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Chan RCH, Mak WWS. Protective and Compensatory Effects of Group Identification on the Mental Health of People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1677-1687. [PMID: 33106924 DOI: 10.1007/s10508-020-01823-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Despite persistent stigmatization of people living with HIV (PLHIV) across the globe, group identification among these individuals may serve to counteract the detrimental effect of prejudice and discrimination associated with the stigmatized identity. Drawing on resilience theory and social identity theory, this study examined how multiple dimensions of group identification (i.e., in-group ties, in-group affect, and centrality) function to buffer and neutralize the negative impact of HIV stigma. A total of 281 PLHIV were recruited from the only community-based public HIV clinic in Hong Kong to participate in this study. The results revealed a protective effect of in-group affect, which moderated the relationship between HIV stigma and mental health, such that HIV stigma was not associated with mental health among people with higher positive in-group affect. In addition, a positive compensatory effect of in-group ties was found in people with higher HIV identity centrality. Given the protective effect of in-group affect, it is important to re-story the lives among PLHIV by challenging their maladaptive beliefs about being PLHIV and building a positive sense of identity in their personal narratives. Community-based interventions should be provided to individuals with higher HIV identity centrality by offering peer support groups and engaging them in community work.
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Affiliation(s)
- Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Quinn KG, Zarwell M, John SA, Christenson E, Walsh JL. Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2117-2128. [PMID: 32240437 PMCID: PMC7321890 DOI: 10.1007/s10508-020-01683-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/29/2020] [Accepted: 03/08/2020] [Indexed: 05/12/2023]
Abstract
A significant proportion of new HIV infections among gay, bisexual, and other men who have sex with men (MSM) occur within primary relationships. Although PrEP use continues to increase, there is a need to better understand the factors that contribute to PrEP decision-making within primary relationships. We qualitatively examined how relationship context influences perceptions of PrEP and decisions to initiate and discontinue PrEP among young Black MSM to provide a nuanced understanding of PrEP use within relationships. Between late 2017 and mid-2018, we conducted 10 focus groups with young Black MSM (n = 80) in Milwaukee, WI, Minneapolis, MN, Kansas City, KS, and Detroit, MI. We used inductive thematic analysis to examine how young Black MSM make decisions about PrEP use within the context of primary relationships. We identified three primary themes: (1) perceptions of PrEP as an indication of distrust and infidelity, (2) perceptions of PrEP use as necessary, even in primary relationships, and (3) the influence of partners on PrEP. Our results demonstrate the considerable variation in how young Black MSM view PrEP within primary relationships and the influence of primary partners in PrEP use decisions. The dynamics between two or more individuals can shape an individual's conceptualizations of and decisions around PrEP use, and these may be key drivers of racial disparities in HIV and PrEP use.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina, Charlotte, Charlotte, NC, USA
| | - Steven A John
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Erika Christenson
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
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Quinn KG, Christenson E, Spector A, Amirkhanian Y, Kelly JA. The Influence of Peers on PrEP Perceptions and Use Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men: A Qualitative Examination. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2129-2143. [PMID: 32016815 PMCID: PMC7321862 DOI: 10.1007/s10508-019-01593-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 05/12/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising part of HIV prevention, yet racial disparities in PrEP uptake persist. Evidence indicates that Black gay, bisexual, and other men who have sex with men (GBM) face numerous social and structural barriers to PrEP, including stigma, medical mistrust, and exclusion from the healthcare system. However, little research has examined how social networks can influence PrEP use and help Black GBM overcome these identified barriers. To understand the influence of peers and social networks on Black GBM's perceptions of and decisions about PrEP use, we conducted in-depth interviews with 46 Black GBM in Milwaukee, WI and Cleveland, OH. Data were analyzed using multistage inductive coding and thematic content analysis, using MAXQDA software. Results indicate that participants' primary source of information on PrEP was other Black GBM in their communities. Peers and social networks served three primary functions with regard to PrEP: (1) filling informational gaps left by healthcare providers, (2) increasing trust of PrEP, and (3) reducing PrEP stigma. Participants described the "movers and shakers" in Black LGBT communities who have been influential in educating others and advocating for PrEP. Well-respected vocal advocates for PrEP have emerged in the Black LGBT community as PrEP champions who have successfully influenced young Black GBM's views on PrEP. Our results reveal the role social networks and peer groups can play in increasing PrEP use among Black GBM. Social network interventions may help overcome the stigma and mistrust that are contributing to PrEP disparities.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Erika Christenson
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Antoinette Spector
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuri Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
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Shelton RC, Lee M, Brotzman LE, Crookes DM, Jandorf L, Erwin D, Gage-Bouchard EA. Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: A systematic review. Soc Sci Med 2018; 220:81-101. [PMID: 30412922 DOI: 10.1016/j.socscimed.2018.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
Interest in conceptualizing, measuring, and applying social network analysis (SNA) in public health has grown tremendously in recent years. While these studies have broadened our understanding of the role that social networks play in health, there has been less research that has investigated the application of SNA to inform health-related interventions. This systematic review aimed to capture the current applied use of SNA in the development, dissemination, implementation, and sustainability of health behavior interventions for adults. We identified 52 articles published between 2004 and 2016. A wide variety of study settings were identified, most commonly in the US context and most often related to sexual health and HIV prevention. We found that 38% of articles explicitly applied SNA to inform some aspect of interventions. Use of SNA to inform intervention development (as opposed to dissemination, implementation, or sustainability) was most common. The majority of articles represented in this review (n = 39) were quantitative studies, and 13 articles included a qualitative component. Partial networks were most represented across articles, and over 100 different networks measures were assessed. The most commonly described measures were network density, size, and degree centrality. Finally, very few articles defined SNA and not all articles using SNA were theoretically-informed. Given the nascent and heterogeneous state of the literature in this area, this is an important time for the field to coalesce on terminology, measures, and theoretical frameworks. We highlight areas for researchers to advance work on the application of SNA in the design, dissemination, implementation and sustainability of behavioral interventions.
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Affiliation(s)
- Rachel C Shelton
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Matthew Lee
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Laura E Brotzman
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 West 168th Street, New York, NY, 10032, USA.
| | - Danielle M Crookes
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, 10032, USA.
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Deborah Erwin
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Rasoolinejad M, Abedinia N, Noorbala AA, Mohraz M, Bayat Jozani Z, Moradmand Badie B. The Effect of Psycho-Social Problems on Risky Behaviors in People Living With HIV in Tehran, Iran. J Family Reprod Health 2018; 12:89-95. [PMID: 30820212 PMCID: PMC6391305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: Over the past years, the prevalence and the progression rate of HIV infection in Iran especially through high-risk sexual relationships have regrettably been reported at very high levels. This cross-sectional study tries to analyze stigma, mental health, and coping skills on risky behaviors in HIV-positive adults in Tehran- Iran. Materials and methods: This cross-sectional study was conducted on a sample of 450 HIV-positive adults. Participants completed a socio-demographic questionnaire, the General HealthQuestionnaire-28, the Berger HIV Stigma Scale as well as the Lazarus Ways of Coping Questionnaire (WOCQ). To analyze the data, the independent-samples t-test and Pearson Correlation were used. Results: The findings of this study revealed that mental health, stigma, and avoidance-escape coping mechanisms were correlated with risky behaviors (p ˂ 0.05).Furthermore, the amount of stigma among female individuals compared to men was reported at higher levels and mental health status in the given group was lower than among male individuals. Conclusion: It seems that psychological treatment techniques could be effective in improving mental health and reducing risky behaviors.
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Affiliation(s)
- Mehrnaz Rasoolinejad
- Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran,Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Abedinia
- Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran,Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran,Maternal Neonatal & Fetal Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- Department of Psychiatric, Psychosomatic Ward, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran,Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Bayat Jozani
- Manager of Tehran Positive Club, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences , Tehran, Iran
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Unpacking the Influence of Sexual Stigma on HIV Risk: Results From a Prospective Study of Men Who Have Sex With Men in Beijing, China. J Acquir Immune Defic Syndr 2017; 74:e38-e44. [PMID: 27787344 DOI: 10.1097/qai.0000000000001217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the mediating roles of coping, depression, anxiety, and encountering difficult sexual situations in explaining the association between stigma against men who have sex with men (MSM) and HIV risk. METHODS We conducted path analyses using longitudinal data collected from 493 Chinese MSM in Beijing at baseline, 6 months, and 12 months from 2011 to 2013. RESULTS MSM stigma, specifically anticipations of stigma, had a marginally significant, protective total effect on unprotected anal intercourse at 12 months. This overall association, however, was the byproduct of 5 significant, indirect associations (3 risk enhancing, 2 protective) that routed through coping, anxiety, and difficult sexual situations. Of note, heavier use of avoidant coping principally had a protective effect on risk behavior by decreasing difficult sexual situations. CONCLUSIONS Interventions to reduce avoidant coping would be an important tool for improving the emotional well-being of Chinese MSM. Such interventions, however, must be paired with biomedical or behavioral HIV prevention strategies to ensure that their benefit is not undermined by unintended increased HIV transmission risk in response to reduced social isolation among MSM.
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