Changes in developmental contexts as predictors of transitions in HIV-risk behaviors among young men who have sex with men (YMSM)

Pride in our community: Reflecting on LGBTQ publications in the American Journal of Community Psychology

In this Virtual Special Issue (VSI), we curate and discuss a set of 28 articles previously published in the American Journal of Community Psychology (AJCP) focused on lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. The purpose of this VSI is to bring visibility to this body of scholarship in AJCP and to reflect on how the strengths of our field have been used throughout this work in pursuit of supporting LGBTQ wellbeing. In this VSI, we first discuss articles that help to set the historical background for publications in AJCP. We then discuss papers under the broad themes of HIV/AIDS, identities within ecological context, and social activism among LGBTQ communities. We then reflect on opportunities for our field to further leverage our strengths in contributing to LGBTQ scholarship. Overall, this VSI celebrates the contributions to LGBTQ research already present in AJCP, and we hope inspires future contributions to the pages of AJCP and beyond.

Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men

As individual sexual behavior is variable over time, the timing of interventions might be vital to reducing HIV transmission. We aimed to investigate transitions between HIV risk levels among men who have sex with men (MSM), and identify determinants associated with behavior change. Participants in a longitudinal cohort study among HIV-negative MSM (Amsterdam Cohort Studies) completed questionnaires about their sexual behavior during biannual visits (2008-2017). Visits were assigned to different HIV risk levels, based on latent classes of behavior. We modelled transitions between risk levels, and identified determinants associated with these transitions at the visit preceding the transition using multi-state Markov models. Based on 7,865 visits of 767 participants, we classified three risk levels: low (73% of visits), medium (22%), and high risk (5%). For MSM at low risk, the six-month probability of increasing risk was 0.11. For MSM at medium risk, the probability of increasing to high risk was 0.08, while the probability of decreasing to low risk was 0.33. For MSM at high risk, the probability of decreasing risk was 0.43. Chemsex, erection stimulants and poppers, high HIV risk perception, and recent STI diagnosis were associated with increased risk at the next visit. High HIV risk perception and young age were associated with decreasing risk. Although the majority of MSM showed no behavior change, a considerable proportion increased HIV risk. Determinants associated with behavior change may help to identify MSM who are likely to increase risk in the near future and target interventions at these individuals, thereby reducing HIV transmission.

Substance Use and Sexual Risk Behavior Among Black Men Who Have Sex With Men in New York City: Evidence for Increased Risk During Young Adulthood

This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18-26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission-particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.

Historical and Developmental Changes in Condom Use Among Young Men Who Have Sex with Men Using a Multiple-Cohort, Accelerated Longitudinal Design

Young men who have sex with men (YMSM) have the highest HIV incidence in the U.S. The last 5 years has seen emergence of new methods for HIV prevention and societal shifts in gay rights. It is important to understand if there have been generational shifts in condom use during the developmental transition from adolescents to young adulthood. To disentangle history from development, we require a multiple-cohort, longitudinal design-a methodology never before applied to study YMSM. We followed three cohorts of YMSM recruited in 2007, 2010, and 2015 (N = 1141) from the ages of 17-26 years and modeled their longitudinal change over time in counts of anal sex acts and the ratio of condomless anal sex (CAS) acts to anal sex acts using latent curve growth modeling. We found that there was no significant developmental change in raw counts of anal sex acts, but there was a significant decline in the ratio of anal sex acts that were condomless. We also found significantly different patterns for ratio of CAS acts for the 2015 cohort. The 2015 cohort reported a significantly lower ratio of CAS acts at age 17, but significantly higher growth in ratio of CAS acts over development. The present study suggests that YMSM recruited in 2015 have very different trajectories of CAS compared to previous cohorts, including lower risk in late adolescence, but with the potential for higher risk after the transition into adulthood.

Perceived social support, problematic drug use behaviors, and depression among prescription drugs-misusing young men who have sex with men

This study examined the relationship of perceived social support with problematic drug use behaviors and depression among young men who have sex with men (YMSM). A diverse sample of 191 substance-using YMSM (aged 18-29 years) reported on perceived social support, high-risk drug use behaviors (i.e., polydrug use and use of drugs before sex in the past 6 months, and lifetime injection drug use), and depression. Associations were examined using bivariate and multivariable logistic regression. Participants receiving higher levels of family social support were at lower odds of reporting polydrug use, drug use before sex, and depressive symptomology. Individuals with higher levels of friends' social support were at lower odds of reporting polydrug use, drug use before sex, and depression. Participants receiving higher levels of support from a special other were at lower odds of reporting depression. Intervention efforts should address YMSM's capacity to build supportive relationships and obtain adequate social support.

Motivations for alcohol use to intoxication among young adult gay, bisexual, and other MSM in New York City: The P18 Cohort Study

INTRODUCTION

Motivations for alcohol use to intoxication vary among young adults depending on social setting and other contextual factors. However, there is limited research exploring the role of different drinking motivations among young men who have sex with men (YMSM).

METHODS

Data from a racially/ethnically and socioeconomically diverse sample of YMSM (n = 426) were used to examine associations between recent (last 30 days) alcohol use to intoxication and scores on three distinct drinking motivation subscales: convivial, intimate, and negative coping drinking. Multinomial logistic regression models were constructed to examine associations between drinking motivations and days of alcohol use to intoxication, controlling for sociodemographic characteristics.

RESULTS

YMSM who scored higher on all three drinking motivation subscales were more likely to engage in recent alcohol use to intoxication compared to those who reported no alcohol use to intoxication. In multivariable models, Black and Hispanic YMSM had lower odds of intoxication compared to White YMSM, and those reporting lower perceived familial SES had lower odds compared to higher SES. In a final model including all three motivations, only convivial drinking was significantly associated with days of intoxication (1-2 days: AOR = 1.22; 3+ days: AOR = 1.45).

CONCLUSIONS

This study identifies distinct associations between different motivations for drinking and alcohol use to intoxication in a sample of YMSM. These findings highlight a need to incorporate an understanding of motivations for alcohol use to intoxication into research and clinical practice with YMSM, as different reasons for drinking carry respective potential health risks.

Sexual Health Education for Adolescent Males Who Are Interested in Sex With Males: An Investigation of Experiences, Preferences, and Needs

PURPOSE

There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior.

METHODS

AMSM (N = 207; ages 14-17) in the United States completed an online sexual health survey. Bivariate associations between sexual education exposure/preferences by sexual behavior were assessed using Fisher's exact tests and one-way analyses of variance.

RESULTS

Eighty-nine (43%) participants reported no sexual contact with male partners, 77 (37%) reported sexual contact without condomless anal sex, and 41 (20%) reported condomless anal sex. Participants received sexual health information from their parents/guardians (n = 122, 59%), formal sources (n = 160, 78%), and the Internet (n = 135, 65%). The most commonly covered topics by parents/guardians and formal sources were how to say no to sex, how to prevent HIV and other sexually transmitted infections, and methods of birth control. The most common online-researched topics were how to safely have anal sex, the types of sex you can have with a male partner, how to use a condom, and how to use lubrication. Participants noted preferring a sexually-explicit online sexual health program that addresses male-male sex.

CONCLUSIONS

Online sexual education programs that explicitly address male-male sex are needed. Tailored programs can help AMSM develop healthy sexual behaviors and decrease their HIV/STI risk.

Setting an Agenda to Address Intimate Partner Violence Among Young Men Who Have Sex With Men: A Conceptual Model and Review

Research investigating intimate partner violence (IPV) among sexual minorities is limited. The research that does exist has found that rates of IPV are similar to or higher than the rates found for heterosexual women, the most commonly studied population in this area. This limited research has resulted in a dearth of prevention/intervention programs targeted for these populations. While some may argue that existing IPV programs can be used for these populations, this review presents an argument for more targeted work with sexual minority populations, using young men who have sex with men (YMSM) as an example. Drawing on the framework of intersectionality, this article argues that the intersectionality of age, sexual identity, and gender combines to create a spectrum of unique factors that require specific attention. This framework allows for the identification of known correlates for IPV as well as factors that may be unique to YMSM or other sexual minority populations. The article presents a conceptual model that suggests new areas of research as well as a foundation for the topics and issues that should be addressed in an intervention.

Sexual behavior across the transition to adulthood and sexually transmitted infections: Findings from the national survey of human papillomavirus prevalence (POP-Brazil)

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history.We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender.There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P < .001). The use of alcohol and drugs and the use of drugs before sexual intercourse impact in STIs equally between the genders. Exclusive for women, the presence of any STI was associated with the practice of vaginal sex and other types of intercourse (adjusted prevalence ratio [APR] 1.43, 95% CI 1.08-1.88). For men, the number of sexual partners in the last year (APR 1.02, 95% CI 1.01-1.04), not having vaginal sex (APR 3.25, 95% CI 1.78-5.92) and sexual experience with someone of the same sex (APR 4.05, 95% CI, 2.88-5.70) were associated with a higher presence of STIs.This is the first report regarding sexual behavior in a nationally representative population sample in Brazil. This study provides more valid estimates of sexual behavior and associated STIs, identifying important differences in sexual behavior and identifying predictors for referred STIs among females and males.

"It Was Supposed To Be a Onetime Thing": Experiences of Romantic and Sexual Relationship Typologies Among Young Gay, Bisexual, and Other Men Who Have Sex with Men

Young gay, bisexual, and other men who have sex with men (MSM) are at elevated risk for HIV infection, highlighting the need to understand the elements of prevention and risk associated with their relationships. We employed a phenomenological approach to explore how young MSM become involved in different romantic and sexual experiences. We analyzed 28 semi-structured interviews conducted with young MSM living in Michigan. Using a phenomenological approach, we analyzed the data using an inductive coding strategy and thematic analysis. Participants defined their romantic and sexual interactions with a limited set of partner classifications (e.g., dating, hooking up, friends-with-benefits), but recognized how these classifications were shifting, sometimes unexpectedly so (e.g., a date turning into a hook up and vice versa). Young MSM described relationships in transition that at times defied available typologies or hybridized elements of multiple partner types at once. Based on our analyses, we underscore the need to acknowledge the fluctuating and contextual nature of young MSM's romantic and sexual experiences. We discuss the relevance of our findings in terms of the developmental period of young adulthood and the implications our findings have HIV prevention efforts among young MSM.

Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort Study

BACKGROUND

HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use.

OBJECTIVES

We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era.

METHODS

Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status.

RESULTS

Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.

Trajectories of alcohol, marijuana, and illicit drug use in a diverse sample of young men who have sex with men

INTRODUCTION

Cross-sectional research has found that young men who have sex with men (YMSM) are more likely to engage in heavy drinking and to have higher rates of marijuana and other illicit drug use compared to their heterosexual peers, but considerably less is known about their patterns of substance use over time.

METHODS

In this study, we combined two longitudinal samples of racially diverse YMSM (N=552) and modeled their substance use trajectories from late-adolescence to young adulthood, including their frequency of alcohol use, frequency of marijuana use, and poly-drug use, using piecewise latent curve growth modeling to model change from ages 17-21 and change from ages 22-24.

RESULTS

We found that all three substance use behaviors increased linearly over the adolescent-to-adult transition. The trajectories for all three substance use behaviors were significantly correlated from ages 17-21. Black YMSM had significantly lower growth from ages 17-21 in alcohol, marijuana, and poly-drug use compared to White YMSM. Hispanic/Latino YMSM had significantly higher growth from ages 22-24 in alcohol use but significantly lower growth in poly-drug use compared to White YMSM. YMSM with higher alcohol frequency slopes and YMSM with higher marijuana use slopes were more likely to have alcohol-related and marijuana-related problems, respectively, at the last wave of the study.

CONCLUSIONS

The results of the present study suggest that the transition from adolescence to adulthood for YMSM is a time of increasing and co-varying substance use and may be a critical period for substance use behaviors to grow into substance use problems.

Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior

Behavioral interventions to reduce sexual risk behavior depend on strong health behavior theory. By identifying the psychosocial variables that lead causally to sexual risk, theories provide interventionists with a guide for how to change behavior. However, empirical research is critical to determining whether a particular theory adequately explains sexual risk behavior. A large body of cross-sectional evidence, which has been reviewed elsewhere, supports the notion that certain theory-based constructs (e.g., self-efficacy) are correlates of sexual behavior. However, given the limitations of inferring causality from correlational research, it is essential that we review the evidence from more methodologically rigorous studies (i.e., longitudinal and experimental designs). This systematic review identified 44 longitudinal studies in which investigators attempted to predict sexual risk from psychosocial variables over time. We also found 134 experimental studies (i.e., randomized controlled trials of HIV interventions), but of these only 9 (6.7 %) report the results of mediation analyses that might provide evidence for the validity of health behavior theories in predicting sexual behavior. Results show little convergent support across both types of studies for most traditional, theoretical predictors of sexual behavior. This suggests that the field must expand the body of empirical work that utilizes the most rigorous study designs to test our theoretical assumptions. The inconsistent results of existing research would indicate that current theoretical models of sexual risk behavior are inadequate, and may require expansion or adaptation.

Sex Partnership and Self-Efficacy Influence Depression in Chinese Transgender Women: A Cross-Sectional Study

BACKGROUND

Transgender women often suffer from transition-related discrimination and loss of social support due to their gender transition, which may pose considerable psychological challenges and may lead to a high prevalence of depression in this population. Increased self-efficacy may combat the adverse effects of gender transition on depression. However, few available studies have investigated the protective effect of self-efficacy on depression among transgender women, and there is a scarcity of research describing the mental health of Chinese transgender women. This study aims to describe the prevalence of depression among Chinese transgender women and to explore the associated factors.

METHODS

A cross-sectional study was conducted in Shenyang, Liaoning Province of China by convenience sampling from January 2014 to July 2014. Two hundred and nine Chinese transgender women were interviewed face-to-face with questionnaires that covered topics including the Zung Self-Rating Depression Scale (SDS), demographic characteristics, transition status, sex partnership, perceived transgender-related discrimination, the Multidimensional Scale of Perceived Social Support (MSPSS) and the adapted General Self-efficacy Scale (GSES). A hierarchical multiple regression analysis was performed to explore the factors associated with SDS scores.

RESULTS

The prevalence of depression among transgender women was 45.35%. Transgender women with regular partners or casual partners exhibited higher SDS scores than those without regular partners or casual partners. Regression analyses showed that sex partnership explained most (16.6%) of the total variance in depression scores. Self-efficacy was negatively associated with depression.

CONCLUSIONS

Chinese transgender women experienced high levels of depression. Depression was best predicted by whether transgender women had a regular partner or a casual partner rather than transgender-related discrimination and transition status. Moreover, self-efficacy had positive effects on attenuating depression due to gender transition. Therefore, interventions should focus on improving the sense of self-efficacy among these women to enable them to cope with depression and to determine risky sex partnership characteristics, especially for regular and casual partners.

Modeling substance use in emerging adult gay, bisexual, and other YMSM across time: the P18 cohort study

OBJECTIVE

To examine patterns of substance use over time in a new generation of emerging adult gay, bisexual, and other young men who have sex with men (YMSM).

METHODS

Data were drawn from the first four waves of on ongoing prospective cohort study of YMSM who were ages 18 to 19 at baseline and were assessed each 6 months for substance use via calendar based methods. Latent growth curve modeling was utilized to assess changes over time for four drug use categories: alcohol, marijuana, inhalant nitrates, and other drugs (e.g., cocaine, ecstasy) and between groups (race/ethnicity, perceived familial socioeconomic status; SES).

RESULTS

Use of all substances increased steadily across the follow-up period. White YMSM demonstrated higher levels of alcohol use at the 18-mo follow-up visit compared to other racial/ethnic groups, while rates of change across groups were similar. Marijuana use at 18 months was highest for Hispanics who also indicated the highest rate of change. Finally, YMSM who reported higher perceived SES reported the lowest use and lowest rates of change for other drug use. Controlling for perceived SES, differences in patterns of drug use by race/ethnicity were evident but differences were not as large.

CONCLUSIONS

Increases in substance use in the emerging adulthood of YMSM indicate the need for structural and behavioral interventions tailored to address substance use in these young men before chronic patterns of use develop. Differences in patterns of drug use across racial/ethnic and SES groups suggest that interventions need to consider person-level differences.

Intimacy, monogamy, and condom problems drive unprotected sex among young men in serious relationships with other men: a mixed methods dyadic study

This mixed methods study aimed to examine partner and relationship characteristics associated with HIV risk among young men who have sex with men (YMSM). A sub-sample of YMSM (18-25 years) who were involved in serious relationships with other men were recruited from two on-going longitudinal studies, Project Q2 and Crew450 (N = 20 couples). The mean age of the dyadic sample was 22.5 years (SD = 5.33, range 18-46 years) and participants were racially and ethnically diverse, with the largest percentage of the sample identifying as African American (47.5 %), followed by Hispanic (20 %). Participants completed individual self-report measures using computer-assisted self-interview technology and engaged in couples-based interviews. Mixed methods analyses indicated three global reasons for unprotected sex among YMSM in serious relationships: (1) the desire to achieve emotional intimacy; (2) the perception of being in a monogamous relationship; and (3) the difficulties associated with accessing and/or using condoms. Couples' decision-making processes, including decisions made "in the heat of the moment," have implications for HIV prevention interventions.