1
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Cornelisse VJ, Murphy D, Lee SJ, Stoove M, Traeger MW, Wright EJ. Physical and mental health of long-term users of HIV preexposure prophylaxis in Australia. AIDS 2024; 38:363-372. [PMID: 37877295 DOI: 10.1097/qad.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION HIV preexposure prophylaxis (PrEP) is highly effective at preventing HIV. We aimed to assess mental and physical health among long-term PrEP users in Australia's X-PLORE cohort. METHODS In early 2021, 1485 X-PLORE participants were emailed a survey covering demographics, sexual practices, ongoing PrEP use, physical and psychological diagnoses received since commencing PrEP, substance use, and impacts of the COVID-19 pandemic. Current anxiety and depression were assessed using GAD-7 and PHQ-9 questionnaires. RESULTS Of 476 participants (completion rate 32.1%), 99.8% were cis-gender men. Median PrEP use duration was 48 months (2002 person-years), with 81.7% currently using PrEP. PrEP-related toxicity was uncommon: 2.9% reported bone fractures, 1.3% low bone density, and 4.0% reported kidney problems, largely not necessitating PrEP cessation. Most (92.0%) rated their health as 'good' to 'excellent', and 22.6% reported improved health since starting PrEP, often because of improved mental health. Only 6.2% reported deterioration in health since starting PrEP, largely unrelated to PrEP. The most common diagnoses were hypertension (9.9%), depression (13.2%) and anxiety (14.9%); 17% had PHQ-9 scores indicating current moderate-to-severe depression, which was associated with unemployment [adjusted odds ratio (aOR) 3.90], regular cannabis use (aOR 2.49), and having ceased PrEP (aOR 2.13). CONCLUSION Among long-term PrEP users, of which over 80% were currently using PrEP, self-reported PrEP toxicity was uncommon. With almost one in five PrEP users categorized as having depression, and with higher risk among those having ceased PrEP, we recommend routine screening for depression and anxiety in PrEP users and corresponding follow-up of patients no longer attending for PrEP.
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Affiliation(s)
- Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Dean Murphy
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Sue J Lee
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
| | - Mark Stoove
- Burnet Institute
- Australian Research Centre in Sex, Health and Society, LaTrobe University
- School of Public Health and Preventive Medicine, Monash University
| | - Michael W Traeger
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Edwina J Wright
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- Burnet Institute
- Doherty Institute, Melbourne, Australia
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2
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Gomillia CE, Burns PA, Xavier Hall CD, Beach LB. The Association of Depression, Social Determinants and PrEP Uptake Among Black Sexual Minority Men in the Deep South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01793-1. [PMID: 37702972 DOI: 10.1007/s40615-023-01793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
Despite its known efficacy in reducing HIV acquisition, pre-exposure prophylaxis (PrEP) uptake and utilization remains alarmingly low among key populations, including Black sexual minority men (SMM). Additionally, research has shown that SMM are at elevated risk of adverse mental health outcomes, including depression, anxiety, illegal drug use, and suicidality. However, there is limited data examining the impact of depression on PrEP uptake among Black SMM. This study analyzes survey data obtained from the ViiV ACCELERATE! Initiative between January 2016 and September 2017 to examine the association between depressive symptoms and uptake of PrEP among a sample of HIV-negative Black SMM ages 18-65 years (N=170) residing in Mississippi, the poorest state in the USA. We found that PrEP-eligible Black SMM reporting depressive symptoms were 60% less likely to take PrEP (aOR = 0.40, CI: 0.18-0.74, p = 0.05). Similarly, PrEP-eligible men lacking health insurance were 63% less likely to start PrEP (aOR = 0.37; CI: 0.17-0.94; p = 0.035). Given the low uptake of PrEP among Black SMM, there is an urgent need for the development and implementation of combination HIV prevention interventions that incorporate access to mental health services among this highly stigmatized and marginalized population.
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Affiliation(s)
- Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA.
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA
| | - Casey D Xavier Hall
- College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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3
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Schadé A, van Grootheest G, Smit JH. The Relation between Depressive Symptoms and Unsafe Sex among MSM Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1595. [PMID: 36674350 PMCID: PMC9861058 DOI: 10.3390/ijerph20021595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
In people living with HIV (PLWH), a positive association is often found between depressive symptoms and unsafe sex, which means sex without a condom. However, the results of such studies are inconclusive. The present study compared the numbers of safe and unsafe sexual contacts from men who have sex with men (MSM) (N = 159), living with HIV and attending a mental health clinic, with those of HIV-negative MSM in the general population (N = 198). We determined whether the presence of depressive symptoms was associated with unsafe sex in either of the two study populations. The depressive symptoms were measured with the Inventory of Depressive Symptoms (IDS), (MSM living with HIV) and with the 2012 Sexual Health Monitor (HIV-negative MSM). Finally, we determined whether MSM living with HIV with depressive symptoms, who received psychiatric treatment as usual, engaged in fewer unsafe sexual contacts one year after baseline. The mental-health-treatment-seeking MSM living with HIV engaged in more unsafe sexual contact than the MSM comparison group without HIV. Neither the treatment-seeking MSM living with HIV nor the MSM without HIV in the general population exhibited a relationship between depressive symptoms and unsafe sex. Moreover, the successful treatment of depressive symptoms in the treatment group did not lead to any reduction in the number of unsafe sexual contacts. Further research is needed to develop interventions that might be effective for MSM living with HIV with mental health symptoms to reduce the number of unsafe sexual contacts.
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Affiliation(s)
- Annemiek Schadé
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Gerard van Grootheest
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Oldenaller 1, 1070 BB Amsterdam, The Netherlands
| | - Johannes H. Smit
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Oldenaller 1, 1070 BB Amsterdam, The Netherlands
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4
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Benjamin S, Parsons M, Apthorp D, Lykins AD. Why take the risk? Exploring the psychosocial determinants of floodwater driving. Front Psychol 2022; 13:913790. [PMID: 35928428 PMCID: PMC9343783 DOI: 10.3389/fpsyg.2022.913790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
As anthropogenic climate change progresses, there is an increasing need for individuals to make appropriate decisions regarding their approach to extreme weather events. Natural hazards are involuntary risk environments (e.g., flooded roads); interaction with them cannot be avoided (i.e., a decision must be made about how to engage). While the psychological and sociocultural predictors of engagement with voluntary risks (i.e., risk situations that are sought out) are well-documented, less is known about the factors that predict engagement with involuntary risk environments. This exploratory study assessed whether mental health (depression, anxiety, and stress symptoms), personality traits, and cultural worldviews combine to predict engagement with involuntary risk, using the situation of floodwater driving. An Australian sample (N = 235) was assessed via questionnaire and scenario measures. Results were analyzed in a binomial logistic regression assessing which individual factors predicted decision-making in a proxy floodwater driving scenario. Agreeableness and gender were individually significant predictors of floodwater driving intention, and four factors (named “affect,” “progressiveness,” “insightfulness,” and “purposefulness”) were derived from an exploratory factor analysis using the variables of interest, though only two (“progressiveness” and “insightfulness”) predicted floodwater driving intention in an exploratory binomial logistic regression. The findings highlight the need for further research into the differences between voluntary and involuntary risk. The implication of cultural worldviews and personality traits in interaction with mental health indicators on risk situations is discussed.
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Affiliation(s)
- Shauntelle Benjamin
- School of Psychology, University of New England, Armidale, NSW, Australia
- Bushfire and Natural Hazards Cooperative Research Centre, Melbourne, VIC, Australia
| | - Melissa Parsons
- Bushfire and Natural Hazards Cooperative Research Centre, Melbourne, VIC, Australia
- School of Humanities, Arts, and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Deborah Apthorp
- School of Psychology, University of New England, Armidale, NSW, Australia
- School of Computing, The Australian National University, Canberra, ACT, Australia
| | - Amy D. Lykins
- School of Psychology, University of New England, Armidale, NSW, Australia
- *Correspondence: Amy D. Lykins,
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5
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Coleman JN, Batchelder AW, Kirakosian N, Choi KW, Shipherd JC, Bedoya CA, Safren SA, Ironson G, O'Cleirigh C. Indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless sex among men who have sex with men with a history of childhood sexual abuse. J Trauma Dissociation 2022; 23:279-295. [PMID: 34678135 PMCID: PMC9023598 DOI: 10.1080/15299732.2021.1989118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms may interfere with gay, bisexual and other men who have sex with men's (MSM) ability to engage in safe sex practices. An indirect relationship with dissociation may help to elucidate the relationship between PTSD symptom severity and condomless sex among MSM with childhood sexual abuse (CSA) histories. These relationships have not previously been examined in this group, which has a unique vulnerability for HIV acquisition. A cross-sectional sample of MSM with histories of CSA (N=290) was recruited at study sites in Boston, MA, and Miami, FL. Participants had a mean age of 37.95 years (SD=11.68), 22% were African American and 29.4% identified as Latino. The sample reported a mean of 10.47 (SD=4.38) lifetime PTSD symptoms and 26.4% met the clinical threshold for dissociation. Logistic regression models (adjusted for age, education, and substance use disorder) were used to assess indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless anal/vaginal sex episodes with serodiscordant or unknown status partners in the past 3 months. Dissociation accounted for the association between lifetime PTSD symptom severity and condomless sex episodes. The Sobel test (Sobel = 2.04, p= .042; CI 95% bias-corrected bootstrap) suggested significant indirect effects for dissociation. Dissociation among MSM with CSA histories may compromise accurate appraisals of sexual risk and safety and increase vulnerability for HIV acquisition. Further research is warranted to address HIV prevention in the context of PTSD symptom severity to improve the mental health of MSM and increase the effectiveness of HIV prevention interventions.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States.,Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States.,The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States
| | - Karmel W Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States.,Department of Epidemiology, Harvard T.h. Chan School of Public Health, Boston, Massachusetts, United States
| | - Jillian C Shipherd
- School of Medicine, Boston University, Boston, Massachusetts, United States.,Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, United States.,Office of Patient Care Services, LGBT Health Program, Veterans Health Administration, Washington, District of Columbia, United States
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, United States
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, Florida, United States
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States.,The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
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6
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Blair CS, Needleman J, Javanbakht M, Comulada WS, Ragsdale A, Bolan R, Shoptaw S, Gorbach PM. Examining the Relative Contributions of Methamphetamine Use, Depression, and Sexual Risk Behavior on Rectal Gonorrhea/Chlamydia Among a Cohort of Men Who Have Sex With Men in Los Angeles, California. Sex Transm Dis 2022; 49:216-222. [PMID: 34654768 PMCID: PMC8821317 DOI: 10.1097/olq.0000000000001568] [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: 11/26/2022]
Abstract
BACKGROUND Methamphetamine use, sexual risk behaviors, and depression contribute to ongoing human immunodeficiency virus (HIV) and sexually transmitted infection (STI) disparities among men who have sex with men (MSM). The relative contributions of these effects longitudinally are not well understood. METHODS This analysis used visit-level data from a longitudinal cohort of MSM, half with HIV, in Los Angeles, CA. From August 2014 to March 2020, participants completed follow-up visits every 6 months and underwent testing for rectal gonorrhea/chlamydia (GC/CT) and completed questionnaires including depressive symptoms, number of receptive anal intercourse (RAI) partners, and methamphetamine use. Path analysis with structural equation modeling using concurrent and lagged covariates was used to identify relative contributions of methamphetamine use and depression on number of RAI partners and rectal GC/CT across time. RESULTS Five hundred fifty-seven MSM with up to 6 visits (3 years) were included for a total of 2437 observations. Methamphetamine use and depressive symptoms were positively associated with number of RAI partners (β = 0.28, P < 0.001; β = 0.33, P = 0.018, respectively), which was positively associated with rectal GC/CT (β = 0.02, P < 0.001). When stratified by HIV status, depressive symptoms were positively associated with RAI partners for HIV-negative MSM (β = 0.50, P = 0.007) but were not associated for MSM living with HIV (β = 0.12, P = 0.57). Methamphetamine use was positively associated with RAI partners in both strata. CONCLUSIONS Factors and patterns, which contribute to risk behaviors associated with rectal GC/CT, may differ by HIV status. Our findings demonstrate the importance of combined treatment and prevention efforts that link screening and treatment of stimulant use and depression with STI prevention and treatment.
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Affiliation(s)
- Cheríe S. Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - W. Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amy Ragsdale
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M. Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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7
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Morell-Mengual V, Gil-Llario MD, Fernádez-García O, Ballester-Arnal R. Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model. AIDS Behav 2021; 25:3836-3845. [PMID: 33914210 DOI: 10.1007/s10461-021-03282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.
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Affiliation(s)
- Vicente Morell-Mengual
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - M Dolores Gil-Llario
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain.
| | - Olga Fernádez-García
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - Rafael Ballester-Arnal
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
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8
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Whiteside-Mansell L, Sockwell L, Knight D, Crone C. Community Legal Systems: Targeting PrEP and HIV Education to Decrease Risk of HIV Transmission. AIDS Behav 2021; 25:2578-2590. [PMID: 33740214 PMCID: PMC8222014 DOI: 10.1007/s10461-021-03219-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N = 218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individuals, HIV prevention is a critical component for increased protective behaviors.
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Affiliation(s)
- Leanne Whiteside-Mansell
- Department of Family and Community Medicine, College of Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive #530, Little Rock, AR, 72205-7199, USA.
| | - LaTunja Sockwell
- Department of Family and Community Medicine, College of Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive #530, Little Rock, AR, 72205-7199, USA
| | - Daniel Knight
- Department of Family and Community Medicine, College of Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive #530, Little Rock, AR, 72205-7199, USA
| | - Cynthia Crone
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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9
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Gutierrez JI, Dubov A, Altice FL, Vlahov D. Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study. Mil Med Res 2021; 8:32. [PMID: 34006328 PMCID: PMC8132436 DOI: 10.1186/s40779-021-00323-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) infection, but its use remains low among U.S. military men who have sex with men (MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population. METHODS HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered (LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue. Relative importance and part-worth utility scores were generated using hierarchical bayes (HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios. RESULTS A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health. CONCLUSION A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Long-acting implants and injections are also desired.
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Affiliation(s)
- José I Gutierrez
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, San Francisco, CA, 94118, USA.
| | - Alex Dubov
- Loma Linda University, Griggs Hall 11065, Loma Linda, CA, 92350, USA
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, 135 College Street, Suite 323, New Haven, CT, 06510, USA.,Department of Epidemiology-Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - David Vlahov
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.,Department of Epidemiology-Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
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10
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Wood SM, Morales KH, Metzger D, Davis A, Fiore D, Petsis D, Barnett K, Koenig HC, Dowshen N, Gross R, Frank I. Mental Health, Social Influences, and HIV Pre-exposure Prophylaxis (PrEP) Utilization Among Men and Transgender Individuals Screening for HIV Prevention Trials. AIDS Behav 2021; 25:524-531. [PMID: 32860114 PMCID: PMC8546869 DOI: 10.1007/s10461-020-03004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence. Participants (n = 247) were 89% cis-male and 46% African-American. Median age was 27 (IQR:23-33). Thirty-seven percent had ever used PrEP, of whom 18% discontinued use. High depressive symptomology was identified in 11% and 9% were receiving mental health treatment. There were no significant associations between depressive symptoms or mental health treatment on the odds of PrEP uptake or discontinuation. Each additional PrEP contact conferred a greater odds of uptake (aOR:1.24, 95% CI: 1.09-1.42). Network-level targets may produce fruitful interventions to increase PrEP uptake.
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Affiliation(s)
- Sarah M Wood
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 11th Floor, Room 11212, 2716 South St., Philadelphia, PA, 19146, USA.
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David Metzger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Annet Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Fiore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Petsis
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kezia Barnett
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Helen C Koenig
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nadia Dowshen
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert Gross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ian Frank
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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11
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Miltz AR, Rodger AJ, Phillips AN, Sewell J, Edwards S, Allan S, Sherr L, Johnson AM, Burman WJ, Lampe FC. Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men. Sex Transm Infect 2021; 97:613-618. [PMID: 33431606 PMCID: PMC8606445 DOI: 10.1136/sextrans-2020-054634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM). METHODS Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011-2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013-2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with 'condom-protected sex only' as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis. RESULTS There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men. CONCLUSIONS Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.
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Affiliation(s)
- Ada R Miltz
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Janey Sewell
- Institute for Global Health, University College London, London, UK
| | - Simon Edwards
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sris Allan
- City of Coventry NHS Healthcare Centre, Coventry, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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12
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Starks TJ, Jones SS, Kyre K, Robles G, Cain D, Jimenez R, Stephenson R, Sullivan PS. Testing the drug use and condomless anal sex link among sexual minority men: The predictive utility of marijuana and interactions with relationship status. Drug Alcohol Depend 2020; 216:108318. [PMID: 33022531 PMCID: PMC7959658 DOI: 10.1016/j.drugalcdep.2020.108318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered monogamish -outside partners permitted when main partners are together). METHODS A nationwide sample of SMM (N = 65,707) were recruited through a geosocial networking app between November 2017 and November 2019. Participants reported on drug use and instances of CAS with casual partners in the previous 30 days. RESULTS Both marijuana and club drug use were associated with the occurrence of CAS with casual partners among single men. Only club drug use was associated with CAS frequency in this group. The association between marijuana and the occurrence of CAS did not differ significantly among monogamous men, while the associations between club drug use and the occurrence as well as frequency of CAS were significantly weaker. Meanwhile, the associations between club drug use and the occurrence as well as frequency of CAS did not differ significantly between single and non-monogamous (open and monogamish) subgroups; however, the association between marijuana and the occurrence of CAS was significantly weaker. CONCLUSIONS Findings largely replicated the robust association between club drug use and CAS with casual partners. They support the assertion that marijuana use predicts sexual risk for some SMM subgroups. Finally, they illustrate the potential for relationship status - and sexual agreements - to contextualize associations between drug use and CAS.
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Affiliation(s)
- Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA,Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA
| | - S. Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Kory Kyre
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Ruben Jimenez
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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13
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Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
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Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
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14
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Hampel B, Kusejko K, Kouyos RD, Böni J, Flepp M, Stöckle M, Conen A, Béguelin C, Künzler‐Heule P, Nicca D, Schmidt AJ, Nguyen H, Delaloye J, Rougemont M, Bernasconi E, Rauch A, Günthard HF, Braun DL, Fehr J, Anagnostopoulos A, Battegay M, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fellay J, Furrer H, Fux CA, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Paioni P, Pantaleo G, Perreau M, Rudin C, Scherrer AU, Schmid P, Speck R, Tarr P, Trkola A, Vernazza P, Wandeler G, Weber R, Yerly S. Chemsex drugs on the rise: a longitudinal analysis of the Swiss HIV Cohort Study from 2007 to 2017. HIV Med 2020; 21:228-239. [DOI: 10.1111/hiv.12821] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- B Hampel
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
- Department of Public Health Epidemiology, Biostatistics and Public Health Institute University of Zurich Zurich Switzerland
| | - K Kusejko
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - RD Kouyos
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Böni
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - M Flepp
- Center of Infectious Diseases Zurich Zurich Switzerland
| | - M Stöckle
- Division of Infectious Diseases & Hospital Epidemiology University Hospital Basel University Basel Basel Switzerland
| | - A Conen
- Division of Infectious Diseases and Hospital Hygiene Cantonal Hospital Aarau Aarau Switzerland
| | - C Béguelin
- Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
| | - P Künzler‐Heule
- Institute of Nursing Science University of Basel, and University Hospital Basel Basel Switzerland
| | - D Nicca
- Institute of Nursing Science University of Basel, and University Hospital Basel Basel Switzerland
| | - AJ Schmidt
- Division of Infectious Diseases Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - H Nguyen
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Delaloye
- Division of Infectious Diseases University Hospital Lausanne Lausanne Switzerland
| | - M Rougemont
- Division of Infectious Diseases University Hospital Geneva Geneva Switzerland
| | - E Bernasconi
- Division of Infectious Diseases Regional Hospital Lugano Lugano Switzerland
| | - A Rauch
- Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
| | - HF Günthard
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - DL Braun
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Institute of Medical Virology University of Zurich Zurich Switzerland
| | - J Fehr
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Zurich University of Zurich Zurich Switzerland
- Department of Public Health Epidemiology, Biostatistics and Public Health Institute University of Zurich Zurich Switzerland
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15
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Perazzo JD, Currie J, Horvat Davey C, Lambert J, Webel AR. Depression and social capital in people living with HIV. J Psychiatr Ment Health Nurs 2020; 27:54-61. [PMID: 31357228 DOI: 10.1111/jpm.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Depression affects 1 in 20 Americans, and people living with HIV experience depression at 2-3 times the rate of the general population. Recent research has shown that a person's level of social connectedness (e.g., social networks) is important to understanding their health and ability to get help when they need it. The scientific rationale of this work is to determine whether there is a direct relationship between levels of depression and a measure of social connectedness in people with HIV who are at higher than normal risk of depression and depressive symptoms. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We examined the relationship between levels of depression and social capital in people living with HIV to determine whether depression may influence their beliefs about their social connectedness and available resources. We found that as depression increases, self-reported social capital decreases, suggesting that people living with HIV who are depressed may feel less socially connected and/or not be confident they can access resources when they need them. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Mental health nurses are particularly well-positioned to help people living with HIV who are living with depression by helping them build skills for building and maintaining relationships, adhering to co-administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness. Helping people living with HIV to address depression and promoting social connectedness can not only improve quality of life, but have major long-term health benefits. Abstract Introduction People living with HIV (PLWH) are disproportionately burdened by depression, with estimates as high as 80% of PLWH reporting depressive symptoms. Depression in PLWH is complex, and has been linked with biological and psychosocial causes, including low social capital. Few studies have examined the relationship between social capital and depression in PLWH. Aim/Question We conducted a secondary analysis of the relationship between social capital (Social Capital Scale score) and depression (Beck Depression Inventory-II scores) to determine whether depression predicted levels of social capital in a sample of 108 PLWH. Results Depression was significantly associated with lower social capital r(105) = -.465 p < .001. Depression remained a significant predictor of social capital in the linear regression model, F(5,101) = 8.508, p < .000, R2 = 0.296, when controlling for age and education level. Discussion Our results suggest that depression may be a significant predictor of low social capital, and these factors may have cyclical relationships that explain persistent depression in this population. Implications for practice Mental health nurses are particularly well-positioned to help PLWH who are living with depression by helping them build skills for building and maintaining relationships, adhering to co-administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness.
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Affiliation(s)
- Joseph D Perazzo
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA.,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson Currie
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Christine Horvat Davey
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joshua Lambert
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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16
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Zheng ZW, Yang QL, Liu ZQ, Qiu JL, Gu J, Hao YT, Song C, Jia ZW, Hao C. Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data. J Med Internet Res 2020; 22:e13201. [PMID: 32012054 PMCID: PMC7053714 DOI: 10.2196/13201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/24/2019] [Accepted: 11/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. Objective This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. Methods A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. Results A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=−0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=−0.8306; P<.001) and a lower positive emotion score (beta=−0.3743; P<.001). Conclusions The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time.
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Affiliation(s)
- Zhi-Wei Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qing-Ling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhong-Qi Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jia-Ling Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Health Information Research Center, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Health Information Research Center, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Chao Song
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhong-Wei Jia
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Health Information Research Center, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
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17
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Agnew-Brune CB, Balaji AB, Mustanski B, Newcomb ME, Prachand N, Braunstein SL, Brady KA, Hoots BE, Smith JS, Paz-Bailey G, Broz D. Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015. AIDS Behav 2019; 23:3419-3426. [PMID: 31065922 DOI: 10.1007/s10461-019-02525-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13-18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population.
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Affiliation(s)
- Christine B Agnew-Brune
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA.
| | - Alexandra B Balaji
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Brian Mustanski
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nik Prachand
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | - Brooke E Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Justin S Smith
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
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18
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Nosrat S, Velez BL, Ciccolo JT. Psychological Distress and Risky Sexual Behavior in a Sample of Men Who Have Sex with Men in the United States. J Assoc Nurses AIDS Care 2019; 30:691-698. [PMID: 31633631 DOI: 10.1097/jnc.0000000000000035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Foley JD, Vanable PA, Brown LK, Carey MP, DiClemente RJ, Romer D, Valois RF. Depressive symptoms as a longitudinal predictor of sexual risk behaviors among African-American adolescents. Health Psychol 2019; 38:1001-1009. [PMID: 31380687 PMCID: PMC6800787 DOI: 10.1037/hea0000780] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Understanding individual level factors associated with sexual risk behaviors among African-American adolescents remains an important public health priority. The current secondary data analysis examined the longitudinal association between a baseline assessment of depressive symptoms and sexual risk behaviors reported 6 months later; the purpose was to determine whether the association of depressive symptoms to risky sex varies as a function of gender. A secondary aim was to examine self-efficacy for sex refusal and condom use assessed at a 3-month follow-up as mediators of the depressive symptoms-sexual risk relationship. METHODS The sample consisted of 782 sexually active African-American adolescents (Mage = 15.3 years, SD = 1.08; 54% female) recruited to participate in a sexual health intervention trial. Data analyses focused on vaginal sex, and outcomes included: (a) sexual activity with 2 or more partners in the previous 3 months; (b) the relative frequency of condom use in the previous 3 months; (c) noncondom use at last occasion of sex; and (d) positive sexually transmitted infection (STI) screening. RESULTS Depressive symptoms predicted sex with 2 more partners for female participants, but no other risk markers for the sample as a whole. However, there was a significant indirect effect of depressive symptoms on condomless sex via decreased condom use self-efficacy for both male and female adolescents. CONCLUSIONS These findings have important implications for HIV/STI prevention, in which behavioral interventions may benefit from modules that include a focus on the influence of mood on self-efficacy for safer sex practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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20
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Rendina HJ, Millar BM, Dash G, Feldstein Ewing SW, Parsons JT. The Somatic Marker Hypothesis and Sexual Decision Making: Understanding the Role of Iowa Gambling Task Performance and Daily Sexual Arousal on the Sexual Behavior of Gay and Bisexual Men. Ann Behav Med 2019; 52:380-392. [PMID: 29684131 DOI: 10.1093/abm/kax006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The sexual decision-making literature suggests that sexual arousal and behavior are associated. The somatic marker hypothesis suggests that individual neuropsychological differences in decision making, as measured by the Iowa Gambling Task (IGT), may moderate these associations; however, this hypothesis has yet to be tested with event-level sexual behavior data. Purpose We hypothesized that (a) daily sexual arousal would be positively associated with likelihood of engaging in sex and condomless anal sex (CAS) and (b) IGT scores would moderate these associations such that the associations would be stronger among those with higher IGT scores. Methods We used daily diary data from 334 highly sexually active gay and bisexual men to examine the main and interaction effects of sexual arousal and IGT scores on sexual engagement and CAS. Results As hypothesized, daily sexual arousal was positively associated with greater odds of both sexual engagement and CAS with casual male partners. Individual-level IGT performance significantly moderated the day-level association between arousal and sexual engagement, which was stronger for men with higher IGT scores. There was no main effect of IGT scores on either sexual behavior outcome, nor did it moderate the association between arousal and CAS. Conclusions These findings highlight the influence of sexual arousal on sexual engagement, which differed by IGT scores; the effect of arousal on CAS was much less variable and may not be moderated by neurocognitive factors. This study supports the importance of exploring integrated behavioral/biomedical interventions to improve individual decision making to prevent HIV infection.
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Affiliation(s)
- H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), Park Avenue, New York, NY, USA.,Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brett M Millar
- Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Genevieve Dash
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | | | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), Park Avenue, New York, NY, USA.,Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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21
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Miltz AR, Lampe FC, Bacchus LJ, McCormack S, Dunn D, White E, Rodger A, Phillips AN, Sherr L, Clarke A, McOwan A, Sullivan A, Gafos M. Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial. BMC Public Health 2019; 19:431. [PMID: 31023281 PMCID: PMC6482482 DOI: 10.1186/s12889-019-6757-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers. Conclusions GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended. Trial registration ClinicalTrials.gov identifier: NCT02065986. Registered 19 February 2014 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6757-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ada R Miltz
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.
| | - Fiona C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ellen White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Andrew N Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | | | - Ann Sullivan
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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22
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Hu Y, Zhong XN, Peng B, Zhang Y, Liang H, Dai JH, Zhang J, Zhong XH, Huang AL. Comparison of depression and anxiety between HIV-negative men who have sex with men and women (MSMW) and men who have sex with men only (MSMO): a cross-sectional study in Western China. BMJ Open 2019; 9:e023498. [PMID: 30610021 PMCID: PMC6326305 DOI: 10.1136/bmjopen-2018-023498] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To compare the prevalence of depression, anxiety and comorbidity between HIV-negative men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) and examine the associated factors with depression and anxiety separately. DESIGN A cross-sectional study. SETTING The study was conducted in Western China. PARTICIPANTS From April 2013 to October 2014, 2422 participants aged 18-65 years, who were male at birth, had engaged in sex with male partners in the past 6 months, self-reported negative or unknown HIV status, were willing to participate and provided informed consent were recruited using non-probability sampling. An anonymous self-administered questionnaire was used to collect the data. A total of 1809 HIV-negative men who have sex with men (MSM) were eligible for the final analysis. RESULTS Of 1809 MSM, 16.1% were MSMW and 83.9% were MSMO. The prevalence of depression, anxiety and comorbidity was 50.86%, 36.43% and 32.65%, respectively, for MSMW; these results were higher than those for MSMO (35.18%, 23.52% and 18.91%, respectively). After adjusting for potential confounding factors, the prevalence of depression and anxiety was higher among MSMW than among MSMO. The prevalence of depression and/or anxiety was associated with young age, lower educational level, lower monthly income, lower HIV score and some risky sexual behaviour (had never engaged in HIV counselling, had obtained commercial sexual services in the past 6 months and sometimes/always looked for sexual partners through the internet). The prevalence of depression and anxiety was lower for those who drank less than once a week than for those who never drank. CONCLUSION Our findings suggest the need to address mental health among MSMW. Future health intervention strategies should integrate mental health services and traditional HIV prevention programmes and should consider the differences between MSMW and MSMO. TRIAL REGISTRATION NUMBER ChiCTR-TRC-13003849; Pre-results.
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Affiliation(s)
- Ying Hu
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiao-Ni Zhong
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Bin Peng
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yan Zhang
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Jiang-Hong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Sichuan, China
| | - Xiao-Hua Zhong
- Hospital of Sichuan International Studies University, Chongqing, China
| | - Ai-Long Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
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23
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Starks TJ, Robles G, Bosco SC, Dellucci TV, Grov C, Parsons JT. The Prevalence and Correlates of Sexual Arrangements in a National Cohort of HIV-Negative Gay and Bisexual Men in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:369-382. [PMID: 30465312 PMCID: PMC6349557 DOI: 10.1007/s10508-018-1282-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/31/2018] [Accepted: 07/26/2018] [Indexed: 05/22/2023]
Abstract
Sexual agreements have received considerable attention as an aspect of dyadic functioning associated with HIV risk. To date, this research has primarily utilized convenience samples which overrepresented men from large urban areas and with higher HIV risk. The current study utilized a national cohort of 1061 HIV-negative gay and bisexual men recruited to be geographically diverse within the U.S. The sample included 531 (50.0%) men who identified as single. Of the 530 partnered men, 240 (45.3%) were monogamous; 238 (44.9%) were in open relationships (where sex with outside partners was permitted); and 52 (9.8%) were in monogamish relationships (where sex with outside partners was limited to instances where both primary partners were present). Regardless of urban (vs. non-urban) residence, men in monogamous relationships engaged in less anal sex generally and condomless anal sex (CAS) specifically with casual partners. Single men reported significantly more frequent anal sex with casual partners compared to open and monogamish men; however, there were no significant differences among these three groups with respect to CAS with casual partners. In multivariable models, monogamish men reported significantly more frequent marijuana use and alcohol consumption compared to all other groups. Urban (vs. non-urban) residence moderated associations between sexual arrangements and depression as well as the use of illicit drugs other than marijuana. These findings point to the need to better examine the potentially unique mechanisms which confer risk and resilience for gay male couples in urban versus non-urban settings. The observed association between sexual arrangements and substance use suggests interventions which facilitate the negotiation of sexual agreements may present an opportunity to engage in dyadic substance use intervention.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Gabriel Robles
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
| | - Stephen C Bosco
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Trey V Dellucci
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA.
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
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24
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Brady JP, Nogg KA, Rozzell KN, Rodriguez-Diaz CE, Horvath KJ, Safren SA, Blashill AJ. Body image and condomless anal sex among Young Latino sexual minority men. Behav Res Ther 2018; 115:129-134. [PMID: 30420133 DOI: 10.1016/j.brat.2018.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate body image and condomless anal sex (CAS) among young Latino sexual minority men (SMM)-a population with health disparities in HIV and body image concerns. METHODS Participants were 151 young Latino SMM from the San Diego area who were HIV-negative or unknown. Participants completed a questionnaire online in either English or Spanish, which included body image and sexual behavior items. A binary CAS variable was created based on the number of CAS partners reported (0 vs 1 + over past 3 months). A logistic regression was conducted with body dissatisfaction, appearance investment, and their interaction term entered as predictor variables and CAS as the outcome. RESULTS Of 151 participants, 54 (35.8%) reported no CAS in the past 3 months. Appearance investment, but not body dissatisfaction, was associated with higher odds of CAS. However, a significant interaction indicated that body dissatisfaction was associated with higher odds of CAS when appearance investment was high. CONCLUSIONS Young Latino SMM who are highly invested in, and dissatisfied with, their appearance may be at significantly increased risk for acquiring HIV through elevated odds of CAS. Reducing appearance concerns in this population may lead to reductions in HIV risk behaviors.
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Affiliation(s)
- John P Brady
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, Department of Psychology, 6363 Alvarado Ct., San Diego, CA, 92120, United States.
| | - Kelsey A Nogg
- San Diego State University, Department of Psychology, 5500 Campanile Dr., San Diego, CA, 92182, United States.
| | - Kaitlin N Rozzell
- San Diego State University, Department of Psychology, 5500 Campanile Dr., San Diego, CA, 92182, United States.
| | - Carlos E Rodriguez-Diaz
- University of Puerto Rico-Medical Sciences Campus, Graduate School of Public Health, PO Box 365067, San Juan, PR, 00936-5067, United States.
| | - Keith J Horvath
- University of Minnesota, School of Public Health, 1300 S 2nd St, Room 300 West Bank Office Building, Minneapolis, MN, 55454, United States.
| | - Steven A Safren
- University of Miami, College of Arts & Sciences, P.O. Box 248185, Coral Gables, FL, 33124-0751, United States.
| | - Aaron J Blashill
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, Department of Psychology, 6363 Alvarado Ct., San Diego, CA, 92120, United States; San Diego State University, Department of Psychology, 5500 Campanile Dr., San Diego, CA, 92182, United States.
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25
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Safren SA, Blashill AJ, Lee JS, O’Cleirigh C, Tomassili J, Biello KB, Mimiaga MJ, Mayer KH. Condom-use self-efficacy as a mediator between syndemics and condomless sex in men who have sex with men (MSM). Health Psychol 2018; 37:820-827. [PMID: 29927272 PMCID: PMC6107409 DOI: 10.1037/hea0000617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Among men who have sex with men (MSM), HIV sexual risk and poor self-care behavior is associated with syndemics, or co-occurring psychosocial problems. Though prior research has demonstrated an additive total effect of syndemics on HIV risk behavior and infection, mostly within cross-sectional designs, it is possible that these associations are not direct but rather that syndemics disrupt relevant individual-level mediating psychological variables. One of the more common individual-level psychological variables that predicts health behavior generally, and HIV risk behavior specifically, is self-efficacy. This study sought to examine the potential effects of syndemics on condomless sex via condom-use self-efficacy as an intermediary variable. METHOD In high-risk MSM (N = 197), across 3 time points (baseline, 3 months, and 6 months) we used latent growth curve modeling to test the degree to which self-efficacy mediated the relationship between syndemics (heavy alcohol use, substance use disorder, sexual compulsivity, depression, social anxiety, intimate partner violence, childhood sexual abuse) and condomless anal sex. RESULTS The baseline analyses were consistent with an indirect effect of the association between syndemics and condomless sex through self-efficacy. Prospective longitudinal mediation was partially supported, such that baseline syndemics were associated with lower baseline self-efficacy, which in turn predicted higher increases in condomless anal sex across time. CONCLUSIONS These findings provide preliminary evidence (due to the partial support for the longitudinal model) that syndemics themselves may not be directly causal in their association with condomless sex, but the association may be through modifiable social-cognitive mechanisms such as condom self-efficacy. (PsycINFO Database Record
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Affiliation(s)
- Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Fenway Institute at Fenway Health, Boston, MA, USA
| | - Aaron J. Blashill
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jasper S. Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Fenway Institute at Fenway Health, Boston, MA, USA
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Julia Tomassili
- Department of Psychology, Sacramento State University, Sacramento, CA, USA
| | - Katie B. Biello
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Matthew J Mimiaga
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Kenneth H. Mayer
- Fenway Institute at Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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26
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Parsons JT, Antebi-Gruszka N, Millar BM, Cain D, Gurung S. Syndemic Conditions, HIV Transmission Risk Behavior, and Transactional Sex Among Transgender Women. AIDS Behav 2018; 22:2056-2067. [PMID: 29589136 DOI: 10.1007/s10461-018-2100-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examined the effect of four syndemic conditions-namely, polydrug use, depression, childhood sexual abuse, and intimate partner violence-on rates of HIV transmission risk behavior (TRB) and separately, transactional sex among transgender women. TRB was defined as the number of condomless penetrative sex events with a casual or main partner of discordant or unknown HIV status. Using data from 212 transgender women in New York City, multivariable analyses revealed that, compared to those with no syndemic conditions, dramatically higher rates of recent HIV TRB events (ARR = 8.84, p < 0.001) and recent transactional sex events (ARR = 8.32, p < 0.001) were reported by participants with all four syndemic conditions. These findings highlight the importance of considering the role of syndemic conditions in HIV risk among transgender women, and the need for comprehensive psychosocial interventions to improve sexual health among this population.
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27
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Impact of insurance coverage on HIV transmission potential among antiretroviral therapy-treated youth living with HIV. AIDS 2018; 32:895-902. [PMID: 29424777 DOI: 10.1097/qad.0000000000001772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the prevalence of high HIV transmission potential in a cohort of youth living with HIV (YLWH), and determine the impact of insurance coverage on potential for HIV transmission. DESIGN Retrospective cohort study of antiretroviral therapy (ART)-treated YLWH at a US adolescent HIV clinic, 2002-2015. METHODS The primary exposure was presence or absence of insurance, defined as private, public or pharmacy-only coverage. The primary outcome was high HIV transmission potential, defined as time-concurrent incident bacterial sexually transmitted infections (STI) (gonorrhea, chlamydia or syphilis) and HIV RNA greater than 1500 copies/ml. Marginal structural models adjusting for baseline demographic covariates, prior history of STI and time-varying retention in care assessed the relationship between insurance status and HIV transmission potential. RESULTS Participants (n = 240) were followed for a median of 22 (IQR 8.1-49) months after ART initiation, and were predominately African-American men and transgender women who have sex with men, with a median age at HIV diagnosis of 19 years (IQR 17-21). We identified 37 (15%) participants with at least one episode of high HIV transmission potential. Insurance coverage was associated with a greater than 50% lower odds of high HIV transmission potential (aOR 0.46, 95% CI 0.26-0.84), and history of STI at or before entry to HIV care conferred more than three-fold higher odds of high transmission potential (aOR 3.21, 95% CI 1.55-6.63). CONCLUSION We found 15% of YLWH to have episodic high HIV transmission potential despite receiving ART. Insurance coverage, including pharmacy-only benefits, was protective against transmission risk, suggesting a pivotal role for universal ART coverage in treatment as prevention.
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28
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Choi KW, Batchelder AW, Ehlinger PP, Safren SA, O’Cleirigh C. Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories. J Consult Clin Psychol 2017; 85:1158-1170. [PMID: 29189032 PMCID: PMC5724394 DOI: 10.1037/ccp0000241] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE High rates of depression and posttraumatic stress disorder (PTSD) contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a network approach to (a) characterize symptom interconnections between depression and PTSD in MSM, (b) identify specific symptoms related to sexual risk behavior, and (c) compare symptom networks across groups at different levels of risk. METHOD Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multisite randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. RESULTS Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient and protective for lower-risk individuals. CONCLUSIONS This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention. (PsycINFO Database Record
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Affiliation(s)
- Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA
| | | | - Steven A. Safren
- The Fenway Institute, Fenway Community Health, Boston, MA
- University of Miami, Miami, FL
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA
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29
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Cain DN, Mirzayi C, Rendina HJ, Ventuneac A, Grov C, Parsons JT. Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men. LGBT Health 2017; 4:352-359. [PMID: 28792886 DOI: 10.1089/lgbt.2017.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Depression negatively impacts the health and well-being of gay and bisexual men (GBM). However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health. The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators. METHODS A nationally representative sample of 1071 GBM (mean age = 40.24) was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized. RESULTS In a path analysis model adjusted for race/ethnicity, college education, age, and relationship status, higher population density was significantly associated with increased social support (B = 0.11, P = 0.002) and decreased internalized homonegativity (B = -0.06, P < 0.001). In turn, lower social support (B = -2.93, P < 0.001) and greater internalized homonegativity (B = 4.93, P < 0.001) were significantly associated with greater depressive symptoms. The indirect effects of population density on depression through social support (B = -0.33, P < 0.001) and internalized homonegativity (B = -0.31, P < 0.001) were statistically significant, suggesting evidence for mediation of the effects. CONCLUSIONS These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.
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Affiliation(s)
- Demetria N Cain
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,2 Community Health Sciences Doctoral Program, Community Health Sciences, University of Illinois at Chicago School of Public Health , Chicago, Illinois
| | - Chloe Mirzayi
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - H Jonathon Rendina
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
| | - Ana Ventuneac
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,6 Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Christian Grov
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,3 Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy , New York, New York
| | - Jeffrey T Parsons
- 1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.,4 Department of Psychology, Hunter College of the City University of New York (CUNY) , New York, New York.,5 Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY) , New York, New York
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30
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Chen YH, Raymond HF. Associations between depressive syndromes and HIV risk behaviors among San Francisco men who have sex with men. AIDS Care 2017; 29:1538-1542. [PMID: 28366006 DOI: 10.1080/09540121.2017.1307925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV prevention plans for men who have sex with men (MSM) are often multifaceted. They involve reduction of sexual risk behaviors, such as condomless intercourse, but also often include pharmaceutical approaches, such as early treatment of HIV-infected individuals with antiretroviral therapy (ART). Effectiveness is possibly threatened by individual-level factors, such as depression. In this study of 322 San Francisco MSM (240 HIV-uninfected individuals and 82 HIV-infected individuals, according to self-report), we examine associations between depressive syndromes and HIV risk behaviors (sexual risk behaviors and ART non-adherence). Our study failed to find evidence that depressive syndromes lead to increases in ART non-adherence (risk difference, RD: 27.9; 95% confidence interval, CI: -3.5, 59.3). However, the study does suggest an association between depressive syndromes and concurrence of non-adherence and potentially HIV-discordant condomless receptive anal intercourse (RD: 36.0; 95% CI: 5.2, 66.8). Among HIV-uninfected MSM, our study suggests negative associations between depressive syndromes and sexual risk behaviors. We recommend screening and treatment of depression among HIV-infected MSM.
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Affiliation(s)
- Yea-Hung Chen
- a Department of Public Health , Center for Public Health Research , San Francisco , USA
| | - Henry Fisher Raymond
- a Department of Public Health , Center for Public Health Research , San Francisco , USA.,b Department of Epidemiology and Biostatistics , University of California , San Francisco , USA
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