Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine ()
| | - Cheryl Gore-Felton
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine ()
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Stevens R, Bernadini S, Jemmott JB. Social environment and sexual risk-taking among gay and transgender African American youth. CULTURE, HEALTH & SEXUALITY 2013; 15:1148-61. [PMID: 23889233 PMCID: PMC4036822 DOI: 10.1080/13691058.2013.809608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
More prevention effort is required as the HIV epidemic increases among gay and transgender African American youth. Using ecological systems theory and an integrative model of behaviour change, this study examines the sexual behaviour of gay and transgender African American young people as embedded within the unique social and structural environments affecting this population. Also examined is the important role played by mobile technology in the social and sexual lives of individuals. Seven focus groups were conducted with 54 African American young adults in a northeastern US city. The findings provide a rich examination of the social and sexual lives of gay and transgender African American youth, focusing on the social environment and the impact of the environment on sexual-risk behaviour.
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Affiliation(s)
- Robin Stevens
- Assistant Professor of Childhood Studies, Rutgers University, New Jersey, USA
| | | | - John B. Jemmott
- Center for Health Behavior and Communication Research,University of Pennsylvania School of Medicine, Philadelphia, USA
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