Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru?

Correlates of high phosphatidylethanol (PEth) levels and their concordance with self-reported heavy alcohol consumption among men who have sex with men who binge drink alcohol

BACKGROUND

Heavy alcohol use, including binge drinking, is associated with high morbidity and mortality among men who have sex with men (MSM). Self-reported alcohol measures may lead to inaccurate estimates due to recall and social desirability biases. Objective alcohol biomarkers like phosphatidylethanol (PEth) can be used to corroborate self-report and could help to inform treatment approaches and research strategies for alcohol using MSM.

METHODS

From 2015 to 2020, alcohol using MSM ≥18 years were enrolled in a randomized controlled trial evaluating the efficacy of naltrexone in reducing binge drinking. Using this trial's baseline data, we applied multivariable logistic regression to identify the correlates of high PEth levels (i.e., ≥87 ng/ml) and concordance between PEth levels and self-reported heavy drinking.

RESULTS

Of 118 MSM, 64% had PEth levels ≥87 ng/ml and 72% had PEth levels that were concordant with self-reported heavy alcohol use. Factors significantly associated in separate models with elevated PEth levels were income ≥$60,000 (adjusted odds ratio [aOR] = 4.09; 95% CI = 1.13 to 14.82), being employed (aOR = 4.04; 95% CI = 1.45 to 11.32), episodic cannabis use (aOR = 4.63; 95% CI = 1.27 to 16.92), and any alcohol/substance use prior to or during anal intercourse (aOR = 2.52; 95% CI = 1.08 to 5.90). Living with HIV was associated with significantly lower odds of elevated PEth levels (aOR = 0.23; 95% CI = 0.09 to 0.61). Factors associated with significantly higher concordance between PEth levels and self-reported heavy alcohol use included at least weekly use of poppers (aOR = 6.41; 95% CI = 1.27 to 32.28) and polysubstance use (aOR = 2.53; 95% CI = 1.02 to 6.27). Living with HIV was associated with lower odds of concordance (aOR = 0.36; 95% CI = 0.14 to 0.97).

CONCLUSIONS

PEth may enhance the detection of heavy drinking among MSM, including the identification of subpopulations that may benefit from targeted alcohol reduction interventions. However, PEth values for MSM living with HIV showed modest concordance with self-reported alcohol use and may need to be supplemented with additional biomarkers or evaluated against a different cutoff.

Transactional sex, HIV and health among young cisgender men and transgender women who have sex with men in Thailand

PURPOSE

To examine how recent sex work is identified and the HIV risk factors and service needs among Thai cisgender men who have sex with men (MSM) and transgender women (TGW) who exchange sex.

METHODS

MSM and TGW in Bangkok and Pattaya who exchanged sex in the last year (n = 890) were recruited through social media, outreach, and word-of-mouth. Recent sex exchange was based on the primary question, "In the last 30 days, have you sold or traded sex"; secondary questions (regarding income source and client encounters) were also investigated.

RESULTS

Overall, 436 (48%) participants engaged in sex work in the last 30 days; among those, 270 (62%) reported exchanging sex by the primary question, and 160 (37%) based on secondary questions only. Recent sex exchange was associated with gonorrhea, syphilis, discussing PrEP with others, and using condoms, alcohol, methamphetamine, amyl nitrate, and Viagra. Exchanging sex based on secondary questions only was associated with being in a relationship, social media recruitment, less recent anal intercourse, and not discussing PrEP.

CONCLUSIONS

Thai MSM and TGW who exchange sex need regular access to HIV/STI prevention, testing, and treatment services, and multiple approaches to assessing sex work will help identify and serve this diverse and dynamic population.

Trauma and Alcohol Use Among Transgender and Gender Diverse Women: An Examination of the Stress-Buffering Hypothesis of Social Support

Transgender and gender diverse (TGD) women (i.e., individuals who were assigned male at birth and identify as women or trans women) experience trauma at disproportionate rates compared to cisgender populations. While trauma is associated with increased alcohol use among TGD women, research regarding factors that are protective of this association is scant. The stress-buffering hypothesis of social support suggests that perceived social support, defined as the judgment that social network members will be helpful when individuals experience stress, may buffer and reduce the association between trauma symptoms and alcohol use. However, this relationship has not been examined among TGD women. We examined whether perceived social support moderates the association between trauma and alcohol use among 89 TGD women. Exploratory multiple regression analyses provided support for this hypothesis, insofar as trauma symptoms were related to alcohol use by individuals with low, relative to high levels of perceived social support. Exploratory analyses demonstrated that this finding was driven by perceived social support from friends and family. Our results are the first to suggest that social support reduces alcohol use among TGD women and add to the literature on their trauma and alcohol use.

Screening, Counseling, and Shared Decision Making for Alcohol Use with Transgender and Gender-Diverse Populations

At-risk alcohol use occurs among transgender and gender-diverse (TGD) populations, yet current alcohol use screening tools and guidelines do not distinguish between sex- and gender-related characteristics, having been developed without accounting for natal sex-based physiology, effects of gender-affirming medical care, and gendered drinking behavior among TGD people. More research on how sex- and gender-related factors independently influence alcohol use can help validate gender-inclusive screening protocols and develop evidence-based guidelines meaningful for people of all genders. In the interim, clinicians must be mindful of gender diversity and engage in transparent, collaborative discussions when screening for and counseling about alcohol use.

Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial

Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.

High-Risk, but Hidden: Binge Drinking among Men Who Have Sex with Men and Transgender Women in Lima, Peru, 2012-2014

Background: Binge drinking (BD) is common in Peru, but may not be routinely detected by standard assessments of hazardous drinking. Objectives: We describe prevalence and risk behaviors of men who have sex with men (MSM) and transgender women (TW) in Peru who met criteria for BD as compared with those who met criteria for hazardous drinking. Methods: In a cross-sectional sample of MSM and TW from Lima (2012-2014), we calculated prevalence of BD (consuming ≥6 alcoholic drinks per occasion by AUDIT-3 criteria), conducted bivariate analyses of associations of BD with demographic and behavioral characteristics, and compared prevalence and behaviors of BD to those of hazardous drinkers (identified by AUDIT-10 criteria). Results: Of 1,520 MSM (n = 1,384) and TW (n = 137) with median age 27 years, 74.4% of MSM and 86.9% of TW met criteria for BD. Among MSM, BD was associated with a greater likelihood of using alcohol (41.6% vs. 13.8%; p < .01) or drugs (7.8% vs. 2.8%; p < .01) prior to a recent sexual contact. Among TW, BD was associated with greater frequency of alcohol use (44.9% vs. 11.1%; p < .01) or unprotected anal intercourse (58.8% vs. 33.3%; p = .04) during ≥1 of their three most recent sexual contacts. There was a higher prevalence of BD (75.5%) than hazardous drinking (53.2%) in our sample, with binge drinkers exhibiting similar sexual risk behaviors to hazardous drinkers. Conclusions: Binge drinking is common among MSM and TW in Lima, associated with risky sexual behavior, and may not be adequately captured by AUDIT-10 criteria.

Alcohol use and binge drinking among men who have sex with men in China: Prevalence and correlates

BACKGROUND

Both alcohol use/misuse and HIV incidence are increasing among men who have sex with men (MSM) in China. Little is known about predictors of alcohol use/misuse.

METHODS

An online nationwide sample (n = 1100) of MSM from mainland China was recruited between 2014 and 2015. The study objective was to examine the prevalence of a history of alcohol use and frequency of binge drinking in the previous 6 months in this population and assess their relationship with psychological and public health issues.

RESULTS

Nearly 62.1% of respondents reported a history of alcohol use; 30.7% were current infrequent binge drinkers; and 13.6% were current frequent binge drinkers. Adjusted logistic models showed that MSM who reported a history of alcohol use were more likely to report drug use in the previous 6 months (AOR = 1.67); higher levels of internalized homophobia (AOR = 1.49); and partial or full disclosure of their sexual orientation (AOR = 1.46). MSM engaging in current frequent binge drinking were more likely to report female sexual partners (AOR = 2.04) and drug use (AOR = 1.61) in the previous 6 months; higher levels of sexual sensation seeking (AOR = 1.68); and higher levels of homosexual stigma (AOR = 1.69). MSM who reported being unsure of their HIV status were less likely to be current frequent binge drinkers (AOR = 0.46).

CONCLUSIONS

A high prevalence of a history of alcohol use and binge drinking exists among Chinese MSM. Strategies that target alcohol use/misuse in this population are needed.