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Valente PK, Neupane R, Eaton L, Watson RJ. Psychosocial Syndemic Burden, Sexual Behaviors, and Engagement in HIV Prevention Care Among Sexual and Gender Minority Youths: United States, 2022. Am J Public Health 2024; 114:892-902. [PMID: 39110931 PMCID: PMC11306613 DOI: 10.2105/ajph.2024.307753] [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] [Indexed: 08/11/2024]
Abstract
Objectives. To examine linear and nonlinear associations between psychosocial syndemic factors and HIV risk and engagement in HIV prevention care among sexual and gender minority (SGM) youths. Methods. Between February and October 2022, we recruited 17 578 SGM youths aged 13 to 18 years in the United States for an online survey. We examined the relationship of syndemics (i.e., binge drinking, drug use, sexual victimization, and anti-lesbian, gay, bisexual, and transgender discrimination) with sexual behaviors (i.e., sexual initiation, condomless anal or vaginal sex, and number of sexual partners) and HIV prevention care (i.e., HIV testing, preexposure prophylaxis awareness and utilization) using regression. Results. Psychosocial syndemic burden (number of syndemic factors reported) was linearly and cubically associated with engagement in sexual behaviors. Psychosocial syndemic burden was linearly associated with higher HIV testing and preexposure prophylaxis awareness and cubically associated with higher preexposure prophylaxis utilization. Conclusions. Our findings are evidence of synergism across psychosocial syndemic factors regarding HIV risk and engagement in HIV prevention care among SGM youths in the United States. Public Health Implications. Multicomponent interventions may help reduce HIV risk and promote access to HIV prevention services among SGM individuals aged 13 to 18 years. (Am J Public Health. 2024;114(9):892-902. https://doi.org/10.2105/AJPH.2024.307753).
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Affiliation(s)
- Pablo K Valente
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Raghavee Neupane
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Lisa Eaton
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Ryan J Watson
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Tran NK, Le TP, Krause KD, Martino RJ, Halkitis PN. An Exploration of Racial Differences of Psychosocial Stressors and Their Association With Mental Health Between Asian and White Sexual Minority Men: The P18 Cohort Study. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2023; 14:364-372. [PMID: 38264160 PMCID: PMC10803058 DOI: 10.1037/aap0000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
There is growing concern that Asian sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, may be at elevated risk of psychological distress and suicidal ideation, yet limited attention has focused on how psychosocial stressors may affect them. This study seeks to (a) explore differences in psychosocial stressors, anxiety, depression, and suicidal ideation between Asian and White SMM and (b) evaluate the potential moderation of associations between psychosocial stressors and mental health by race. Data were obtained from the P18 Cohort Study. We restricted the sample to only those who identified as non-Hispanic Asian or White and used regression analysis to assess the associations of psychosocial stressors and mental health outcomes in the overall sample by race. Of the 217 participants in our analytic sample, 23% self-identified as Asian. Compared with White SMM, Asian SMM had a higher prevalence of loneliness, internalized homophobia, and public gay-related stigma. In regression analyses, most psychosocial stressors were significantly associated with anxiety, depression, and suicidal ideation in the overall sample. Associations between each stressor and mental health outcome primarily did not differ between Asian and White SMM. However, White SMM experiencing higher levels of public gay-related stigma had greater odds of suicidal ideation, although this was not observed for Asian SMM. Overall, Asian SMM may be experiencing similar effects of psychosocial stressors on mental health to White SMM. Health professionals may want to consider how these stressors impact the mental health and well-being of their Asian SMM clients.
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Affiliation(s)
- Nguyen K. Tran
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA, 19104, USA
| | - Thomas P. Le
- Department of Psychology, University of Maryland, College Park, 3128 Biology Psychology Building, College Park, MD, 20770, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
| | - Richard J. Martino
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA
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Sang JM, Moore DM, Wang L, Chia J, Toy J, Montaner J, Skakoon-Sparling S, Cox J, Lambert G, Grace D, Hart TA, Lal A, Jollimore J, Lachowsky NJ. Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada. BMC Public Health 2023; 23:2124. [PMID: 37904163 PMCID: PMC10614320 DOI: 10.1186/s12889-023-17049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. METHODS Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. RESULTS Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). CONCLUSION There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
- BC Centre on Substance Use, Vancouver, BC, Canada.
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Center, Montreal, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
- Institut national de santé publique du Québec, Quebec City, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University (formerly Ryerson), Toronto, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Nathan J Lachowsky
- Community Based Research Centre, Vancouver, Canada
- University of Victoria, Victoria, Canada
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5
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Moody RL, Carter JA, Talan A, Sizemore KM, Russell ST, Rendina HJ. Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men. Psychol Med 2023; 53:5615-5624. [PMID: 36117279 PMCID: PMC10024646 DOI: 10.1017/s0033291722002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. METHODS Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. RESULTS 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. CONCLUSION To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.
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Affiliation(s)
- Raymond L. Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 181st Street, New York, NY 10032, USA
| | - Joseph A. Carter
- Department of Psychology, City University of New York Graduate Center, Health Psychology and Clinical Sciences Program, New York, NY, USA
| | - Ali Talan
- Whitman-Walker Institute, Washington, DC, USA
| | - K. Marie Sizemore
- Department of Psychiatry, Rutgers University Institute for Health, Health Care Policy, and Aging, New Brunswick, NJ, USA
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, University of Texas at Austin School of Human Ecology, Austin, TX, USA
| | - H. Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, and Whitman-Walker Institute, Washington, DC, USA
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Storholm ED, Reynolds HE, Muthuramalingam S, Nacht CL, Felner JK, Wagner GJ, Stephenson R, Siconolfi DE. Intimate Partner Violence and the Sexual Health of Sexual Minority Men. LGBT Health 2023; 10:S39-S48. [PMID: 37754928 PMCID: PMC10623463 DOI: 10.1089/lgbt.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Hannah E. Reynolds
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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Driver R, Schneider JA, Hickson DA, Timmins L, Brewer RA, Goedel WC, Duncan DT. Sexual Orientation, HIV Vulnerability-Enhancing Behaviors and HIV Status Neutral Care Among Black Cisgender Sexual Minority Men in the Deep South: The N2 Cohort Study. AIDS Behav 2023; 27:2592-2605. [PMID: 36648630 PMCID: PMC11034832 DOI: 10.1007/s10461-023-03984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Black sexual minority men (SMM) in the Deep South are heavily impacted by HIV; yet studies fail to consider discordance across aspects of sexual orientation (i.e., identity, attraction, behavior) or how a lack of concordance enhances vulnerability to HIV. We sought to explore the overlap across aspects of sexual orientation and examine associations between each aspect and the number of sexual partners who engaged in HIV vulnerability-enhancing behaviors, and HIV prevention and care outcomes. A total of 204 Black SMM completed surveys, reporting their sexual identity, attraction, and behavior (i.e., sex with men only vs. sex with men and women), number of condomless sex or transactional sex (e.g., buyers vs. sellers) partners in the past 6 months, and adherence to pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) among users. Less than one in four participants (22.5%) reported overlap in same-sex sexual orientations, while 17.1% of bisexual men reported overlap across aspects. In multivariable models, differences were found in how aspects of sexual orientation were associated with the number of partners who bought or sold sex; as well as how often participants tested for HIV in the past 12 months. Results suggest different aspects of sexual orientation have implications for addressing HIV among Black SMM in the Deep South.
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Affiliation(s)
- Redd Driver
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA.
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Crown School of Social Work, University of Chicago, Chicago, IL, USA
| | | | - Liadh Timmins
- School of Psychology, Swansea University, Swansea, Wales, UK
| | | | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Dustin T Duncan
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Cascalheira CJ, Nelson J, Flinn RE, Zhao Y, Helminen EC, Scheer JR, Stone AL. High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104103. [PMID: 37413908 PMCID: PMC10528101 DOI: 10.1016/j.drugpo.2023.104103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/16/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience). METHODS Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender. RESULTS Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support. CONCLUSION This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.
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Affiliation(s)
- Cory J Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA.
| | - Jessie Nelson
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Ryan E Flinn
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yuxuan Zhao
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, USA
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Storholm ED, Huang W, Ogunbajo A, Horvath KJ, Reback CJ, Blumenthal J, Moore DJ, Flynn RP, Bolan RK, Corado KC, Morris SR. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 2023; 27:745-759. [PMID: 36053404 PMCID: PMC9908815 DOI: 10.1007/s10461-022-03807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low-low, high-low, and high-high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Adedotun Ogunbajo
- RAND Corporation, Santa Monica, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cathy J Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - David J Moore
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | | | | | | | - Sheldon R Morris
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
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10
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Storholm ED, Siconolfi DE, Wagner GJ, Huang W, Nacht CL, Sallabank G, Felner JK, Wolf J, Lee SD, Stephenson R. Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study. JMIR Res Protoc 2022; 11:e41453. [PMID: 36378519 PMCID: PMC9709678 DOI: 10.2196/41453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. OBJECTIVE This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. METHODS This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. RESULTS Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. CONCLUSIONS This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41453.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, United States
- RAND Corporation, Santa Monica, CA, United States
| | | | | | | | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Greg Sallabank
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
| | - Jennifer K Felner
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Joshua Wolf
- RAND Corporation, Santa Monica, CA, United States
| | - Sarita D Lee
- RAND Corporation, Santa Monica, CA, United States
| | - Rob Stephenson
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
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11
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D'Avanzo PA, LoSchiavo CE, Krause KD, Karr A, Halkitis PN. Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study. AIDS Patient Care STDS 2022; 36:416-424. [PMID: 36367994 PMCID: PMC9700354 DOI: 10.1089/apc.2022.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.
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Affiliation(s)
- Paul A. D'Avanzo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Caleb E. LoSchiavo
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
| | - Anita Karr
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
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12
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Azucar D, Hidalgo MA, Wright D, Slay L, Kipke MD. Development of an HIV Prevention Intervention for African American Young Men Who Have Sex With Men (Y2Prevent): Study Protocol. JMIR Res Protoc 2022; 11:e36718. [PMID: 36173675 PMCID: PMC9562086 DOI: 10.2196/36718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/01/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND African American young men who have sex with men (YMSM) possess many intersecting identities that may increase their vulnerability to social stigmatization and discrimination, which yields a negative influence on their well-being and behaviors. These experiences often manifest as increased general and sexual risk-taking behaviors that place this particular group at an increased risk for HIV. This scenario is exacerbated by the lack of HIV prevention interventions specifically designed for African American YMSM. OBJECTIVE In this paper, we discuss the development of research designed to refine, pilot, and evaluate the feasibility, acceptability, and preliminary efficacy of a behavioral intervention designed to build resilience and reduce substance use and HIV risk behaviors among African American YMSM. The overarching aim of this research, funded by the National Institutes of Health, is to further refine and pilot test an intervention called Young Men's Adult Identity Monitoring (YM-AIM). YM-AIM is a theory-driven, group-level intervention designed to help African American YMSM develop a healthy vision for their future (or possible future self) by defining a set of short-term and long-term goals in the areas of education, health, family, and intimate relationships. METHODS Through partnerships with community members and community-based organizations, we will further strengthen and refine YM-AIM to include 3 new components: biomedical HIV prevention strategies (pre-exposure prophylaxis and postexposure prophylaxis); HIV and sexually transmitted infection (STI) testing and HIV care referral, drug screening, and drug treatment referral; and a youth mentoring component. We will recruit African American YMSM, aged 18 to 24 years, into 2 working groups; each group will consist of 6 to 8 members and will convene on a weekly basis, and each meeting will focus on one specific YM-AIM topic. This feedback will be used to further refine the intervention, which will then be evaluated for its feasibility and acceptability. Intervention outcomes include drug use in the past 30 days and 3 months, alcohol use, condomless sex, number of sex partners, and increasing condom use intention, condom use self-efficacy, HIV and STI testing recency and frequency, and linkage to care. RESULTS As of June 2022, we completed phase 1 of Y2Prevent and launched phase 2 of Y2Prevent to begin recruitment for working group participants. Phase 3 of Y2Prevent is anticipated to be launched in September and is expected to be completed by the end of this project period in December 2022. CONCLUSIONS Few youth-focused interventions have sought to help youth identify and develop the skills needed to navigate the social and structural factors that contribute to individual-level engagement in prevention among sexual minority youth. This research seeks to promote young men's adoption and maintenance of HIV-protective behaviors (eg, safer sex, pre-exposure prophylaxis use, HIV and STI testing, and health care use). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36718.
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Affiliation(s)
- Danny Azucar
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Marco A Hidalgo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Medicine-Pediatrics Section, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Deja Wright
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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13
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LoSchiavo C, D’Avanzo PA, Emmert C, Krause KD, Ompad DC, Kapadia F, Halkitis PN. Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015-2020. Am J Mens Health 2022; 16:15579883221119084. [PMID: 36005272 PMCID: PMC9421230 DOI: 10.1177/15579883221119084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.
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Affiliation(s)
- Caleb LoSchiavo
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
- Department of Health Behavior, Society
& Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Paul A. D’Avanzo
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
- The HIV Center for Clinical and
Behavioral Studies, New York State Psychiatric Institute, Columbia University, New
York, NY, USA
| | - Connor Emmert
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
- Department of Urban-Global Public
Health, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Danielle C. Ompad
- Department of Epidemiology, School of
Global Public Health, New York University, New York City, USA
- Center for Drug Use and HIV/HCV
Research (CDUHR), School of Global Public Health, New York University, New York
City, USA
| | - Farzana Kapadia
- Department of Epidemiology, School of
Global Public Health, New York University, New York City, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior
& Prevention Studies (CHIBPS), Rutgers School of Public Health, Piscataway, NJ,
USA
- Department of Urban-Global Public
Health, Rutgers School of Public Health, Piscataway, NJ, USA
- Department of Biostatistics and
Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
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14
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Discrimination is associated with C-reactive protein among young sexual minority men. J Behav Med 2022; 45:649-657. [PMID: 35394239 DOI: 10.1007/s10865-022-00307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022]
Abstract
This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.
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15
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Jaiswal J, LoSchiavo C, Meanley S, Hascher K, Cox AB, Dunlap KB, Singer SN, Halkitis PN. Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health. AIDS Behav 2021; 25:3057-3073. [PMID: 33830327 PMCID: PMC8419019 DOI: 10.1007/s10461-021-03254-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.
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Affiliation(s)
- J Jaiswal
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA.
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
| | - C LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - S Meanley
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - K Hascher
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - A B Cox
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - K B Dunlap
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - S N Singer
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA
| | - P N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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16
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Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2825-2841. [PMID: 33483851 PMCID: PMC8295412 DOI: 10.1007/s10508-020-01850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 05/10/2023]
Abstract
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Anthony J Maiolatesi
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
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17
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Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: The P18 Cohort Study. Addict Behav 2021; 117:106831. [PMID: 33588290 DOI: 10.1016/j.addbeh.2021.106831] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Knowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood. METHODS A prospective cohort study was conducted in two waves: 2009-2014 (Wave I) and 2014-2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18-19 years were recruited for Wave I. A total of 665 SMM ages 22-23 years were recruited for Wave II, of which 41.2% (n = 274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit. RESULTS A total of 5.4% of participants of between the ages of 18-27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F = 4.34, p = 0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I. CONCLUSION We have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM.
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18
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Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
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Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- 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
| | - Leigh A Bukowski
- 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
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D 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
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Halkitis PN, LoSchiavo C, Martino RJ, De La Cruz BM, Stults CB, Krause KD. Age of Sexual Debut among Young Gay-identified Sexual Minority Men: The P18 Cohort Study. JOURNAL OF SEX RESEARCH 2021; 58:573-580. [PMID: 32609010 PMCID: PMC7775328 DOI: 10.1080/00224499.2020.1783505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Age of sexual debut is a critical health indicator for young sexual minority men (YSMM), associated with an increased likelihood of HIV acquisition, use of alcohol, tobacco, and other substances, and psychological distress. This study examined the age of same-sex sexual debut for five sexual behaviors in a sample of racially/ethnically and socioeconomically diverse gay-identified YSMM in New York City. The mean age of sexual debut of any behavior was 14.5 years old and 19% of the sample reported sexual debut prior to age 13. Overall, mutual masturbation occurred at the youngest mean age, followed by performed oral, received oral, receptive anal, and insertive anal intercourse. There were significant differences by race/ethnicity and perceived familial socioeconomic status (SES), such that Black and Hispanic/Latino men had earlier ages of debut for performed oral and receptive and insertive anal sex, while upper SES men had later ages of debut for receptive and insertive anal intercourse. These findings are relevant to trends in HIV incidence in the U.S., which are highest among Black and Hispanic/Latino YSMM and may be associated with earlier age of sexual debut. These findings also underscore a need for comprehensive and inclusive sex education at younger ages.
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Affiliation(s)
- Perry N. Halkitis
- School of Public Health, Rutgers University, 683 Hoes Ln. West, Piscataway, NJ 08854
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
| | - Caleb LoSchiavo
- School of Public Health, Rutgers University, 683 Hoes Ln. West, Piscataway, NJ 08854
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
| | - Richard J. Martino
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
| | - Blas Martin De La Cruz
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
- School of Social Work, Rutgers University, 120 Albany St., Tower One - Suite 200, New Brunswick, NJ 08901
| | - Christopher B. Stults
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
- Baruch College, City University of New York, 55 Lexington Ave., New York, NY 10010
| | - Kristen D. Krause
- School of Public Health, Rutgers University, 683 Hoes Ln. West, Piscataway, NJ 08854
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, 1 Riverfront Plaza, Suite 1020, Newark, NJ 07102
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20
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Meiksin R, Melendez-Torres GJ, Falconer J, Witzel TC, Weatherburn P, Bonell C. eHealth Interventions to Address Sexual Health, Substance Use, and Mental Health Among Men Who Have Sex With Men: Systematic Review and Synthesis of Process Evaluations. J Med Internet Res 2021; 23:e22477. [PMID: 33890855 PMCID: PMC8105760 DOI: 10.2196/22477] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/05/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Men who have sex with men (MSM) face disproportionate risks concerning HIV and other sexually transmitted infections, substance use, and mental health. These outcomes constitute an interacting syndemic among MSM; interventions addressing all 3 together could have multiplicative effects. eHealth interventions can be accessed privately, and evidence from general populations suggests these can effectively address all 3 health outcomes. However, it is unclear how useable, accessible, or acceptable eHealth interventions are for MSM and what factors affect this. Objective We undertook a systematic review of eHealth interventions addressing sexual risk, substance use, and common mental illnesses among MSM and synthesized evidence from process evaluations. Methods We searched 19 databases, 3 trials registers, OpenGrey, and Google, and supplemented this by reference checks and requests to experts. Eligible reports were those that discussed eHealth interventions offering ongoing support to MSM aiming to prevent sexual risk, substance use, anxiety or depression; and assessed how intervention delivery or receipt varied with characteristics of interventions, providers, participants, or context. Reviewers screened citations on titles, abstracts, and then full text. Reviewers assessed quality of eligible studies, and extracted data on intervention, study characteristics, and process evaluation findings. The analysis used thematic synthesis. Results A total of 12 reports, addressing 10 studies of 8 interventions, were eligible for process synthesis. Most addressed sexual risk alone or with other outcomes. Studies were assessed as medium and high reliability (reflecting the trustworthiness of overall findings) but tended to lack depth and breadth in terms of the process issues explored. Intervention acceptability was enhanced by ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM’s experiences, and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race or ethnicity and educational level; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics. Conclusions Findings suggest that eHealth interventions targeting sexual risk, substance use, and mental health are acceptable for MSM across sociodemographic groups. We identified the factors shaping MSM’s receipt of such interventions, highlighting the importance of tailored content reflecting MSM’s experiences and of language affirming sexual-minority identities. Intervention developers can draw on these findings to increase the usability and acceptability of integrated eHealth interventions to address the syndemic of sexual risk, substance use, and mental ill health among MSM. Evaluators of these interventions can draw on our findings to plan evaluations that explore the factors shaping usability and acceptability.
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Affiliation(s)
- Rebecca Meiksin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jane Falconer
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - T Charles Witzel
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Bonell
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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21
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Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study. J Community Health 2021; 45:702-711. [PMID: 32016677 DOI: 10.1007/s10900-019-00784-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.
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22
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Drückler S, Speulman J, van Rooijen M, De Vries HJC. Sexual consent and chemsex: a quantitative study on sexualised drug use and non-consensual sex among men who have sex with men in Amsterdam, the Netherlands. Sex Transm Infect 2021; 97:268-275. [PMID: 33833086 PMCID: PMC8165144 DOI: 10.1136/sextrans-2020-054840] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Chemsex (drug use to enhance sex) has emerged among men who have sex with men (MSM). Non-consensual sex (NCS) is hypothesised to occur frequently under the influence of chemsex, however data are scarce. In this cross-sectional study, it was aimed to assess whether NCS is associated with chemsex. Methods We offered a survey about chemsex in the past 6 months (crystal methamphetamine, mephedrone and/or gamma-hydroxybutyrate/gamma-butyrolacton use) and NCS (sexual experiences beyond one’s limits or unpleasant sexual experiences) in the past 5 years to Amsterdam-located gay dating platform users. Associations were assessed using χ² test, Fisher’s exact test and multivariable logistic regression. Results Of 891 participants, 30.6% (273 of 891) engaged in chemsex; 21.2% engaging and 16.7% not engaging in chemsex reported any NCS experiences (p=0.109). Among MSM who reported any NCS experiences, chemsex engagers reported being touched against one’s will less often compared with non-engagers (22.4% vs 39.8%; p=0.036). Yet, chemsex engagers reported passing out and not remembering what happened during drug use more often (41.4% vs 8.7%; p<0.001). The level of suffering from NCS experiences did not differ between chemsex engagers and non-engagers (p=0.539); and was rated by most participants with no suffering at all or low suffering (77.1%). In the multivariable regression analyses, chemsex engagement in the past 6 months was associated with NCS (adjusted OR 1.46; 95% CI 1.01 to 2.11). Conclusions A substantial proportion of MSM (regardless of chemsex engagement) reported NCS in the past 5 years. In multivariate logistic regression analysis, chemsex engagement was associated with an NCS experience. Among participants who reported NCS, suffering related to NCS however, did not differ between chemsex engagers and non-engagers. Sexual healthcare professionals need to address chemsex and NCS during consultations involving MSM and refer men for specialised help if deemed necessary.
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Affiliation(s)
- Susanne Drückler
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Jilke Speulman
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Martijn van Rooijen
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Henry J C De Vries
- Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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23
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Walters SM, Braksmajer A, Coston B, Yoon I, Grov C, Downing MJ, Teran R, Hirshfield S. A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1965-1978. [PMID: 31965453 PMCID: PMC7321855 DOI: 10.1007/s10508-020-01628-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 05/18/2023]
Abstract
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, 380 2nd Ave., Suite 306, NY 10010, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | | | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Irene Yoon
- Research and Advisory, Gartner L2, New York, NY, USA
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy and the CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | | | - Richard Teran
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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24
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Shiau S, Krause KD, Valera P, Swaminathan S, Halkitis PN. The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective. AIDS Behav 2020; 24:2244-2249. [PMID: 32303925 PMCID: PMC7165075 DOI: 10.1007/s10461-020-02871-9] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID-19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Kristen D Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, Newark, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Rutgers School of Public Health, Newark, NJ, USA
| | - Pamela Valera
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, NJ, USA
| | - Shobha Swaminathan
- Department of Medicine, Infectious Diseases Practice, New Jersey Medical School, Newark, NJ, USA
- Infectious Diseases Practice, University Hospital, Newark, NJ, USA
| | - Perry N Halkitis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, Newark, NJ, USA
- Department of Urban-Global Health, Rutgers School of Public Health, Newark, NJ, USA
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25
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The Impact of Emotional Symptoms and Family Support on the Association Between Homophobic Bullying and Sedative/Hypnotic Use among Gay and Bisexual Men in Taiwan: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113870. [PMID: 32485987 PMCID: PMC7311954 DOI: 10.3390/ijerph17113870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Sedative/hypnotic use and homophobic bullying have become a big mental health concern for gay and bisexual men. However, few studies have investigated the mediators and moderators of the association between them. The current study aimed to build a conceptual model to estimate the mediating effect of emotional symptoms and the moderating effect of family support on this association among gay and bisexual men in Taiwan. A total of 500 gay or bisexual men were recruited for the study. Their history of homophobic bullying, their experience of sedative/hypnotic use, their perceived family support, and their current emotional symptoms were evaluated using self-reporting questionnaires. A moderated mediation model was developed to test the mediating effect of emotional symptoms and the moderating effect of family support. A higher level of homophobic bullying was significantly associated with sedative/hypnotic use among gay and bisexual men and this was mediated by a higher severity of emotional symptoms. A moderating effect of family support was identified, wherein the mediating effect of emotional symptoms was weaker when there was a higher level of perceived family support, thus revealing the protective effect of family support. The significant impact of emotional symptoms and family support on the association between homophobic bullying and sedative/hypnotic use was identified. Timely interventions for emotional symptoms and the enhancement of family support are crucial for gay and bisexual men.
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26
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LoSchiavo C, Krause KD, Singer SN, Halkitis PN. The Confluence of Housing Instability and Psychosocial, Mental, and Physical Health in Sexual Minority Young Adults: The P18 Cohort Study. J Health Care Poor Underserved 2020; 31:1693-1711. [PMID: 33416747 PMCID: PMC7794398 DOI: 10.1353/hpu.2020.0127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sexual and gender minority (SGM) youth experience housing instability, including homelessness, at higher rates than heterosexuals. Few studies have examined differences within SGM populations and intersections of housing and health. Data were drawn from a study of SGM young adults who were assigned male at birth. Nearly one-quarter of the sample reported homelessness, unstable housing, or both in the six months prior to assessment. Housing instability was higher among those of lower income and educational attainment. Additionally, those who experienced any housing instability reported higher levels of depression, poorer self-rated health, and greater gay-related stigma; in multivariable models, only self-rated health was related to housing status. Stigma and discrimination may lead to poorer mental health; housing instability and homelessness may be a manifestation of stigma perpetuated by social conditions and mental health burdens directed by familial rejection. Findings indicate the importance of a biopsychosocial perspective in addressing housing instability in SGM youth.
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27
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Alio AP, Sibley C, Ouedraogo HS, Wallace SE, Wakefield S, Humes DL, Fields SD, Keefer MC. House Ball Community Leaders' Perceptions of HIV and HIV Vaccine Research. Int J MCH AIDS 2020; 9:136-145. [PMID: 32123636 PMCID: PMC7031880 DOI: 10.21106/ijma.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND OR OBJECTIVES Worldwide, men who have sex with men (MSM) and Transgender persons are vulnerable to psychosocial factors associated with high risk for HIV, and suffer disproportionately high rates of HIV/AIDS. In the United States (US), the House Ball Community (HBC) is a social network comprised predominantly of Black and Hispanic MSM and Transgender persons who reside in communal settings. This study explores Western New York HBC leaders' perceptions of HIV in their communities and their knowledge of HIV prevention strategies, including HIV vaccine trials. METHODS The project was conducted using an exploratory approach based on the principles of Community-Based Participatory Research (CBPR) methods. An HIV behavioral risk assessment provided descriptive data, while qualitative measures explored psychosocial and behavioral factors. RESULTS Behavioral assessments indicated high levels of risky sexual behaviors and experiences of violence. Interviews with 14 HBC leaders revealed that knowledge of HIV and local HIV vaccines trials was limited. Barriers to HIV knowledge included fear of peer judgment, having inaccurate information, and lack of formal education. Experiencing violence was identified as barrier to positive health behavior. Nevertheless, the HBC was described as a safe and creative space for marginalized MSM and Transgender youth. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Findings suggest that the interrelation between health problems and social context amplify HIV risk in the HBC. The organizational structure and resources of the HBC, and MSM/Transgender communities worldwide can be instrumental in informing interventions to address HIV-related risk behaviors and create appropriate recruitment tools to ensure their representation in HIV research.
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Affiliation(s)
- Amina P Alio
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences, Division of Social and Behavioral Sciences, 265 Crittenden Blvd, Rochester NY, 14642, USA
| | - Candace Sibley
- ICF International, 3 Corporate Blvd NE #370, Atlanta, GA 30329, USA
| | - Halimah S Ouedraogo
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences, Division of Social and Behavioral Sciences, 265 Crittenden Blvd, Rochester NY, 14642, USA
| | - Stephaun E Wallace
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Steven Wakefield
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Damon L Humes
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Sheldon D Fields
- New York Institute of Technology, School of Health Professions, Riland Academic Health Center, Room 347, Old Westbury, NY, 11568, USA
| | - Michael C Keefer
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences, Division of Social and Behavioral Sciences, 265 Crittenden Blvd, Rochester NY, 14642, USA
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28
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Jiang H, Li J, Tan Z, Chen X, Cheng W, Gong X, Yang Y. Syndemic Factors and HIV Risk Among Men Who Have Sex with Men in Guangzhou, China: Evidence from Synergy and Moderated Analyses. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:311-320. [PMID: 31617111 DOI: 10.1007/s10508-019-01488-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/24/2019] [Accepted: 06/06/2019] [Indexed: 06/10/2023]
Abstract
Syndemic factors tend to co-occur and increase the risks of condomless anal intercourse (CAI), multiple sexual partners (MSP) and HIV vulnerability among men who have sex with men (MSM). This study aimed to test the synergistic effects of syndemic factors on HIV risk and to further explore the moderators between syndemics and HIV risk among Chinese MSM. A cross-sectional study was conducted to recruit MSM in Guangzhou to collect data on syndemic factors (depression, intimate partner violence, childhood sexual abuse [CSA], alcohol, and rush popper use before anal sex). The relative excess risk due to interactions (RERIs) was calculated to test the synergy in adjusted regression models. A moderated analysis was conducted to test the buffer effects of potential resilience factors (education and income). Among the 976 included MSM, individuals experiencing more syndemic factors were more likely to have CAI (odds ratio [OR]= 1.26, 95% confidence interval [CI] 1.11-1.44), MSP (OR= 1.33, 95% CI 1.16-1.52), and HIV infection (OR= 1.46, 95% CI 1.12-1.90). RERIs showed a synergy of depression and rush popper use prior to sex for MSP (1.17, 95% CI 0.03-2.03) and CSA and rush popper use prior to sex for HIV infection (1.72, 95% CI 0.05-3.43). However, no significant association was found for the interaction between the number of syndemic factors and education or income. Our findings support the synergy approach in syndemic studies and highlight the need for comprehensive and multifactorial intervention strategies on sexual health of MSM. Future studies are needed to identify potential resilience factors among Chinese MSM.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Xiaobin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Xiao Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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29
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Vasilenko SA, Espinosa-Hernández G, Rice CE, Biello KB, Novak DS, Mayer KH, Mimiaga MJ, Rosenberger JG. Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico. JOURNAL OF SEX RESEARCH 2019; 56:1168-1178. [PMID: 30638395 PMCID: PMC6626694 DOI: 10.1080/00224499.2018.1563667] [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: 06/09/2023]
Abstract
Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals' specific patterns of sexual behavior.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University
| | | | - Cara E Rice
- The Methodology Center, Pennsylvania State University
| | - Katie B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University, and The Fenway Institute
| | | | - Kenneth H Mayer
- The Fenway Institute and Department of Global Health and Population, Harvard University
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University and The Fenway Institute
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30
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Perry NS, Nelson KM, Carey MP. Diversity of Psychosocial Syndemic Indicators and Associations with Sexual Behavior with Male and Female Partners Among Early Adolescent Sexual Minority Males. LGBT Health 2019; 6:386-392. [PMID: 31657657 DOI: 10.1089/lgbt.2019.0113] [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: 01/04/2023] Open
Abstract
Purpose: Psychosocial syndemic indicators (e.g., internalizing symptoms, alcohol/substance use, and violence exposure) have been associated with increased risk for HIV among older adolescent sexual minority males and adult sexual minority men. No studies have examined these concerns among early adolescents (<16 years old). The purpose of this study was to examine syndemic indicators among early adolescent sexual minority males and their associations with sexual behavior. Methods: Sexual minority males (N = 207; ages 14-17; drawn from 40 U.S. states) completed a cross-sectional online survey. Descriptive statistics were used to document profiles of syndemic indicators. Firth logistic regressions tested the associations between count of syndemic indicators and sexual behavior with male and female partners. Results: Psychosocial syndemic indicators were highly prevalent and co-occurring, with diverse psychosocial profiles. After controlling for age, race, and ethnicity, having more syndemic indicators was significantly positively associated with condomless anal sex with male partners (adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] 1.02-1.84) and vaginal and/or anal sex with females (AOR = 1.75, 95% CI 1.25-2.47). Conclusions: This study documents the psychosocial profiles of syndemic indicators with a sample of early adolescent sexual minority males and the association of syndemic indicators with sexual behavior. Among early adolescent sexual minority males, psychosocial concerns were prevalent, similar to rates seen among adult sexual minority males, and conferred vulnerability to HIV transmission. Behavioral and psychosocial interventions must reach sexual minority males in early adolescence to address mental health and substance use concerns and to help reduce the risk of HIV acquisition.
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Affiliation(s)
- Nicholas S Perry
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Kimberly M Nelson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Michael P Carey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
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Validating the Syndemic Threat Surrounding Sexual Minority Men's Health in a Population-Based Study With National Registry Linkage and a Heterosexual Comparison. J Acquir Immune Defic Syndr 2019; 78:376-382. [PMID: 29940602 DOI: 10.1097/qai.0000000000001697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared with heterosexual, men. SETTING AND METHODS The sample comprised adult men in the Stockholm Public Health Cohort. A total of 29,328 (91.9%) self-identified as heterosexual, 535 (1.7%) as gay, and 396 (1.2%) as bisexual. We linked survey responses to national health registry data. RESULTS Gay men had vastly elevated risk of HIV infection (>150 times) compared with heterosexuals. Gay men also had an elevated risk of depression, suicidality, and violent assaults compared with heterosexuals. Bisexual men had 16 times higher risk of being HIV-positive than heterosexual men. The number of psychosocial syndemic conditions was significantly associated with HIV infection among gay men (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [95% CI]: 1.18 to 2.36), but not among bisexual and heterosexual men (AOR = 0.51; 95% CI: 0.07 to 3.59; AOR = 1.92; 95% CI: 0.96 to 3.84). Among gay men, the association between co-occurring syndemic conditions and odds of HIV infection was synergistic (ie, more than additive). CONCLUSIONS This study confirms emerging evidence of the syndemic health threats affecting sexual minority men, finds stronger evidence for syndemics among gay compared with bisexual men, and suggests the need for HIV-prevention interventions that comprehensively address the co-occurring, and synergistically perpetuating, disparities affecting this population.
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Pachankis JE, McConocha EM, Reynolds JS, Winston R, Adeyinka O, Harkness A, Burton CL, Behari K, Sullivan TJ, Eldahan AI, Esserman DA, Hatzenbuehler ML, Safren SA. Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men's mental and sexual health. BMC Public Health 2019; 19:1086. [PMID: 31399071 PMCID: PMC6688287 DOI: 10.1186/s12889-019-7346-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men's health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. METHODS This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. DISCUSSION Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. TRIAL REGISTRATION Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069 .
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Affiliation(s)
- John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Erin M. McConocha
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Jesse S. Reynolds
- Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Roxanne Winston
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Oluwaseyi Adeyinka
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, USA
| | - Charles L. Burton
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Kriti Behari
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Timothy J. Sullivan
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Adam I. Eldahan
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Mark L. Hatzenbuehler
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, USA
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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Eklund AC, Dillon FR, Ebersole RC. Individual and structural factors predicting HIV testing among Latinx MSM: substance use as a moderator. AIDS Care 2019; 32:193-201. [PMID: 31104481 DOI: 10.1080/09540121.2019.1619664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The rate of HIV infection for Latinx men who have sex with men (LMSM) increased by 20% from 2008 to 2014 even as rates stabilized among MSM of other racial and ethnic backgrounds. We hypothesize that this disparity is partially attributable to individual and structural factors associated with HIV testing, including substance use practices, among LMSM. In this retrospective study, we examined data from 502 LMSM to determine whether (a) hypothesized relationships exist between individual factors (perceived HIV susceptibility, experiences with HIV prevention, condom use, sex under the influence, sexual identity development status, heterosexual self-presentation, and traditional Latinx gender norms) and structural factors (access to healthcare resources and social support) and HIV testing for LMSM. We also tested whether (b) substance use practices moderate relations between individual and structural factors and HIV testing. Findings indicate that (a) relationships exist between several individual and structural factors and HIV testing and that (b) substance use moderated these relationships to HIV testing in a number of hypothesized ways. Practice and prevention implications are discussed.
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Affiliation(s)
- Austin C Eklund
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | | | - Ryan C Ebersole
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
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Batchelder AW, Choi K, Dale SK, Pierre-Louis C, Sweek EW, Ironson G, Safren SA, O'Cleirigh C. Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men. Health Psychol 2019; 38:509-517. [PMID: 30973745 DOI: 10.1037/hea0000724] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Syndemic theory posits that co-occurring problems (e.g., substance use, depression, and trauma) synergistically increase HIV risk in men who have sex with men (MSM). However, most investigations have assessed these problems additively using self-report. METHOD In a sample of HIV-negative MSM with trauma histories (n = 290), we test bivariate relationships between four clinical diagnoses (substance use disorder [SUD]); major depressive disorder [MDD], posttraumatic stress disorder [PTSD], and anxiety disorders) and their additive and interactive effects on three health indicators (i.e., high-risk sex, visiting the emergency room [ER], and sexually transmitted infections [STIs]). RESULTS We found significant bivariate relationships between SUD and MDD (χ² = 4.85, p = .028) and between PTSD and MDD (χ² = 35.38, p = .028, p < .001) but did not find a significant relationship between SUD and PTSD (χ² = 3.64, p = .056). Number of diagnoses were associated with episodes of high-risk sex (incidence rate ratio [IRR] = 1.14, 95% CI [1.03, 1.26], p = .009) and visiting the ER (odds ratio = 1.27; 95% CI [1.01, 1.60], p = .040) but not with STIs. No interactions were found between diagnoses and health-related indicators. CONCLUSIONS This is the first study to demonstrate additive effects of clinical diagnoses on risk behavior and health care utilization among MSM with developmental trauma histories. Results indicate the need to prioritize empirically supported treatments for SUD and MDD, in addition to trauma treatment, for this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Halkitis PN, Valera P, LoSchiavo CE, Goldstone SE, Kanztanou M, Maiolatesi AJ, Ompad DC, Greene RE, Kapadia F. Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort Study. AIDS Patient Care STDS 2019; 33:149-156. [PMID: 30932696 PMCID: PMC6459271 DOI: 10.1089/apc.2018.0276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
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Affiliation(s)
- Perry N. Halkitis
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, RWJ School of Medicine, Rutgers University, Newark, New Jersey
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
- School of Public Affairs and Administration, Rutgers University, Newark, New Jersey
| | - Pamela Valera
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Caleb E. LoSchiavo
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Stephen E. Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Kanztanou
- Department of Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anthony J. Maiolatesi
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Danielle C. Ompad
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
| | - Richard E. Greene
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, Langone School of Medicine, New York University, New York, New York
| | - Farzana Kapadia
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
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Chou FY, Armstrong HL, Wang L, Bacani N, Lachowsky NJ, Patterson TL, Walsh Z, Olarewaju G, Card KG, Roth EA, Hogg RS, Moore DM. A longitudinal analysis of cannabis use and mental health symptoms among gay, bisexual, and other men who have sex with men in Vancouver, Canada. J Affect Disord 2019; 247:125-133. [PMID: 30665075 PMCID: PMC6588188 DOI: 10.1016/j.jad.2019.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cannabis use, anxiety, and depression are common among gay, bisexual, and other men who have sex with men (gbMSM) and some report using cannabis to manage mental health symptoms. METHODS Sexually-active gbMSM aged ≥16 years were recruited into a longitudinal cohort through respondent-driven sampling and completed study visits every six months. Data on demographics, drug use, and anxiety and depression symptoms were collected via a self-administered computer-based survey. A study nurse determined previous mental health diagnoses and treatment. Using multivariable generalized linear mixed models, we examined factors associated with regular cannabis use (≥weekly in the previous 3 months) and, among individuals who reported anxiety or depression/bipolar diagnoses, factors associated with moderate/severe anxiety or depression symptoms. RESULTS Of 774 participants (551 HIV-negative, 223 HIV-seropositive), 250 (32.3%) reported regular cannabis use, 200 (26.4%) reported ever being diagnosed with anxiety, and 299 (39.3%) reported ever being diagnosed with depression or bipolar disorder at baseline. Regular cannabis use was positively associated with HIV-seropositivity (aOR = 2.23, 95%CI:1.40-3.54) and previous mental health diagnosis (aOR = 1.52, 95%CI: 1.00-2.31, p = 0.05). Among those previously diagnosed with anxiety or depression/bipolar disorder, regular cannabis use was not associated with moderate/severe anxiety (aOR = 1.16, 95%CI:0.69-1.94) or depression symptoms (aOR = 0.96, 95%CI:0.59-1.58), respectively. LIMITATIONS Because of observational study design, we are unable to determine absolute effect. CONCLUSIONS Regular cannabis use was more likely among HIV-positive gbMSM and those previously diagnosed with a mental health disorder. No association was found between regular cannabis use and severity of anxious or depressive symptoms among those diagnosed with these conditions.
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Affiliation(s)
- Frank Y Chou
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Queen's University, Kingston, Ontario, Canada
| | - Heather L Armstrong
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Nicanor Bacani
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of Victoria, Victoria, BC, Canada
| | | | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Gbolahan Olarewaju
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of Victoria, Victoria, BC, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Parent MC, Arriaga AS, Gobble T, Wille L. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress 2019; 10:100146. [PMID: 30937352 PMCID: PMC6430403 DOI: 10.1016/j.ynstr.2018.100146] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/23/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.
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Affiliation(s)
- Mike C. Parent
- University of Texas at Austin, Department of Educational Psychology, Sanchez 262H, Austin, TX, 78749, USA
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An Application of Syndemic Theory to Identify Drivers of the Syphilis Epidemic Among Gay, Bisexual, and Other Men Who Have Sex With Men. Sex Transm Dis 2019; 45:163-168. [PMID: 29420444 DOI: 10.1097/olq.0000000000000713] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We applied syndemic theory to explore the degree to which syndemic conditions explain the syphilis epidemic affecting Canadian gay and bisexual men who have sex with men (GBMSM). METHODS Data from a national survey comprising 7872 GBMSM were analyzed using multivariable logistic regression to measure associations between recent syphilis diagnosis (RSD; in previous 12 months) and the following variables: (1) sociodemographic information (sexuality, HIV status, age, income, ethnicity, relationship status), (2) antigay stigma (bullying, physical violence, sexual violence, career discrimination, health care discrimination), (3) syndemic conditions (suicidality, intimate partner violence, depression, illicit substance use, binge drinking), (4) sexual behaviors, (5) health care discrimination, and (6) the cumulative count of antigay experiences and syndemic conditions. RESULTS Three percent (n = 235) of GBMSM surveyed reported an RSD. Men were more likely to report an RSD if they were HIV positive (adjusted odds ratio [AOR], 6.27; 95% confidence interval [CI], 4.66-8.43). Recent syphilis diagnosis was also positively associated with career discrimination, health care discrimination, substance use, and intimate partner violence. Furthermore, prevalence of RSD increased with each additional form of stigma or syndemic condition. The odds of reporting RSD was 5.2 (95% CI, 1.0-25.9) times higher for men who reported experiencing all 4 forms of antigay stigma compared with those who reported no stigma, after adjusting for sociodemographics. Similarly, the adjusted odds of reporting RSD was 12.2 (95% CI, 2.0%-74.8%) times higher for GBMSM experiencing 5 syndemic conditions compared with those reporting no syndemic conditions. CONCLUSIONS Evidence from this large cross-sectional study suggests that the Canadian syphilis epidemic among GBMSM is being driven by a syndemic constituted by multiple social and psychological conditions. Interventions addressing specific psychosocial health outcomes that increase the risk for syphilis should be developed and integrated within targeted sexual health services and syphilis prevention initiatives.
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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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LoSchiavo C, Halkitis PN, Kapadia F. Sexual Orientation and Gender Identity Victimization Among Young Adults in the New York City Metropolitan Area: The P18 Cohort Study. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:399-407. [PMID: 32864389 DOI: 10.1037/sgd0000336] [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: 11/08/2022]
Abstract
Sexual and gender minority populations are significantly more likely to experience verbal and physical victimization in young adulthood. These analyses examine the types, contexts, and sources of lifetime sexual orientation and gender identity victimization (SGV) in a diverse sample of sexual minority men (SMM) and transgender women as well as the extent to which experiences of SGV vary between subgroups of the population. Cross-sectional data were collected as part of a study of sexual health, mental health, and HIV examined through the lens of syndemic production in young SMM. Measures assessed sociodemographic characteristics as well as the types, sources, and contexts of physical assault and verbal harassment due to actual or perceived gender or sexuality. Verbal harassment was more prevalent in the sample than physical assault (44.5% vs. 11.6%). Schools or sports teams and neighborhoods were the most common contexts for verbal and physical SGV. Strangers were the most frequent perpetrators of SGV, followed by family and peers. Bivariate analyses showed significant differences in SGV based on race, education, perceived familial SES, sexual identity, and borough of residence. In multivariate analyses, race, SES, sexual identity, and borough of residence were significant predictors of verbal SGV. Findings suggest that SGV experiences are not uniform in sexual minority young adults, and thus prevention and care must be targeted. Understanding the multiple identities of sexual minority young adults who experience greater levels of victimization can allow for policy and interventions to best support those at risk.
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Card KG, Armstrong HL, Carter A, Cui Z, Wang C, Zhu J, Lachowsky NJ, Moore DM, Hogg RS, Roth EA. Assessing the longitudinal stability of latent classes of substance use among gay, bisexual, and other men who have sex with men. Drug Alcohol Depend 2018; 188:348-355. [PMID: 29859447 PMCID: PMC7583659 DOI: 10.1016/j.drugalcdep.2018.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Association between substance use and HIV-risk among gay and bisexual men (GBM) is well documented. However, their substance use patterns are diverse, and it is unknown whether self-reported use patterns are stable over time. METHODS Sexually-active GBM, aged >16 years, were recruited in Metro Vancouver using respondent-driven sampling and followed across 5 study visits at six-month intervals (n = 449). To identify distinct patterns of substance use and their longitudinal stability, Latent Transition Analysis (LTA) was conducted for drugs reported by at least 30 participants. Intraclass correlation coefficients (ICC) quantified the stability of class assignments. RESULTS Six classes characterizing 'limited drug use' (i.e., low use of all drugs, except alcohol), 'conventional drug use' (i.e., use of alcohol, marijuana, and tobacco), 'club drug use' (i.e., use of alcohol, cocaine, and psychedelics), 'sex drug use' (i.e., use of alcohol, crystal meth, GHB, poppers, and erectile dysfunction drugs), 'street drug use' (i.e., use of alcohol and street opioids) and 'assorted drug use' (i.e., use of most drugs) were identified. Across five visits (2.5 years), 26.3% (n = 118/449) of GBM transitioned between classes. The prevalence of limited use trended upwards (Baseline:24.5%, Visit 5:28.3%, p < 0.0001) and assorted use trended downwards (13.4%-9.6%, p = 0.001). All classes had strong longitudinal stability (ICC > 0.97). CONCLUSION The stability of latent substance use patterns highlight the utility of these measures in identifying patterns of substance use among people who use drugs - potentially allowing for better assessment of these groups and interventions related to their health.
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Affiliation(s)
- Kiffer G. Card
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,Faculty of Health Science, Simon Fraser University, 11300 Blusson Hall, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Heather L. Armstrong
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Allison Carter
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada; Faculty of Health Science, Simon Fraser University, 11300 Blusson Hall, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Zishan Cui
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Clara Wang
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Julia Zhu
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Nathan J. Lachowsky
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,School of Public Health and Social Policy, University of Victoria, B202 HSD Building, Victoria, British Columbia, V8P 5C2, Canada
| | - David M. Moore
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Robert S. Hogg
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,Faculty of Health Science, Simon Fraser University, 11300 Blusson Hall, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Eric A. Roth
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada,Department of Anthropology, University of Victoria, B228 Cornett Building, Victoria, British Columbia, V8P 5C2, Canada
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Card KG, Lachowsky NJ, Armstrong HL, Cui Z, Wang L, Sereda P, Jollimore J, Patterson TL, Corneil T, Hogg RS, Roth EA, Moore DM. The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men. Addict Behav 2018; 82:158-165. [PMID: 29533847 PMCID: PMC5894339 DOI: 10.1016/j.addbeh.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/22/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. METHODS We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months. RESULTS Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex. CONCLUSION An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex - supporting a syndemic understanding of the production of HIV risk.
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Affiliation(s)
- Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada; Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community Based Research Centre for Gay Men's Health, Vancouver, British Columbia, Canada
| | | | - Trevor Corneil
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Swartz JA, McCarty-Caplan D. A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM. AIDS Behav 2018; 22:1395-1409. [PMID: 29248970 DOI: 10.1007/s10461-017-2008-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.
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Bränström R, Pachankis JE. Sexual orientation disparities in the co-occurrence of substance use and psychological distress: a national population-based study (2008-2015). Soc Psychiatry Psychiatr Epidemiol 2018; 53:403-412. [PMID: 29450600 PMCID: PMC5862943 DOI: 10.1007/s00127-018-1491-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/24/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Although strong evidence documents the elevated prevalence of both substance use and mental health problems among sexual minorities (i.e., gay, lesbian, and bisexuals), relatively less research has examined whether risk of the co-occurrence of these factors is elevated among sexual minorities compared to heterosexuals. The object of this study was to (1) explore sexual orientation-based differences in substance use, psychological distress, and their co-occurrence in a representative sample in Sweden, and (2) examine if greater exposure to stressors, such as discrimination, victimization/threats, and social isolation, could explain these potential disparities and their co-occurrence. METHODS Data come from the cross-sectional Swedish National Public Health Survey, which collected random samples of individuals (16-84 years of age) annually from 2008 to 2015, with an overall response rate of 49.7% (n = 79,568 individuals; 1673 self-identified as lesbian, gay, or bisexual). Population-level sexual orientation differences in substance use (i.e., alcohol, tobacco, and cannabis) and psychological distress were examined. RESULTS Our findings showed significantly elevated prevalence of high-risk alcohol use, cannabis use, and daily tobacco smoking, among sexual minorities compared to heterosexuals. These substantial disparities in substance use more often co-occurred with psychological distress among sexual minorities than among heterosexuals. The elevated risk of co-occurring psychological distress and substance use was most notable among gay men relative to heterosexual men (adjusted odds ratio [AOR] = 2.65, CI 1.98, 3.55), and bisexual women relative to heterosexual women (AOR = 3.01, CI 2.43, 3.72). Multiple mediation analyses showed that experiences of discrimination, victimization, and social isolation partially explained the sexual orientation disparity in these co-occurring problems. CONCLUSIONS This study adds to a growing body of research showing that sexual minorities experience multiple threats to optimal health and points toward future interventions that address the shared sources of these overlapping health threats in stigma-related stress.
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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.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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De Boni RB, Machado IK, De Vasconcellos MTL, Hoagland B, Kallas EG, Madruga JV, Fernandes NM, Cerqueira NB, Moreira RI, Goulart SP, Veloso VG, Grinsztejn B, Luz PM. Syndemics among individuals enrolled in the PrEP Brasil Study. Drug Alcohol Depend 2018; 185:168-172. [PMID: 29454927 DOI: 10.1016/j.drugalcdep.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Concurrent psychosocial problems may synergistically increase the risk of HIV infection (syndemics), representing a challenge for prevention. We aimed to evaluate the prevalence and associated factors of syndemics among men who have sex with men (MSM) and transgender women (TGW) enrolled in the Brazilian pre-exposure prophylaxis demonstration study (PrEP Brasil Study). METHODS Secondary cross-sectional analysis of the PrEP Brasil Study was performed. Of 450 HIV-seronegative MSM/TGW enrolled in the PrEP Brasil Study- conducted at Rio de Janeiro and São Paulo, Brazil- 421 participants with complete data were included in the present analysis. Syndemics was defined as occurrence of ≥2 of the following conditions: polysubstance (≥2) use, binge drinking, positive depression screen, compulsive sexual behavior, and intimate partner violence (IPV). RESULTS The prevalence of recent polysubstance use was 22.8%, binge drinking 51.1%, positive depression screening 5.2%, compulsive sexual behavior 7.1%, and IPV 7.3%. Syndemics prevalence was 24.2%, and associated factors were younger age (adjusted Odds Ratio (aOR) 0.95, 95% Confidence Interval (95% CI) 0.92-0.98 per year increase), TGW vs. MSM (aOR 3.09, 95% CI: 1.2-8.0), some college education or more vs. less than college (aOR 2.49, 95% CI: 1.31-4.75), and multiple male sexual partners in prior 3 months (aOR 1.69, 95% CI: 0.92-3.14). CONCLUSION Given the high prevalence of syndemics, particularly of polysubstance use and binge drinking, PrEP delivery offers an opportunity to diagnose and intervene in mental and social well-being.
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Affiliation(s)
- Raquel B De Boni
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Iona K Machado
- Columbia College of Physicians and Surgeons, 630 W. 168 St., New York City, NY, USA
| | | | - Brenda Hoagland
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Esper G Kallas
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - José Valdez Madruga
- Centro de Referencia e Treinamento DST/AIDS, 81 Vila Mariana, São Paulo, Brazil
| | - Nilo M Fernandes
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Natalia B Cerqueira
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Silvia P Goulart
- Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil
| | - Valdilea G Veloso
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectology Evandro Chagas, Lapclin STD/AIDS, Avenida Brasil 4.365, Fiocruz, Rio de Janeiro, Brazil.
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Halkitis PN, Bub K, Stults CB, Bates FC, Kapadia F. Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort Study. Subst Use Misuse 2018; 53:101-113. [PMID: 28820622 PMCID: PMC6085877 DOI: 10.1080/10826084.2017.1334067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use. OBJECTIVES We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era. METHODS Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status. RESULTS Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.
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Affiliation(s)
- Perry N Halkitis
- a Department of Biostatistics, School of Public Health , Rutgers University , Piscataway Township , New Jersey , USA.,b Department of Social and Behavioral Health Sciences, School of Public Health , Rutgers University , Piscataway Township , New Jersey , USA.,c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Kristen Bub
- e College of Education , University of Illinois , Chicago , Illinois , USA
| | - Christopher B Stults
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Francesca C Bates
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA
| | - Farzana Kapadia
- c Center for Health, Identity, Behavior & Prevention Studies , College of Global Public Health, New York University , New York , New York , USA.,d Department of Population Health, School of Medicine , New York University
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Hammack PL, Frost DM, Meyer IH, Pletta DR. Gay Men's Health and Identity: Social Change and the Life Course. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:59-74. [PMID: 28585157 PMCID: PMC5903851 DOI: 10.1007/s10508-017-0990-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 05/19/2023]
Abstract
Due to significant historical change in the late 20th and early 21st century related to both health and cultural attitudes toward homosexuality, gay men of distinct birth cohorts may diverge considerably in their health and identity development. We argue that research on gay men's health has not adequately considered the significance of membership in distinct generation-cohorts, and we present a life course paradigm to address this problem. Focusing on the U.S. as an exemplar that can be adapted to other cultural contexts, we identify five generations of gay men alive today and review unique issues related to health and identity development for each. Implications for research, practice, and advocacy on gay men's health and development are discussed.
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Affiliation(s)
- Phillip L Hammack
- Department of Psychology, University of California, Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA.
| | - David M Frost
- Department of Psychology, University of Surrey, Guildford, UK
| | - Ilan H Meyer
- William Institute, School of Law, University of California, Los Angeles, Los Angeles, CA, USA
| | - David R Pletta
- Department of Psychology, University of California, Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
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Ferlatte O, Salway T, Trussler T, Oliffe JL, Gilbert M. Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1380298] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Olivier Ferlatte
- Men’s Health Research Program, University of British Columbia , Vancouver, Canada
- Community-Based Research Centre for Gay Men’s Health , Vancouver, Canada
| | - Travis Salway
- Community-Based Research Centre for Gay Men’s Health , Vancouver, Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Terry Trussler
- Community-Based Research Centre for Gay Men’s Health , Vancouver, Canada
| | - John L. Oliffe
- Men’s Health Research Program, University of British Columbia , Vancouver, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control , Vancouver, Canada
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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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