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Feelemyer J, Duncan DT, Akhidenor N, Mazumdar M, Irvine NM, Scheidell JD, Brewer RA, Turpin RE, Hucks-Ortiz C, Dyer TV, Cleland CM, Mayer KH, Khan MR. Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01909-1. [PMID: 38609695 DOI: 10.1007/s40615-024-01909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk. METHODS We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis. RESULTS Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)). CONCLUSION PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Naomi Akhidenor
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Natalia M Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Feelemyer JP, Duncan DT, Remch M, Kaufman JS, Cleland CM, Geller AB, Dyer TV, Scheidell JD, Turpin RE, Brewer RA, Hucks-Ortiz C, Mazumdar M, Mayer KH, Khan MR. Associations between police harassment and distrust in and reduced access to healthcare among Black sexual minority men: A longitudinal analysis of HPTN 061. PLoS One 2023; 18:e0290378. [PMID: 37594960 PMCID: PMC10437825 DOI: 10.1371/journal.pone.0290378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/25/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE Evaluate associations between racialized and homophobia-based police harassment (RHBPH) and healthcare distrust and utilization among Black Sexual Minority Men (BSMM). METHODS We utilized data from a longitudinal cohort study from HIV Prevention Trials Network (HPTN) 061 with baseline, six and 12 month follow-up assessments. Using multivariable analysis, we evaluated associations between RHBPH and healthcare distrust and utilization reported at the 6 and 12 month visits. RESULTS Of 1553 BSMM present at baseline, 1160 were available at six-month follow-up. In multivariable analysis, increasing frequency of RHBPH was associated with increasing levels of distrust in healthcare providers (aOR 1.31, 95% CI: 1.00, 1.74) and missing 50% or more of healthcare visits at six-month follow-up (aOR 1.93, 95% CI: 1.09, 3.43). CONCLUSIONS Recent experiences of RHBPH are associated with reduced trust in and access to healthcare among BSMM, with more frequent RHBPH associated with greater vulnerability.
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Affiliation(s)
- Jonathan P Feelemyer
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Molly Remch
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, United States of America
| | - Charles M Cleland
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Amanda B Geller
- Department of Criminology, Law and Society at the University of California, Irvine, CA, United States of America
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States of America
| | - Joy D Scheidell
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States of America
| | - Russell A Brewer
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | | | - Medha Mazumdar
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
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Parra LA, Spahr CM, Goldbach JT, Bray BC, Kipke MD, Slavich GM. Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color. J Clin Psychol 2023; 79:1130-1155. [PMID: 36459589 PMCID: PMC10010942 DOI: 10.1002/jclp.23463] [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: 01/04/2022] [Revised: 07/25/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced. PURPOSE The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons. METHOD Participants were 285 ethnic/racial minority young adults (Mage = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation. RESULTS Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic. CONCLUSION Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.
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Affiliation(s)
- Luis A. Parra
- School of Nursing, University of Michigan, Ann Arbor, MI USA
| | - Chandler M. Spahr
- Department of Psychology, University of California, Riverside, CA, USA
| | | | - Bethany C. Bray
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Michele D. Kipke
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Departments of Pediatrics and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Nouri E, Moradi Y, Moradi G. What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis. Ann Gen Psychiatry 2022; 21:38. [PMID: 36096814 PMCID: PMC9465955 DOI: 10.1186/s12991-022-00414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM). OBJECTIVES This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis. METHODS This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16. RESULTS The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate. CONCLUSION The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.
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Affiliation(s)
- Elham Nouri
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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5
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Winiker AK, Schneider KE, Dayton L, Latkin CA, Tobin KE. Associations between depressive esymptoms and identity-specific social support among Black men who have sex with men (BMSM) in Baltimore City, Maryland. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021; 27:175-195. [PMID: 37347093 PMCID: PMC10281699 DOI: 10.1080/19359705.2021.1957741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 04/18/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Introduction Depression and other adverse mental health outcomes are prevalent among Black men who have sex with men (BMSM). Social support can be protective against symptoms of depression, the effects of which may be amplified by experiences of a shared social identity. Methods We explored the associations between BMSM-specific social support and depressive symptoms among a sample of 280 BMSM. We used chi-square and t-tests to examine bivariate associations between social support, depressive symptoms, and key correlates, and logistic regression to adjust the relationship between social support and depressive symptoms. Results Most participants reported high (43.2%) or moderate (41.8%) levels of BMSM-specific social support, 38% reported depressive symptoms, and 47.6% were living with HIV. Adjusting for socioeconomic and structural vulnerabilities, health, and involvement in the gay community, high social support was associated with a marginal decrease in the odds of depressive symptoms compared to low social support. Conclusions Results indicate that BMSM-specific social support is protective against depressive symptoms even in the context of other socioeconomic and structural vulnerabilities, suggesting that strengths-based interventions focused on building community and mutual support among BMSM may be valuable tools to prevent depression and promote positive mental health outcomes for members of this population.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin E. Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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Boyd DT, Ramos SR, Quinn CR, Jones KV, Wilton L, Nelson LE. Family Support and Sociocultural Factors on Depression among Black and Latinx Sexual Minority Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6759. [PMID: 34201780 PMCID: PMC8268525 DOI: 10.3390/ijerph18136759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Family-based approaches are critical for improving health outcomes in sexual minority men (SMM) of color. Yet, it is unclear how family context, internalized homophobia, and stress influence mental health outcomes among sexual minority men of color. From a cross-sectional sample of 448 participants, aged 16-24 years, survey data were analyzed to examine rates of family social support, the perception of sexuality by family, the stressfulness of life events, internalized homophobia, and other contextual variables on depression using linear regression. Our results indicated that an 86% increase in family social support was related to a -0.14 decrease in depression (ß = -0.14, p = 0.004). In addition, SMM who were separated by family and friends because of their sexuality were statistically significant and positively associated with depression (ß = 0.09, p < 0.001). Findings from our study suggest that the influence from the microsystem is salient in modifying mental health outcomes for SMM of color.
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Affiliation(s)
- Donte T. Boyd
- College of Social Work, Ohio State University, Columbus, OH 43210, USA;
- Center for Interdisciplinary Research on AIDS, New Haven, CT 06510, USA;
| | - S. Raquel Ramos
- Department, Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
| | - Camille R. Quinn
- College of Social Work, Ohio State University, Columbus, OH 43210, USA;
| | - Kristian V. Jones
- School of Social Work, University of Texas at Austin, Austin, TX 78712, USA;
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY 13902, USA;
- Faculty of Humanities, University of Johannesburg, Johannesburg 2006, South Africa
| | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, New Haven, CT 06510, USA;
- School of Nursing, Yale University, New Haven, CT 06477, USA
- St. Michael’s Hospital, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, ON M5B 1W8, Canada
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Turpin R, Dyer T, Watson L, Mayer K. Classes of Sexual Identity, Homophobia, and Sexual Risk among Black Sexual Minorities in HPTN 061. JOURNAL OF SEX RESEARCH 2021; 58:638-647. [PMID: 33630695 PMCID: PMC8154646 DOI: 10.1080/00224499.2021.1886228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Homophobia is associated with sexual risk among sexual minorities, including Black sexual minority men, though experienced homophobia may differ across sexual identities. We conducted latent class analysis of sexual identities and experienced homophobia associated with sexual risk, and tested mediators of this association. We used longitudinal data from the HIV Prevention Trials Network Study 061 (n = 1,553). We generated rate ratios between baseline latent classes of experienced homophobia and sexual identity and 12-month outcomes: Condomless receptive anal intercourse (CRAI), number of partners, and transactional sex. Mediators included 6-month internalized homophobia, depression, social support, and substance use. We selected the following 7-class model: "Bisexual, rare homophobia" (reference), "Mixed identities, mixed homophobia", "Bisexual, frequent homophobia", "Heterosexual/Same-gender loving, frequent homophobia", "Gay, frequent homophobia", " Gay/Same-gender loving, frequent homophobia," and "Gay, rare homophobia." All other classes had greater CRAI than the reference. For bisexual/mixed/heterosexual classes, approximately 20% of this association was positively mediated through our mediators (p < .05). The Heterosexual/Same-gender loving class had the largest proportion mediated through internalized homophobia. For gay-identifying classes, mediation was marginally significant (.05 < p < .10). Classes of sexual identity and experienced homophobia were associated with CRAI among Black sexual minority men, partially mediated through internalized homophobia, depression, social support, and substance use.
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Affiliation(s)
- Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Lakeshia Watson
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
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8
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Feelemyer J, Duncan DT, Dyer TV, Geller A, Scheidell JD, Young KE, Cleland CM, Turpin RE, Brewer RA, Hucks-Ortiz C, Mazumdar M, Mayer KH, Khan MR. Longitudinal Associations between Police Harassment and Experiences of Violence among Black Men Who Have Sex with Men in Six US Cities: the HPTN 061 Study. J Urban Health 2021; 98:172-182. [PMID: 33821426 PMCID: PMC8079523 DOI: 10.1007/s11524-021-00526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
Interactions with the police may result in police brutality, particularly for people of color. Black men who have sex with men (BMSM) face disproportionate risk of police contact and may experience elevated violence risk. We measured longitudinal associations between discriminatory police harassment (DPH) and subsequent risk of a range of interpersonal violence experiences, including intimate partner violence (IPV). In this study, we estimated associations between DPH motivated by racism, homophobia, or both, and subsequent violent experiences (being physically harassed, hit, threatened with weapons, and intimate partner violence) among BMSM. Bivariate and multivariable regression analyses were used to control for demographic and behavioral factors. Among 1160 BMSM included at 12-month follow-up, experiencing DPH motivated by racism and homophobia was associated with over four times the odds of being threatened with violence (AOR 4.85, 95% CI 3.20, 7.33), four times the odds of or experiencing violence defined as being punched, kicked, or beaten, or having an object thrown at them (AOR 4.51, 95% CI 2.82, 7.19), and nearly three times the odds of physical partner abuse (AOR 3.49, 95% CI 1.69, 7.19). Findings suggest that for BMSM, DPH is associated with the threat and experience of violence, with a dose-response relationship between DPH motivated by one or more causes. Given that BMSM are a population particularly vulnerable to both police harassment related to race and sexual orientation and violence coupled with stigma, additional research evaluating mechanisms linking these associations is needed in order to develop additional supportive interventions.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Amanda Geller
- Department of Criminology, Law, and Society, University of California, Irvine, Irvine, CA, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kailyn E Young
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | | | | | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Individual and Social Network Factors Associated with High Self-efficacy of Communicating about Men's Health Issues with Peers among Black MSM in an Urban Setting. J Urban Health 2020; 97:668-678. [PMID: 32740700 PMCID: PMC7560668 DOI: 10.1007/s11524-020-00458-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Black men who have sex with men (BMSM) bear a disproportionate burden of HIV in the USA. BMSM face stigma, discrimination and barriers to health care access, and utilization. Peers (male or female) may assist BMSM in navigating their health issues by engaging in communication to support in their health care needs. Individuals with high self-efficacy of communicating about men's health issues with peers can be trained as community popular opinion leaders (CPOLs) to change peer behaviors by promoting risk reduction communication. We examined the characteristics associated with high self-efficacy of communicating with peers about men's health issues among 256 BMSM from a behavioral HIV intervention conducted in Baltimore, Maryland. In the multivariate logistic model, gay identity (AOR: 2.10, 95% CI: 1.15,3.83), involvement in the house and ballroom community (AOR: 2.50, 95% CI: 1.14,5.49), larger number of network members who are living with HIV (AOR: 6.34, 95% CI: 1.48,27.11), and larger number of network members who would loan them money (AOR: 1.46, 95% CI: 1.05,2.03) were statistically significantly associated with high self-efficacy of communicating with peers about men's health issues. We also found that having depressive symptoms (AOR: 0.43, 95% CI: 0.24, 0.77) was negatively associated with high self-efficacy of communicating with peers about men's health issues. Findings from the current study can inform future studies to identify better CPOLs who are able to communicate effectively with peers about men's health issues for BMSM.
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Maragh-Bass AC, Gamble T, Tolley EE. 'Either You Float or You Drown:' The Role of Social Ties and Stigma in Lived Experiences of the HIV Care Continuum in HPTN 065. AIDS Behav 2020; 24:2532-2545. [PMID: 32086602 DOI: 10.1007/s10461-020-02811-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HPTN 065 utilized financial incentives to promote viral suppression among HIV-positive participants. Exit interviews were conducted in a sub-study of participants in Washington, DC and Bronx, NY. The present analyses explored lived experiences of social ties and stigma as individuals navigated the HIV care continuum, including gender differences in lived experiences. Using viral load data and informed by stages-of-change theory, participants were categorized into "Low-Adherers (n = 13)", "Action (n = 29)" and "Maintenance (n = 31)" stages. Secondary analyses of qualitative data were informed by grounded theory, and instances of social ties and stigma discussed by participants were quantified with descriptive statistics. Participants (N = 73) were mostly male (64%), African American (58%), with yearly income under $10,000 (52%). Low-adherers identified fewer, and sometimes more combative social ties than those in other adherence stages. Maintainers identified supportive ties as motivation for medication adherence (68%) but relied less on them for motivation than individuals in other adherence stages. Low-adherers described current experiences of stigma related to being diagnosed with HIV more than other adherence stages (23%). Individuals in Action reported stigma related to disclosing their HIV status to others (52%), while individuals in Maintenance mostly stigmatized others engaging in "risky" behaviors (32%). Findings suggest that women may perceive greater HIV stigma than men, perceive less supportive social ties, and were the majority of Low-adherers. Gender-informed approaches can facilitate community de-stigmatization of HIV, as African American women may be at greater risk of negative HIV health outcomes.
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Affiliation(s)
| | | | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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11
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Syndemic latent transition analysis in the HPTN 061 cohort: Prospective interactions between trauma, mental health, social support, and substance use. Drug Alcohol Depend 2020; 214:108106. [PMID: 32652374 PMCID: PMC7423755 DOI: 10.1016/j.drugalcdep.2020.108106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Substance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. METHODS Using a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. RESULTS Our analysis identified four statuses: A "low-risk" status characterized by the lowest proportions of syndemic factors, and 3 "high-risk" statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with "high-risk status C" (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). CONCLUSIONS Our findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.
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Vincent W, Peterson JL, Huebner DM, Storholm ED, Neilands TB, Rebchook GM, Pollack L, Tan JY, Kegeles SM. Resilience and Depression in Young Black Men Who Have Sex with Men: A Social-Ecological Model. STIGMA AND HEALTH 2020; 5:364-374. [PMID: 35505775 PMCID: PMC9060536 DOI: 10.1037/sah0000206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the health of young Black men who have sex with men (YBMSM) is typically discussed in terms of HIV, they are significantly affected by depression. The present study explored protective and risk pathways to depressive symptoms among YBMSM within a social-ecological framework. A cross-sectional sample of 1,817 YBMSM in two large, southern cities in the United States completed a survey of sociodemographic characteristics as well as individual (e.g., resilience, internalized heterosexism) and contextual (e.g., peer social support, experiences of racism) factors. In cross-sectional analyses, structural equation modeling was used to examine whether there were indirect associations between contextual factors and depressive symptomology that were mediated by individual factors. Higher peer social support was associated with lower depressive symptoms via greater resilience; there was no direct association between peer social support and depressive symptoms when controlling for this indirect association. Additionally, there were indirect associations between several contextual risk factors and higher depressive symptoms via perceived HIV-related stigma and internalized heterosexism; some direct associations between contextual risk factors and higher depressive symptoms were significant when controlling for these indirect associations. Despite a number of risk factors for depression for YBMSM, resilience is a key protective factor that may play a critical role in the beneficial effects of peer social support. Broadly, findings suggest that public health efforts must continue to build upon and leverage YBMSM's community-based strengths in the service of improving their mental health and, indirectly, their physical health.
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13
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Solomon H, Linton SL, Del Rio C, Hussen SA. Housing Instability, Depression, and HIV Viral Load Among Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia. J Assoc Nurses AIDS Care 2020; 31:219-227. [PMID: 31369417 DOI: 10.1097/jnc.0000000000000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Housing instability is common among sexual minority youth. Research suggests that psychological distress, such as depression, may mediate the association between housing instability and poor HIV-related outcomes, but this hypothesis remains underexplored. Housing instability was assessed using two variables (residential moves in 6 months, and self-reported homelessness at any time since age 15 years). We examined cross-sectional relationships between the housing instability variables and detectable HIV-1 viral load (VL) in a sample of young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV (N = 81) in Atlanta, GA, in 2015-2016. Additionally, we explored whether depressive symptoms mediated this relationship. Our exploratory study suggests that psychological distress may partially mediate the association between housing instability and detectable VL. In addition to structural interventions that ensure housing stability, increasing use of mental health services by unstably housed YB-GBMSM may improve VL suppression in this high-risk population.
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14
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Watson CC, Wilton L, Lucas JP, Bryant L, Victorianne GD, Aradhya K, Fields SD, Wheeler DP. Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030871. [PMID: 32028553 PMCID: PMC7037695 DOI: 10.3390/ijerph17030871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Black men who have sex with men (MSM) have disproportionate HIV disease burden in the United States. Black MSM have been underrepresented in biomedical research, including HIV clinical trials, due to a myriad of socio-structural, socio-cultural, and psychosocial factors. The HIV Prevention Trials Network (HPTN) 061, a feasibility study of a multi-component HIV prevention intervention for Black MSM in six US cities, incorporated the development and implementation of a Black Caucus as a culturally grounded model for the integration of Black MSM in clinical trials and research in HPTN. Based on a qualitative methodological approach, we describe the formation and implementation of the Black Caucus from the perspective of Black MSM key community stakeholders. Three major themes emerged from the qualitative narratives: (1) the role of the Black Caucus in shaping the HPTN, (2) how the Black Caucus addresses the needs of Black MSM communities pertaining to the influence of race and sexual identity, and (3) socio-cultural needs of Black MSM. These findings have implications for the provision of culturally congruent expertise, community engagement, cultural mistrust, recruitment and retention of Black MSM in HIV clinical trials, culturally-relevant study design and implementation, and the role of developing Black MSM prevention researchers.
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Affiliation(s)
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY 13902, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg 2006, South Africa
- Correspondence: ; Tel.: +1-607-777-9215
| | - Jonathan Paul Lucas
- Science Facilitation Department, FHI 360, Durham, NC 27701, USA; (J.P.L.); (K.A.)
| | - Lawrence Bryant
- Department of Health Administration, School of Nursing and Health Sciences, Capella University, Minneapolis, MN 55402, USA;
| | - Gregory D. Victorianne
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90024, USA;
| | - Kerry Aradhya
- Science Facilitation Department, FHI 360, Durham, NC 27701, USA; (J.P.L.); (K.A.)
- Invitae, San Francisco, CA 93103, USA
| | - Sheldon D. Fields
- Harriet Rothkopf Heilbrunn School of Nursing, Long Island University-Brooklyn, Brooklyn, NY 11201, USA;
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15
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Valente PK, Edeza A, Klasko-Foster L, Mimiaga MJ, Mayer KH, Safren SA, Biello KB. Sexual orientation and social network size moderate associations between stigma and problematic alcohol use among male sex workers in the US Northeast: an observational study. Sex Health 2020; 17:429-436. [PMID: 33176902 DOI: 10.1071/sh20137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Abstract
Background Stigma is associated with poor health among sexual minority individuals. However, no studies have examined the relationship between stigma and problematic drinking among male sex workers (MSWs). This study examined the relationship between sex work stigma and problematic alcohol use among MSWs. METHODS Using baseline data from a cohort of 98 MSWs in the US Northeast enrolled between 2015 and 2016, we used logistic regression to examine associations between sex work stigma and hazardous drinking (Alcohol Use Disorders Identification Test (AUDIT) score ≥8) and sex work while drunk, and tested whether sexual orientation (gay vs non-gay identified) and social network size moderated these associations. RESULTS Almost half the sample (n = 46; 44%) reported hazardous drinking and 56 MSWs (57%) reported engaging in sex work while drunk. Sex work stigma was associated with hazardous drinking (adjusted odds ratio (aOR) 1.2, 95% confidence interval (CI) 1.05-1.36). Sexual orientation marginally moderated this relationship (P = 0.07), such that it was only significant among gay-identified MSWs (aOR 1.91, 95% CI 1.11-3.28), not among non-gay MSW. Similarly, sexual orientation moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among gay-identified MSWs (aOR 1.65, 95% CI 1.05-1.60). Social network size also moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among MSWs with small networks (aOR 1.26, 95% CI 1.00-1.58), suggesting large networks can be protective. CONCLUSIONS Gay MSWs may be particularly vulnerable to alcohol-related effects of stigma. Future interventions should consider engaging social networks to curb problematic drinking among MSWs.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 700 Butler Drive, Box G-BH, Providence, RI 02906, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Harvard University Medical School, 25 Shattuck Street, Boston, MA 02115, USA; and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Corresponding author.
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16
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Duncan DT, Sutton MY, Park SH, Callander D, Kim B, Jeffries WL, Henny KD, Harry-Hernández S, Barber S, Hickson DA. Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:185-193. [PMID: 31950381 PMCID: PMC7410008 DOI: 10.1007/s10508-019-01619-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
There is a disproportionately high HIV incidence among Black men who have sex with men (MSM) despite equal or lower levels of HIV risk behaviors compared to White MSM. Due to high levels of racial segregation in the U.S., Black MSM have an elevated likelihood of living in neighborhoods that contain psychosocial stressors, which, in turn, may increase behaviors promoting HIV infection. We examined associations between perceived neighborhood problems and sexual behaviors among Black MSM in the Deep South, a population at highest risk of HIV. Data came from the MARI Study, which included Black MSM ages 18-66 years recruited from the Jackson, MS, and Atlanta, GA, metropolitan areas (n = 377). Participants completed questions about neighborhood problems (e.g., excessive noise, heavy traffic/speeding cars and trash/litter) and sexual behaviors (e.g., condomless sex and drug use before or during sex). We used Poisson's regression model with robust standard errors to estimate the adjusted prevalence ratio (aPR; 95% confidence intervals [CI]) of neighborhood problems (coded as tertiles [tertile 1 = low neighborhood problems, tertile 2 = medium neighborhood problems, tertile 3 = high neighborhood problems] as well as continuously) with sexual behaviors, after adjustment for sociodemographic characteristics and other variables. About one-fourth of the sample reported at least one neighborhood problem, with the most common (31.6%) being no/poorly maintained sidewalks, which indicates an infrastructural problem. In multivariable models, compared to those in the lowest tertile, those reporting more neighborhood problems (tertile 2: aPR = 1.49, 95% CI = 1.04, 2.14 and tertile 3: aPR = 1.53, 95% CI = 1.05, 2.24) reported more drug use before or during sex (p for trend = .027). Neighborhood problems may promote behaviors (e.g., drug use before or during sex) conducive to HIV infection. Structural interventions could improve community infrastructure to reduce neighborhood problems (e.g., no/poorly maintained sidewalks and litter). These interventions may help to reduce HIV incidence among Black MSM in the Deep South.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA.
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kirk D Henny
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salem Harry-Hernández
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - DeMarc A Hickson
- Center for Research, Evaluation and Environmental and Policy Change, My Brother's Keeper, Inc, Jackson, MS, USA
- Us Helping Us, People Into Living, Inc, Washington, DC, USA
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17
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Hermanstyne KA, Green HD, Tieu HV, Hucks-Ortiz C, Wilton L, Shoptaw S. The Association Between Condomless Anal Sex and Social Support Among Black Men Who Have Sex With Men (MSM) in Six U.S. Cities: A Study Using Data from the HIV Prevention Trials Network BROTHERS Study (HPTN 061). AIDS Behav 2019; 23:1387-1395. [PMID: 30377980 DOI: 10.1007/s10461-018-2315-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We assessed how egocentric (i.e., self-generated descriptions of a person's social contacts) network structure and composition corresponded with reported instances of condomless receptive and insertive anal intercourse with men who were reportedly HIV-infected or of unknown HIV serostatus in a sample of black men who have sex with men (MSM) in six U.S. cities. Ratings showing a higher percentage of network members who provided social participation and medical support were positively associated with reporting condomless sex. There were also significant positive associations between stimulant use and condomless insertive and receptive anal sex. Future research should examine the social processes that underlie these associations and explore ways that social support can affect HIV prevention efforts for black MSM.
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Affiliation(s)
- Keith A Hermanstyne
- Department of Psychiatry, UCSF Weil Institute for Neurosciences, University of California, 1930 Market Street, San Francisco, CA, 94102, USA.
| | - Harold D Green
- Indiana University Network Science Institute, Bloomington, IN, USA
- Center for Applied Network Analysis and Systems Science, RAND Corporation, Santa Monica, CA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA
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18
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Yan H, Li X, Li J, Wang W, Yang Y, Yao X, Yang N, Li S. Association between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive men who have sex with men (MSM) in Nanjing, China. AIDS Care 2019; 31:1069-1076. [PMID: 30942086 DOI: 10.1080/09540121.2019.1601677] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Among Chinese HIV-positive men who have sex with men (MSM), high levels of depression are common. The association between HIV and depression is attributed to several factors, particularly HIV-related stigma. However, to date, how HIV-related stigma leads to depression among Chinese HIV-positive MSM is still unclear. As such, this study aims to examine the relationships between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive MSM in China. We conducted a cross-sectional survey study among 347 HIV-positive MSM from July to August 2016 in Nanjing, China. Measurements were sociodemographic and psychological constructs including perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms. Structural equation modeling (SEM) was used to examine the relationships among these constructs. Overall,134 (38.6%) participants had depressive symptoms. Perceived stigma was directly associated with depressive symptoms (β = .196, p < .001). Perceived stigma also indirectly affected depressive symptoms (β = .200, p < .001)through social support and self-esteem. Social support (β = -.124, p = .004) and self-esteem (β = -.536, p = .001), but not resilience, were direct predictors of depressive symptoms. Resilience was directly associated with self-esteem (β = .512, p < .001). Perceived HIV stigma could directly and indirectly impact depressive symptoms in HIV-positive MSM. Improving personal self-esteem, resilience and social support might reduce impact of perceived stigma on depressive symptoms among HIV-positive MSM in China.
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Affiliation(s)
- Hong Yan
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Xiaoyan Li
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Jingjing Li
- b Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , USA
| | - Wei Wang
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Yinmei Yang
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Xing Yao
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Ningxi Yang
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
| | - Shiyue Li
- a School of Health Sciences , Wuhan University , Wuhan , People's Republic of China
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19
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Bauermeister JA, Muessig KE, Flores DD, LeGrand S, Choi S, Dong W, Harper GW, Hightow-Weidman LB. Stigma Diminishes the Protective Effect of Social Support on Psychological Distress Among Young Black Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:406-418. [PMID: 30332312 PMCID: PMC6524771 DOI: 10.1521/aeap.2018.30.5.406] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Addressing stigma remains a pressing HIV priority globally. Young Black men who have sex with men (YBMSM, ages 18-30; N = 474) completed an in-person baseline survey and reported their experiences of externalized stigma (i.e., racial and sexuality discrimination), internalized stigma (i.e., homonegativity), social support, and psychological distress (i.e., anxiety and depression symptoms). We used structural equation modeling to test the association between stigma and psychological distress, and examined whether social support mediated the relationship between stigma and psychological distress. Recognizing that these associations may differ by HIV status, we compared our models by self-reported HIV status (n = 275 HIV negative/unknown; n = 199 living with HIV). Our findings suggest that YBMSM who experience stigma are more vulnerable to psychological distress and may have diminished buffering through social support. These effects are accentuated among YBMSM living with HIV, highlighting the need for additional research focused on the development of tailored stigma reduction interventions for YBMSM.
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Affiliation(s)
| | | | | | | | - Seulki Choi
- University of North Carolina, Chapel Hill, North Carolina
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20
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Hussen SA, Easley KA, Smith JC, Shenvi N, Harper GW, Camacho-Gonzalez AF, Stephenson R, Del Rio C. Social Capital, Depressive Symptoms, and HIV Viral Suppression Among Young Black, Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV. AIDS Behav 2018; 22:3024-3032. [PMID: 29619586 PMCID: PMC6076871 DOI: 10.1007/s10461-018-2105-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Social capital, the sum of an individual's resource-containing social network connections, has been proposed as a facilitator of successful HIV care engagement. We explored relationships between social capital, psychological covariates (depression, stigma and internalized homonegativity), and viral suppression in a sample of young Black gay, bisexual and other men who have sex with men (YB-GBMSM). We recruited 81 HIV-positive YB-GBMSM 18-24 years of age from a clinic setting. Participants completed a cross-sectional survey, and HIV-1 viral load (VL) measurements were extracted from the medical record. Sixty-five percent (65%) were virally suppressed (HIV-1 VL ≤ 40 copies/ml). Forty-seven percent (47%) had a positive depression screen. Depressive symptoms affected viral suppression differently in YB-GBMSM with lower vs. higher social capital (p = 0.046, test for statistical interaction between depression and social capital). The odds of viral suppression among YB-GBMSM with lower social capital was 93% lower among those with depressive symptoms (OR 0.07, p = 0.002); however, there was no association between depressive symptoms and viral suppression among those with higher social capital. Our results suggest that social capital may buffer the strong negative effects of depressive symptoms on clinical outcomes in YB-GBMSM living with HIV. In addition to treating depression, there is a role for interventions to augment social capital among YB-GBMSM living with HIV as a strategy for enhancing care engagement.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Mailstop 1518-002-7BB, 30322, Atlanta, GA, Georgia.
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Kirk A Easley
- Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Justin C Smith
- Department of Behavioral Science and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Neeta Shenvi
- Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andres F Camacho-Gonzalez
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Carlos Del Rio
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Mailstop 1518-002-7BB, 30322, Atlanta, GA, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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21
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López JA, García RF, Martí TS. Drugs and Mental Health Problems among the Roma: Protective Factors Promoted by the Iglesia Evangélica Filadelfia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020335. [PMID: 29443877 PMCID: PMC5858404 DOI: 10.3390/ijerph15020335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/28/2022]
Abstract
Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of these practices. Objective: In this article, authors analyze in which ways the IEF favors processes of drug rehabilitation and mental health recovery as well as the prevention of these problems among its Roma members. Methods: A communicative qualitative approach was developed. It was communicative because new knowledge was created by dialogically contrasting the existing state of the art with study participants. It was qualitative because everyday life stories were collected, gathering the experiences, perceptions and interpretations of Roma people who are actively involved in three different IEF churches based in Barcelona. Results: This article identifies these protective factors: anti-drug discourse, a supportive environment, new social relations, role model status, the promotion of interactions, the revaluation of oneself, spiritual activities and the improvement of the feeling of belonging and the creation of meaning. Conclusion: The present research contributes new evidence to the current understanding of the role played by the IEF in improving Roma health status and how the identified protective factors can contribute to rehabilitation and recovery from such problems in other contexts.
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Affiliation(s)
- Jelen Amador López
- CREA-Community of Research on Excellence for All, Facultat d'Economia i Empresa, University of Barcelona, Diagonal Nord, Diagonal 690, 08034 Barcelona, Spain.
| | - Ramón Flecha García
- Department of Sociology, Facultat d'Economia i Empresa, University of Barcelona, Diagonal Nord, Diagonal 690, 08034 Barcelona, Spain.
| | - Teresa Sordé Martí
- Department of Sociology, Autonomous University of Barcelona, Edifici B, Office B3-179, 08193 Bellaterra, (Cerdanyola del Vallès), 08034 Barcelona, Spain.
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Vermund SH. The Continuum of HIV Care in the Urban United States: Black Men Who Have Sex With Men (MSM) Are Less Likely Than White MSM to Receive Antiretroviral Therapy. J Infect Dis 2017; 216:790-794. [PMID: 28368523 PMCID: PMC5853891 DOI: 10.1093/infdis/jix009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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