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Boyd DT, Jones KV, Quinn CR, Hill M, Nelson LE, Beauchamp G, Emel L, Hightow-Weidman L, Shoptaw S, Magnus M, Piwowar-Manning E, Mayer KH, Fields SD, Wheeler DP, Dyer TV, Wilton L. Ethnic identity and social support as mediators between childhood sexual abuse and depression among black men who have sex with men. CHILD ABUSE & NEGLECT 2024; 157:107064. [PMID: 39303435 DOI: 10.1016/j.chiabu.2024.107064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Survivors of childhood sexual abuse (CSA) often experience long-term adverse mental health effects, a trend that has been observed in research focusing on men who have sex with men (MSM), especially Black MSM. OBJECTIVE The aim of this study was to investigate the direct and indirect effects of childhood sexual abuse on depression symptoms among Black MSM through early sexual debut, histories of incarceration, ethnic identity, and social support. In addition, we examine the role of social support and ethnic identity as mediators of depression symptoms. PARTICIPANTS AND SETTING The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles; Washington, DC; and Chapel Hill, North Carolina) from February 2013 to September 2015. Study participants were offered once-daily oral emtricitabine/tenofovir preexposure prophylaxis combined with counseling and followed for 52 weeks. METHODS A path analysis was used to examine direct and indirect effects of CSA experiences on depression symptoms through incarceration, early sexual debut ethnic identity, and social support, and to see whether social support and ethnic identity mediated the relationship between incarceration and depression symptoms. RESULTS Our results indicate that childhood sexual abuse was direct and positively associated with early sexual debut (β = 0.21, p < .001). Both ethnic identity (β = -0.14, p < .001) and social support (β = -0.82, p < .001) were direct and negatively associated with depressive symptoms. CONCLUSION Our research underscores the significant impact of CSA factors on the life trajectories of some Black MSM, including experiences such as incarceration, sexual debut, and depression symptoms.
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Affiliation(s)
- Donte T Boyd
- The Ohio State University, College of Social Work, Columbus, OH, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
| | - Kristian V Jones
- University of Washington, School of Social Work, Seattle, WA, USA
| | - Camille R Quinn
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Mandy Hill
- University of Texas, McGovern Medical School, Houston, TX, USA
| | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA; Yale School of Nursing, New Haven, CT, USA
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lynda Emel
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Steve Shoptaw
- University of California Los Angeles, David Geffen School of Medicine, Division of Family Medicine, Los Angeles, California, USA
| | - Manya Magnus
- George Washington University, Milken Institute School of Public Health, Department of Epidemiology, DC, USA
| | | | | | - Sheldon D Fields
- Pennsylvania State University, Ross and Carl Nese College of Nursing, University Park, PA, USA
| | | | - Typhanye V Dyer
- University of Maryland, Department of Epidemiology and Biostatistics, College Park, MD, USA
| | - Leo Wilton
- State University of New York at Binghamton, Department of Human Development, Binghamton, NY, USA; University of Johannesburg, Department of Humanities, South Africa
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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Feelemyer J, Duncan DT, Akhidenor N, Mazumdar M, Irvine NM, Scheidell JD, Brewer RA, Turpin RE, Hucks-Ortiz C, Dyer TV, Cleland CM, Mayer KH, Khan MR. Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01909-1. [PMID: 38609695 DOI: 10.1007/s40615-024-01909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk. METHODS We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis. RESULTS Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)). CONCLUSION PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Naomi Akhidenor
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Natalia M Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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4
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Storholm ED, Siconolfi DE, Campbell CK, Pollack LM, Kegeles SM, Rebchook GM, Tebbetts S, Vincent W. Structural Inequities, Syndemics, and Resilience: The Critical Role of Social Support in Overcoming Barriers and Empowering Engagement in HIV Care for Young Black Sexual-Minority Men in the US South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01869-y. [PMID: 38095825 DOI: 10.1007/s40615-023-01869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/12/2023] [Accepted: 11/12/2023] [Indexed: 01/19/2024]
Abstract
Young Black sexual minority men (YBSMM) living in the US South are among those most disproportionately impacted by HIV in the USA. This health inequity is, in part, due to lower rates of sustained engagement in the HIV care continuum, resulting in a lower prevalence of viral suppression and higher overall community-level viral load. Social, structural, and economic inequities have previously been linked with poorer HIV care engagement among YBSMM. HIV-related social support, individual-level resilience, and healthcare empowerment have been shown to be independently associated with improved HIV care engagement. The current study sought to assess the relative contribution of individual, structural, and economic factors on engagement in HIV care and to elucidate the potentially mediating role of healthcare empowerment. Data from 224 YBSMM with HIV in the US South indicated that greater levels of socioeconomic distress, intimate partner violence, and depressive symptoms were associated with lower levels of engagement in HIV care, while greater levels of individual-level resilience and healthcare empowerment were associated with higher levels of HIV care engagement. Importantly, healthcare empowerment mediated the association between resilience and engagement in HIV care and the association between social support and engagement in HIV care. Findings emphasize the critical role that HIV-related social support plays in fostering resilience and overcoming syndemic factors to promote empowerment and engagement in HIV care for YBSMM in the USA.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | | | - Chadwick K Campbell
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Greg M Rebchook
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, CA, USA
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5
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Liu Y, Ramos SD, Hanna DB, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Friedman MR, Plankey M, Chichetto NE. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 2023; 27:4094-4105. [PMID: 37418062 PMCID: PMC10615787 DOI: 10.1007/s10461-023-04123-y] [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] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.
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Affiliation(s)
- Yiyang Liu
- University of Florida, Gainesville, FL, USA
| | - Stephen D Ramos
- University of California - San Diego, San Diego, La Jolla, CA, USA
| | | | - Deborah L Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Mardge H Cohen
- Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Jenni M Wise
- University of Alabama at Birmingham, Birmingham, AL, England
| | - Mackey R Friedman
- School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada
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6
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Chavez JV, Wang P, Larson ME, Vazquez V, De La Rosa M, Behar-Zusman V. Methodologies used in studies examining substance abuse, violence and HIV/AIDS (SAVA) constructs using a syndemic framework: a scoping review. AIDS Care 2023; 35:1708-1715. [PMID: 36942772 PMCID: PMC10511665 DOI: 10.1080/09540121.2023.2176426] [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] [Received: 12/23/2021] [Accepted: 01/22/2023] [Indexed: 03/23/2023]
Abstract
The syndemic theoretical framework has been used in health disparities research to explain several co-occurring epidemics, particularly in populations facing disparate health conditions. A prominent example of this is seen in Singer's Substance Abuse, Violence and HIV/AIDS (SAVA) syndemic theory. However, even though numerous studies support some of the theoretical underpinnings of the SAVA syndemic, the empirical applications of the theory remain methodologically underdeveloped. The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), to present the state of the science of methodologies examining SAVA constructs using the syndemic framework. Seven bibliographic databases were searched with no language or date restrictions. Studies were synthesized by author, year of publication, study location, total sample size, study population, SAVA outcomes, analytic method of SAVA measurement, intervention type, level of influence, disease interaction and concentration, main findings of the study, and possible future areas of research. Our search yielded a total of 967 articles, and 123 were included in the review. Methodologic and statistical innovation is needed to elevate the impact of syndemic theory for elucidating the synergistic effects of determinants leading to health disparities.
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Affiliation(s)
- Jennifer V. Chavez
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Piao Wang
- School of Nursing and Health Studies, University of Miami
| | - Michaela E. Larson
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Vicky Vazquez
- Stempel College of Public Health and Social Work, Florida International University
| | - Mario De La Rosa
- Stempel College of Public Health and Social Work, Florida International University
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7
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Okafor CN, Ware D, Meanley S, Brennan-Ing M, Haberlen S, Teplin L, Mimiaga MJ, Reuel Friedman M, Plankey M. Individual-Level Psychosocial Resiliencies as Mediators of the Relationship Between Internalized Homophobia and Depressive Symptoms Among Middle-Aged and Older Men Living With and Without HIV. AIDS Behav 2023; 27:3171-3182. [PMID: 36943601 DOI: 10.1007/s10461-023-04037-9] [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] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
Among sexual minority men (SMM), internalized homophobia (IH) has been consistently associated with increased depression symptoms. However, some SMM experiencing IH demonstrate resilience to buffer against depression symptoms. In this analysis, we used the Stress Process Model (SPM) as a conceptual framework to explore individual-level psychosocial resilience (ILPR) factors serving as a buffer of the IH-depression relationship. To utilize the SPM to explore whether four ILPR factors, including volunteerism, optimism, religiosity/spirituality, and global resiliency measure mediate the relationship between IH and depression symptoms among middle-aged and older SMM living with and without HIV. We used exploratory and confirmatory factor analysis to construct measurement models for the four ILPR factors. We examined whether the four ILPR factors mediated the IH-depression relationship. IH was significantly and positively associated with depression symptoms. There was a partial mediation of the IH-depression association by the four ILPR. Specifically, we found statistically significant indirect effects of optimism and the global resilience measure and supporting buffering effects of the IH-depression association. Although, the indirect effects religiosity/spirituality on the IH-depression relationship was significant, it did not support a buffering of effect. The indirect effects of volunteerism were not statistically significant. Our findings highlight the potential role of ILPR factors in the development of resilience against the negative effects of IH. Implications of these results for future research and practice are discussed.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging at Hunter College, City University of New York, New York City, USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Linda Teplin
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers School of Public Health, Piscataway, USA
| | - Michael Plankey
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA
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8
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Storholm ED, Reynolds HE, Muthuramalingam S, Nacht CL, Felner JK, Wagner GJ, Stephenson R, Siconolfi DE. Intimate Partner Violence and the Sexual Health of Sexual Minority Men. LGBT Health 2023; 10:S39-S48. [PMID: 37754928 PMCID: PMC10623463 DOI: 10.1089/lgbt.2023.0134] [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: 09/28/2023] Open
Abstract
Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Hannah E. Reynolds
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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9
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Chandler CJ, Liu Q, Brown AL, Matthews DD, Tsai AC, Bukowski LA, Eaton LA, Stall RD, Friedman MR. Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black Sexual Minority Men. STIGMA AND HEALTH 2023; 8:372-380. [PMID: 37789829 PMCID: PMC10545331 DOI: 10.1037/sah0000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This secondary analysis of a mixed serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status or some "other" reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality and Resilience (POWER), a serial, cross-sectional study conducted between 2014-2017 (N=4430). Experiences of multiple stigmas were reported by n=938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with "other" stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and SES, particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM, but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Qimin Liu
- Psychological Sciences, Vanderbilt University 2301 Vanderbilt Place · Nashville, TN 37240-7817, USA
| | - Andre L. Brown
- Behavioral and Community Health Science, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Derrick D. Matthews
- Health Behavior, Gillings School of Public Health, University of North Carolina, 361 Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital 100 Cambridge St Suite 1600, Boston, MA 02114, USA
| | - Leigh A. Bukowski
- Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Scaife Hall, Suite 600 Pittsburgh, PA 15213, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Rd, Storrs, CT 06269-1248, USA
| | - Ronald D. Stall
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
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10
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Quinn KG, Edwards T, Takahashi L, Johnson A, Spector A, Dakin A, Bouacha N, Valadez-Tapia S, Voisin D. "The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8162-8186. [PMID: 36803199 PMCID: PMC10714286 DOI: 10.1177/08862605231153891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.
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Affiliation(s)
- Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Travonne Edwards
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL
| | - Antoinette Spector
- Department of Physical Therapy, Rehabilitation Sciences & Technology, University of Wisconsin, Milwaukee, Milwaukee, WI
| | | | | | | | - Dexter Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
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11
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Storholm ED, Huang W, Ogunbajo A, Horvath KJ, Reback CJ, Blumenthal J, Moore DJ, Flynn RP, Bolan RK, Corado KC, Morris SR. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 2023; 27:745-759. [PMID: 36053404 PMCID: PMC9908815 DOI: 10.1007/s10461-022-03807-1] [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] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low-low, high-low, and high-high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Adedotun Ogunbajo
- RAND Corporation, Santa Monica, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cathy J Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - David J Moore
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | | | | | | | - Sheldon R Morris
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
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12
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Houang ST, Kafka JM, Choi SK, Meanley SP, Muessig KE, Bauermeister JA, Hightow-Weidman LB. Co-occurring Epidemic Conditions Among Southern U.S. Black Men Who Have Sex with Men in an Online eHealth Intervention. AIDS Behav 2023; 27:641-650. [PMID: 35986818 PMCID: PMC9391640 DOI: 10.1007/s10461-022-03799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
Black men who have sex with men (BMSM) face disproportionately higher risks for adverse sexual health outcomes compared to their non-Hispanic White counterparts. This disparity can be attributable to overlapping and intersecting risk factors at the individual and structural levels and can be understood through syndemic theory. Using longitudinal data from the HealthMPowerment trial (n = 363), six conditions related to stigma syndemics were indexed as a cumulative risk score: high alcohol use, polydrug use, depression and anxiety symptomology, and experiences of racism and sexual minority stigma. Using Poisson regression, we found a positive association between baseline risk scores and sexual risk behavior (b: 0.32, SE: 0.03, p < 0.001). Using a Generalized Estimating Equation, we also found a 0.23 decrease in the within-participant risk scores at 3-month follow-up (SE: 0.10, p < 0.020). Future work examining how care and prevention trials improve health outcomes in this population is needed.
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Affiliation(s)
- Steven T Houang
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA.
| | - Julie M Kafka
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
| | - Seul Ki Choi
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Steven P Meanley
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
| | - Jose A Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Lisa B Hightow-Weidman
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
- Institute for Global Health and Infectious Diseases, University North Carolina Chapel Hill, Chapel Hill, USA
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13
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Shangani S, van den Berg JJ, Dyer TV, Mayer KH, Operario D. Childhood sexual abuse, alcohol and drug use problems among Black sexual minority men in six US Cities: Findings from the HPTN 061 study. PLoS One 2022; 17:e0279238. [PMID: 36548261 PMCID: PMC9778556 DOI: 10.1371/journal.pone.0279238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Prior research has found a high prevalence of childhood sexual abuse (CSA) among sexual minority men (SMM) in the US, and has indicated that CSA is associated with higher rates of alcohol and drug use disorders. However, most of these studies have focused almost exclusively on White SMM. We assessed associations of CSA, alcohol use, and drug use problems among adult Black SMM. METHODS Participants were 1,016 Black SMM recruited from six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington, DC) between July 2009 and December 2011. We used hierarchical logistic regression to evaluate the associations between CSA, alcohol use problems (≥ 8 AUDIT), and drug use problems (excluding marijuana). RESULTS Mean (SD) age was 37.8 (11.7) years, and 28.6% and 49.2% reported alcohol and drug use disorders in the past six months, respectively. Most of the study participants reported history of CSA (70.3%). Adjusting for sociodemographic and confounding variables, CSA was associated with higher odds of alcohol use problems (odds ratio (OR) = 1.52, 95% CI 1.09, 2.12) and drug use problems (OR = 1.58, 95% CI 1.19, 2.10) than non-CSA group. CONCLUSION Prevalence of CSA is high among BSMM in the US and is positively associated with alcohol and drug use problems. Substance use interventions should address the psychological health needs of BSMM with a history of CSA.
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Affiliation(s)
- Sylvia Shangani
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA, United States of America
| | - Jacob J. van den Berg
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, United States of America
- Department of Behavioral, Social and Health Education, and Social Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute of Fenway Health, Boston, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Don Operario
- Department of Behavioral, Social and Health Education, and Social Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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14
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Storholm ED, Siconolfi DE, Wagner GJ, Huang W, Nacht CL, Sallabank G, Felner JK, Wolf J, Lee SD, Stephenson R. Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study. JMIR Res Protoc 2022; 11:e41453. [PMID: 36378519 PMCID: PMC9709678 DOI: 10.2196/41453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. OBJECTIVE This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. METHODS This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. RESULTS Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. CONCLUSIONS This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41453.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, United States
- RAND Corporation, Santa Monica, CA, United States
| | | | | | | | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Greg Sallabank
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
| | - Jennifer K Felner
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Joshua Wolf
- RAND Corporation, Santa Monica, CA, United States
| | - Sarita D Lee
- RAND Corporation, Santa Monica, CA, United States
| | - Rob Stephenson
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
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15
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Sharma BB, Small E, Okumu M, Mwima S, Patel M. Addressing the Syndemics of HIV, Mental Health, and COVID-19 Using the Health and Human Rights Framework among Youth Living with HIV, in Uganda: an Interpretive Phenomenological Study. JOURNAL OF HUMAN RIGHTS AND SOCIAL WORK 2022; 7:285-298. [PMID: 36090014 PMCID: PMC9446591 DOI: 10.1007/s41134-022-00221-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/08/2023]
Abstract
Stigma and discrimination negatively impact the prevention, treatment, and care of HIV. The COVID-19 pandemic increased this complexity and created a cluster of synergistic health contexts, wherein the physiological aspects of HIV and the social and environmental conditions increased the vulnerability in health outcomes for youth living with HIV (YPLHIV) in Kampala, Uganda. We used interpretive phenomenological analysis (IPA) and the syndemics framework to understand the lived experiences of YPLHIV. From December 2020 to May 2021, six qualitative focus groups were held with 31 youth living with HIV to understand the lived experiences of YPLHIV. The guided questions used were audio-recorded, transcribed verbatim, and coded for thematic analysis. Findings highlight the complexity of intersecting stigma of HIV and COVID-19 that have worsened antiretroviral treatment adherence and mental health issues due to lack of access to critical needs such as fears of food insecurity, health-related worries, the fear of perishing due to COVID-19, and human rights concerns related to gender and sexual identity. The study recommends addressing human rights-related concerns in addition to health-related concerns to comprehensively mitigate the syndemics of HIV and COVID-19 for YPLHIV in Uganda.
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Affiliation(s)
- Bonita B. Sharma
- Department of Social Work, University of Texas at San Antonio, College for Health, Community, and Policy, 501 W. Cesar Chavez Blvd, San Antonio, TX 78207 USA
| | - Eusebius Small
- School of Social Work, University of Texas, 211 S. Cooper St., Bldg. A, ArlingtonArlington, TX 76019 USA
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W. Nevada Street, Urbana, IL 61801 USA
- School of Science, Uganda Christian University, Mukuno, Uganda
| | - Simon Mwima
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W. Nevada Street, Urbana, IL 61801 USA
| | - Mansi Patel
- School of Social Work, University of Texas, 211 S. Cooper St., Bldg. A, ArlingtonArlington, TX 76019 USA
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16
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Chandler CJ, Adams BJ, Eaton LA, Meunier É, Andrade E, Bukowski LA, Stall RD, Friedman MR. Intersectional Experienced Stigma and Psychosocial Syndemic Conditions in a Sample of Black Men Who Have Sex with Men Engaged in Sex Work (BMSM-SW) from Six US Cities. JOURNAL OF SEX RESEARCH 2022; 59:920-930. [PMID: 35580257 PMCID: PMC9835797 DOI: 10.1080/00224499.2022.2072799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and "other" attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6-50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, USA 37203
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Brian J. Adams
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Leigh A. Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Ronald D. Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
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17
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Liu Y, Brown L, Przybyla S, Bleasdale J, Mitchell J, Zhang C. Characterizing Racial Differences of Mental Health Burdens, Psychosocial Determinants, and Impacts on HIV Prevention Outcomes Among Young Men Who have Sex With Men: a Community-based Study in Two U.S. Cities. J Racial Ethn Health Disparities 2022; 9:1114-1124. [PMID: 33987809 DOI: 10.1007/s40615-021-01052-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
Few studies examine racial differences (e.g., Black vs. White) regarding the psychosocial pathways linking mental health burdens and various HIV-related outcomes among young men who have sex with men (MSM) in the U.S. We conducted a community-based study to examine the racial differences of mental health burdens (e.g., depression, anxiety, stress), the psychosocial determinants (e.g., HIV stigma, homonegativity, resilience, social support, loneliness, housing/food security) and impact on HIV-related outcomes (e.g., event-level alcohol/drug use before sex, condomless insertive/receptive anal sex, recent HIV testing, and PrEP awareness/willingness/use) among young Black MSM (YBMSM; n = 209) and young White MSM (YWMSM; n = 109) from two cities (Nashville, TN and Buffalo, NY) in the United States. Overall, we found YBMSM were more likely (p < 0.05) to experience anxiety and depression compared to YWMSM. Among YBMSM, we found structural inequities (housing instability, food insecurity, internalized homonegativity) were positively associated with anxiety/depression/stress (p < 0.001); we also found anxiety/depression was associated with increased alcohol/drug use before sex, and stress was associated with reduced recent HIV testing and pre-exposure prophylaxis awareness/willingness/use. Among YWMSM, we found psychological buffers (perceived social support, resilience) were associated with reduced anxiety/depression/stress (p < 0.001); anxiety was associated with increased condomless insertive/receptive anal sex and recent HIV testing among this subgroup. YBMSM and YWMSM differed in psychosocial determinants and HIV-related consequences regarding their mental health. Our findings provide important implications for developing culturally and contextually tailored interventions to address mental health burdens and HIV prevention outcomes among young MSM at highest risk for HIV acquisition.
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Affiliation(s)
- Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 256 Crittenden Blvd, Ste. 3305, Rochester, NY, 14642, USA.
| | - Lauren Brown
- Meharry Medical College, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, USA
| | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, USA
| | - Jason Mitchell
- Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY, USA
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18
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Stephenson R, Darbes LA, Rosso MT, Washington C, Hightow-Weidman L, Sullivan P, Gamarel KE. Perceptions of Contexts of Intimate Partner Violence Among Young, Partnered Gay, Bisexual and Other Men Who Have Sex With Men in the United States. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12881-NP12900. [PMID: 33729057 DOI: 10.1177/08862605211001472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There has been a growth in research illustrating that gay, bisexual, and other men who have sex with men (GBMSM) experience intimate partner violence (IPV) at rates that are comparable to those among heterosexual women. However, the majority of research on IPV among same-sex male couples has focused on adults, and research on the experience of IPV among younger men (those aged under 18), remains at a nascent stage, despite knowledge that IPV is often common among younger men. This article adds to the growing body of literature on IPV among young GBMSM (YGBMSM) through of an analysis of qualitative data from in-depth interviews (IDI) with GBMSM aged 15-19 (n = 30) in romantic relationships partnerships. The study sought to explore issues of relationship development, relationship contexts, and understandings of IPV. More than one-half of the sample reported experiencing some form of IPV in their current or past relationships. Participants described a range of experiences of IPV, including physical IPV, emotional IPV, sexual IPV, and controlling behaviors. Emotional IPV in the form of negative comments and controlling behaviors such as jealousy were the most commonly reported forms of violence behaviors. Although few participants reported experiencing physical or sexual IPV, several discussed concerns about giving, and partners' acknowledging, sexual consent. Antecedents to IPV included wanting or feeling pressured to participate in normative development milestones, short-lived relationships, and societal stigma. Interventions that develop content on IPV and that reflect the lived realities of YGBMSM who are experiencing their first relationships are urgently needed. Study findings also support the need for training teachers, health care providers, and parents to identify signs of IPV and provide them with the knowledge and skills to talk to YGBMSM about relationships and violence to reduce IPV.
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Affiliation(s)
| | | | | | | | | | - Patrick Sullivan
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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19
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Caballero-Hoyos R, Monárrez-Espino J, Ramírez-Ortíz MG, Cárdenas-Medina FM. Factors Associated with Unprotected Anal Sex among Men Who Have Sex with Men in Mexico. Infect Dis Rep 2022; 14:547-557. [PMID: 35893477 PMCID: PMC9326714 DOI: 10.3390/idr14040058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
The global prevalence of HIV is notably higher in men who have sex with men (MSM) compared with other male populations. Unprotected anal intercourse is the riskiest sexual behavior for HIV acquisition and/or transmission among this minority population. The purpose of the study was to identify if the syndemic of psychosocial stressors and experienced stigma are predictors of unprotected anal sex in Mexican MSM. A cross-sectional analytic study was carried out. It included adults residing in Manzanillo, Mexico, with oral/anal sex practices within the last year. Informed consent was given by 142 participants selected using snowball sampling. Collected data included sociodemographic characteristics, psychosocial stressors, experienced stigma, HIV knowledge, knowing a friend/acquaintance living with HIV/AIDS, and sexual risk behaviors. Adjusted logistic regression was used to identify predictors of unprotected anal sex within the last six months. Presence of syndemic of psychosocial stressors, drug use during sex, having friends/acquaintances with HIV/AIDS, and experiencing high stigma were positively associated; high level of HIV knowledge was negatively linked. Reducing psychosocial stressors and integrating stigma-mitigation strategies are key elements to reduce HIV transmission.
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Affiliation(s)
- Ramiro Caballero-Hoyos
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Colima 28040, Mexico;
| | - Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza del Parque Hospital, University of Monterrey, Chihuahua 31000, Mexico
- Medicine and Health Sciences Unit, Zacatecas Autonomous University, Zacatecas 98000, Mexico
- Correspondence:
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Hossain MM, Saha N, Rodela TT, Tasnim S, Nuzhath T, Roy TJ, Burdine JN, Ahmed HU, McKyer ELJ, Basu BK, Ma P. Global research on syndemics: a meta-knowledge analysis (2001-2020). F1000Res 2022; 11:253. [PMID: 36936050 PMCID: PMC10015119 DOI: 10.12688/f1000research.74190.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years. METHODS We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. RESULTS We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. CONCLUSIONS The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.
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Affiliation(s)
- Md Mahbub Hossain
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Tahmina Tasnim Rodela
- Department of Economics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Samia Tasnim
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tasmiah Nuzhath
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tamal Joyti Roy
- Institute of Information and Communication Technology, Khulna, Bangladesh
| | - James N. Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - E. Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
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21
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Hossain MM, Saha N, Rodela TT, Tasnim S, Nuzhath T, Roy TJ, Burdine JN, Ahmed HU, McKyer ELJ, Basu BK, Ma P. Global research on syndemics: a meta-knowledge analysis (2001-2020). F1000Res 2022; 11:253. [PMID: 36936050 PMCID: PMC10015119 DOI: 10.12688/f1000research.74190.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years. METHODS We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. RESULTS We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. CONCLUSIONS The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.
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Affiliation(s)
- Md Mahbub Hossain
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Tahmina Tasnim Rodela
- Department of Economics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Samia Tasnim
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tasmiah Nuzhath
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tamal Joyti Roy
- Institute of Information and Communication Technology, Khulna, Bangladesh
| | - James N. Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - E. Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
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Davis DA, Rock A, Santa Luce R, McNaughton-Reyes L, Barrington C. Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1637-NP1657. [PMID: 32552467 PMCID: PMC7941092 DOI: 10.1177/0886260520928960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.
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Affiliation(s)
- Dirk A. Davis
- The University of North Carolina at Chapel Hill, USA
| | - Amelia Rock
- The University of North Carolina at Chapel Hill, USA
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Souleymanov R, Star J, McLeod A, Amjad S, Moore S, Campbell C, Lorway R, Payne M, Ringaert L, Larcombe L, Restall G, Migliardi P, Magwood B, Lachowsky NJ, Brennan DJ, Sharma UN. Relationship between sociodemographics, healthcare providers' competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study. BMJ Open 2022; 12:e054596. [PMID: 35105639 PMCID: PMC8804644 DOI: 10.1136/bmjopen-2021-054596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba. DESIGN Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men. SETTING Community-based cross-sectional study in Manitoba, Canada. PARTICIPANTS Community-based sample of 368 2SGBQ+ men. OUTCOMES Logistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers' 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months. RESULTS In multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare provider with poor (AOR=0.19, 95% CI 0.04 to 0.90) or very poor competence/knowledge (AOR=0.03, 95% CI 0.03 to 0.25) of 2SGBQ+ men's issues (compared with very good competence) was associated with lower odds of having a regular healthcare provider. Living in Brandon (AOR=0.05, 95% CI 0.02 to 0.17) and smaller towns (AOR=0.25, 95% CI 0.67 to 0.90) in Manitoba (compared with living in Winnipeg) was associated with lower odds of having a healthcare visit in the past 12 months, while identifying as a gay man compared with bisexual (AOR=12.57, 95% CI 1.88 to 83.97) was associated with higher odds of having a healthcare visit in the past 12 months. CONCLUSIONS These findings underscore the importance of reducing the gap between the healthcare access of rural and urban 2SGBQ+ men, improving healthcare providers' cultural competence and addressing their lack of knowledge of 2SGBQ+ men's issues.
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Affiliation(s)
- Rusty Souleymanov
- Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Star
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Albert McLeod
- Two-Spirited People of Manitoba, Winnipeg, Manitoba, Canada
| | - Sana Amjad
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Samantha Moore
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Robert Lorway
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Payne
- Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Laurie Ringaert
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Manitoba, Canada
| | - Linda Larcombe
- Department of Internal Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paula Migliardi
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Nathan J Lachowsky
- Community-Based Research Centre, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Kaplan-Lewis E, Banga J, Khan M, Casey E, Mazumdar M, Bratu S, Abdallah M, Pitts R, Leider J, Hennessey K, Cohen GM, Cleland CM, Salama C. HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak. AIDS Patient Care STDS 2021; 35:457-466. [PMID: 34780305 DOI: 10.1089/apc.2021.0124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Reports conflict on how HIV infection influences the clinical course of COVID-19. The New York City (NYC) public hospital system provides care for over 14,000 people with HIV, was central in responding to the COVID-19 pandemic, and is therefore in a unique position to evaluate the intersection of these concurrent infections. Retrospective chart review of patients presenting to NYC Health and Hospitals (NYC H+H) diagnosed with COVID-19 infection from March 1, 2020, through April 28, 2020, compared people living with HIV (PLWH) and a propensity-matched (PM) control group of patients without HIV to evaluate associations between HIV status and COVID-19 outcomes. Two hundred thirty-four PLWH presented for COVID-19 testing and 110 (47%) were diagnosed with COVID-19. Among 17,413 patients with COVID-19 and without HIV, 1:n nearest neighbor propensity score matching identified 194 patients matched on age, sex, race, and any comorbidity. In the sample with COVID-19 (N = 304), PLWH (9.1%) had lower rates of mortality than controls [19.1%; PM odds ratio (PM-OR): 0.41, 95% confidence interval (CI): 0.19-0.86]. Among hospitalized COVID-19 patients (N = 179), HIV infection was associated with lower rates of mechanical ventilation (PM-OR: 0.31, 95% CI: 0.11-0.84) and mortality (PM-OR: 0.40, 95% CI: 0. 17-0.95). In the extended pandemic period through April 2021, aggregate data by HIV status suggested elevated hospitalization and mortality rates in PLWH versus people without HIV. These results suggest that the direct biological impacts of the HIV virus do not negatively influence COVID-19-related outcomes when controlling for comorbidity and demographic variables.
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Affiliation(s)
- Emma Kaplan-Lewis
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health and Hospitals, New York, New York, USA
| | - Jaspreet Banga
- Department of Medicine, NYC Health and Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Maria Khan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Eunice Casey
- Office of Ambulatory Care and Population Health, HIV Services, NYC Health and Hospitals, New York, New York, USA
| | - Medha Mazumdar
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Simona Bratu
- Division of Infectious Diseases, NYC Health and Hospitals/Harlem, New York, New York, USA
| | - Marie Abdallah
- Division of Infectious Diseases, NYC Health and Hospitals/Kings County, Brooklyn, New York, USA
| | - Robert Pitts
- Division of Infectious Diseases, NYC Health and Hospitals/Bellevue, New York, New York, USA
| | - Jason Leider
- Division of Infectious Diseases, NYC Health and Hospitals/Jacobi, Bronx, New York, USA
| | - Karen Hennessey
- Division of Infectious Diseases, NYC Health and Hospitals/Lincoln, Bronx, New York, USA
| | - Gabriel M. Cohen
- Division of Infectious Diseases, NYC Health and Hospitals/Bellevue, New York, New York, USA
| | - Charles M. Cleland
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Carlos Salama
- Division of Infectious Diseases, NYC Health and Hospitals/Elmhurst, Elmhurst, New York, USA
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Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav 2021; 25:3574-3604. [PMID: 33866444 PMCID: PMC8053369 DOI: 10.1007/s10461-021-03262-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
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Egan JE, Haberlen SA, Meanley S, Ware D, Brown AL, Siconolfi D, Brennan-Ing M, Stall R, Plankey MW, Friedman MR. Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men: Protocol for an Observational Cohort Study. JMIR Res Protoc 2021; 10:e25750. [PMID: 34554100 PMCID: PMC8498890 DOI: 10.2196/25750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. OBJECTIVE This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. METHODS This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. RESULTS Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. CONCLUSIONS Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/25750.
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Affiliation(s)
- James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, United States
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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27
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Hsueh L, Layland EK, Kipke MD, Bray BC. Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study. Soc Sci Med 2021; 284:114219. [PMID: 34271403 PMCID: PMC8958666 DOI: 10.1016/j.socscimed.2021.114219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experiences with racism predict healthcare system distrust among people of color, but Black and Latino young men who have sex with men (YMSM) also experience overlapping forms of stigma associated with their sexual identities and behaviors (i.e., homonegativity and internalized homonegativity). These forms of minority stress may drive healthcare system distrust among Black and Latino YMSM but have received far less attention. OBJECTIVES To examine the associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust among a community sample of Black and Latino YMSM. METHODS Data came from waves 2-4 (years 2017-2018) of the Healthy Young Men's study, a longitudinal cohort study of Black and Latino YMSM living in Los Angeles County. Data across waves (n = 424, nobs = 1272) were combined and analyzed using a fixed effects approach and adjusting for repeated measures across participants. A series of regression models that added sets of covariates (demographics, syndemic indicators, and health-related factors) were tested to examine associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust. RESULTS Adjusting for demographics and syndemic indicators, racism, but not homonegativity or internalized homonegativity, was associated with healthcare system distrust. Adjustment for health-related factors had little impact on results. CONCLUSIONS Among Black and Latino YMSM, greater exposure to racism is associated with greater healthcare system distrust. Efforts to strengthen healthcare system trust should explicitly target the institutional policies that disproportionately harm people of color.
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Affiliation(s)
- Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Michele D Kipke
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA; Departments of Pediatrics and Preventive Medicine, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA, 90027, USA
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 South Wolcott Ave., Chicago, IL, 60612, USA
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28
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Barriers and Facilitators to Promoting Resilience to HIV/AIDS: A Qualitative Study on the Lived Experiences of HIV-Positive, Racial and Ethnic Minority, Middle-Aged and Older Men Who Have Sex with Men from Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158084. [PMID: 34360376 PMCID: PMC8345717 DOI: 10.3390/ijerph18158084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Evidence-based research has highlighted the need for exploring factors that support the mental health of men who have sex with men living with HIV/AIDS (MSMLWH), and environmental influences that promote their resilience to HIV/AIDS. This exploratory study utilized a community-based participatory research approach to investigate barriers and facilitators to promoting resilience to HIV/AIDS, specifically among racial and ethnic minority, middle-aged and older MSMLWH, a population that continues to be significantly impacted by HIV/AIDS today. This collaborative, qualitative study recruited participants who identified as racial or ethnic minority MSMLWH, were aged 40 or older, and resided in Ontario, Canada. Participants (n = 24) discussed in their interviews barriers and facilitators to promoting resilience to HIV/AIDS, which they recognized from their lived experiences. Utilizing thematic analysis, themes related to barriers and facilitators to promoting resilience to HIV/AIDS were identified. Themes related to identified barriers included: (1) language proficiency, (2) racism, (3) pernicious norms in North American gay culture, and (4) HIV stigma. Themes related to identified facilitators included: (1) compartmentalization, (2) perseverance, and (3) community-based health and social services. This article discusses the implications of the study’s findings, particularly on how they may influence the development of future services for racial and ethnic minority, middle-aged and older MSMLWH.
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29
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Leblanc NM, Crean HF, Dyer TP, Zhang C, Turpin R, Zhang N, Smith MDR, McMahon J, Nelson L. Ecological and Syndemic Predictors of Drug Use During Sex and Transactional Sex among U.S. Black Men Who Have Sex with Men: A Secondary Data Analysis from the HPTN 061 Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2031-2047. [PMID: 33903969 DOI: 10.1007/s10508-020-01871-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Abstract
Threats to sexual health among U.S. Black men who have sex with men (MSM) may manifest in a context of social adverse experiences. Situational sex is one such context, which we characterize as sexual behaviors driven either by a desire to cultivate a specific sexual experience or attributable to social vulnerability. Two characterizations of situational sex explored in this study were drug use during sex and transactional sex. Guided by ecological and syndemic frameworks, we conducted a secondary data analysis of social conditions and sexual behaviors among a prospective cohort of Black MSM from the HIV Prevention Trial Network (HPTN) 061 study. Using structural equation modeling, this analysis examined the indirect effect of syndemic factors (substance use, depression, violence exposure) in the relationship between ecological constructs (anti-Black/homophobic stigma, childhood violence, and economic vulnerability) and situational sex (drug use during sex, transactional sex). Model fit indices, CFI (.870) and SRMR (.091), demonstrated reasonable fit. Significant indirect effects emerged via substance use for economic vulnerability (indirect effect = .181, 95% CI [.078, .294]) and anti-Black/homophobic violence and stigma (indirect effect = .061, 95% CI [.008, .121]) on drug use during sex; as well as on transactional sex (economic vulnerability indirect effect = .059, 95% CI [.018, .121] and anti-Black/homophobic stigma and violence indirect effect = .020, 95% CI [.003, .051]). Findings implicate the need for social and fiscal intervention to address upstream, ecological, and syndemic factors that influence inherent vulnerability of situational sex and overall threats to sexual health among Black MSM.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA.
| | - Hugh F Crean
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - Typhanye P Dyer
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - Rodman Turpin
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martez D R Smith
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - James McMahon
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - LaRon Nelson
- Yale University School of Nursing, New Haven, CT, USA
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30
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Harkness A, Rogers BG, Balise R, Mayo D, Weinstein ER, Safren SA, Pachankis JE. Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav 2021; 25:2195-2209. [PMID: 33483898 PMCID: PMC8169533 DOI: 10.1007/s10461-020-03148-x] [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] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA.
| | - Brooke G Rogers
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - John E Pachankis
- Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public Health, Yale University, New Haven, CT, USA
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Satyanarayana S, Rogers BG, Bainter SA, Christopoulos KA, Fredericksen RJ, Mathews WC, Moore RD, Mugavero MJ, Napravnik S, Carrico AW, Mimiaga MJ, Mayer KH, Crane HM, Safren SA. Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care. AIDS Patient Care STDS 2021; 35:220-230. [PMID: 34097465 PMCID: PMC8336208 DOI: 10.1089/apc.2021.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Psychosocial syndemic conditions have received more attention regarding their deleterious effects on HIV acquisition risk than for their potential impact on HIV treatment and viral suppression. To examine syndemic conditions' impact on the HIV care continuum, we analyzed data collected from people living with HIV (N = 14,261) receiving care through The Centers for AIDS Research Network of Integrated Clinical Systems at seven sites from 2007 to 2017 who provided patient-reported outcomes ∼4-6 months apart. Syndemic condition count (depression, anxiety, substance use, and hazardous drinking), sexual risk group, and time in care were modeled to predict antiretroviral therapy (ART) adherence and viral suppression (HIV RNA <400 copies/mL) using multilevel logistic regression. Comparing patients with each other, odds of ART adherence were 61.6% lower per between-patient syndemic condition [adjusted odds ratio (AOR) = 0.384; 95% confidence interval (CI), 0.362-0.408]; comparing patients with themselves, odds of ART adherence were 36.4% lower per within-patient syndemic condition (AOR = 0.636 95% CI, 0.606-0.667). Odds of viral suppression were 29.3% lower per between-patient syndemic condition (AOR = 0.707; 95% CI, 0.644-0.778) and 27.7% lower per within-patient syndemic condition (AOR = 0.723; 95% CI, 0.671-0.780). Controlling for the effects of adherence (AOR = 5.522; 95% CI, 4.67-6.53), each additional clinic visit was associated with 1.296 times higher odds of viral suppression (AOR = 1.296; 95% CI, 1.22-1.38), but syndemic conditions were not significant. Deploying effective interventions within clinics to identify and treat syndemic conditions and bolster ART adherence and continued engagement in care can help control the HIV epidemic, even within academic medical settings in the era of increasingly potent ART.
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Affiliation(s)
- Satyanand Satyanarayana
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Address correspondence to: Satyanand Satyanarayana, JD, MS, Department of Psychology, University of Miami, Coral Gables, FL 33124, USA
| | - Brooke G. Rogers
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sierra A. Bainter
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Rob J. Fredericksen
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William C. Mathews
- Department of Medicine, UCSD School of Medicine, San Diego, California, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J. Mugavero
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Medicine, UAB School of Medicine, Birmingham, Alabama, USA
| | - Sonia Napravnik
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, California, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Kenneth H. Mayer
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA.,Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Heidi M. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
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Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
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Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Latent Profile Analysis of a Syndemic of Vulnerability Factors on Incident Sexually Transmitted Infection in a Cohort of Black Men Who Have Sex With Men Only and Black Men Who Have Sex With Men and Women in the HIV Prevention Trials Network 061 Study. Sex Transm Dis 2021; 47:571-579. [PMID: 32496390 DOI: 10.1097/olq.0000000000001208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are important public health concerns among black men who have sex with men only (BMSMO), as well as those who have sex with both men and women (BMSMW). Sexually transmitted infections also increase risk of acquiring and HIV, which is also a critical concern. Compared with BMSMO, research shows that BMSMW experience elevated levels of HIV/STI vulnerability factors occurring at the intrapersonal, interpersonal, and social/structural levels. These factors may work independently, increasing one's risk of engaging in high-risk sexual behaviors, but often work in a synergistic and reinforcing manner. The synergism and reinforcement of any combination of these factors are known as a syndemic, which increases HIV/STI risk. METHODS Data from the HIV Prevention Trials Network (HPTN) 061 study (n = 799) was used to conduct a latent profile analysis to identify unique combinations of risk factors that may form a syndemic and that may vary between BMSMO and BMSMW. We hypothesized that the convergence of syndemic factors would differ between groups and predict sexual risk and subsequent incident STI. RESULTS For BMSMO who had a high sexual risk profile, the syndemic factors characterizing this group included perceived racism, incarceration, intimate partner violence, depression, and binge drinking. For BMSMW with a high sexual risk profile, the syndemic factors that characterized this group were incarceration, depression, and binge drinking. CONCLUSIONS The current analysis highlights syndemic profiles that differentiated BMSMO and BMSMW from one another and supports the need for tailored interventions that address specific syndemic factors for both subpopulations of black men who have sex with men.
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Turpin RE, Salerno JP, Rosario AD, Boekeloo B. Victimization, Substance Use, Depression, and Sexual Risk in Adolescent Males Who Have Sex with Males: A Syndemic Latent Profile Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:961-971. [PMID: 32274744 PMCID: PMC10712424 DOI: 10.1007/s10508-020-01685-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 05/10/2023]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of HIV/STI acquisition compared to other adolescents, making sexual risk behaviors in this population a priority public health focus. AMSM experience more victimization (including sexual/partner violence), depression, and substance abuse than their heterosexual counterparts; these may form a syndemic associated with risky sexual behavior. We pooled data from the 2015 and 2017 Youth Risk Behavior Survey, restricted to male students who reported a previous male sexual partner (n = 448). Latent profile analysis was used to identify syndemic profiles, with log-binomial and cumulative complementary log-log models used to test associations with substance use at last intercourse, condomless sex at last intercourse, and the number of sexual partners. Nearly all measures of victimization, depression, and substance use had bivariate associations with greater substance use during sex and more sexual partners. We identified three profiles of AMSM: The profile (n = 55) with the greatest risk factors (evident of a syndemic) had substantially higher prevalence of substance use during sex (aPR = 4.74, 95% CI 3.02, 7.43) and more sexual partners (aPR = 2.45, 95% CI 1.39, 4.31) than the profile with the lowest risk factors (n = 326) after adjusting for confounders. This profile was not associated with condomless sex. We identified a syndemic characterized by victimization, depression, and substance use associated with risky sexual behaviors in a nationally representative sample of AMSM. Comprehensive sexual risk reduction interventions incorporating mental health and substance use are critically important in this population.
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Affiliation(s)
- Rodman E Turpin
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, 4200 Valley Dr., #2242, College Park, MD, 20742, USA.
| | - John P Salerno
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Andre D Rosario
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Bradley Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
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35
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Mimiaga MJ, Hughto JM, Klasko-Foster L, Jin H, Mayer KH, Safren SA, Biello KB. Substance Use, Mental Health Problems, and Physical and Sexual Violence Additively Increase HIV Risk Between Male Sex Workers and Their Male Clients in Northeastern United States. J Acquir Immune Defic Syndr 2021; 86:305-312. [PMID: 33148992 PMCID: PMC8343953 DOI: 10.1097/qai.0000000000002563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW. SETTING Community-based organization and health center in 2 Northeastern US cities. METHODS Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus. RESULTS Mean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62). CONCLUSIONS Internet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
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Affiliation(s)
- Matthew J. Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M.W. Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Harry Jin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical, Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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36
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Satyanarayana S, Safren SA, Rogers BG, Bainter SA, Christopoulos KA, Fredericksen RJ, Mathews WC, Moore RD, Mugavero MJ, Napravnik S, Carrico AW, Mimiaga MJ, Mayer KH, Crane HM. Estimating HIV transmissions in a large U.S. clinic-based sample: effects of time and syndemic conditions. J Int AIDS Soc 2021; 24:e25679. [PMID: 33724718 PMCID: PMC7962793 DOI: 10.1002/jia2.25679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Little is known about onward HIV transmissions from people living with HIV (PLWH) in care. Antiretroviral therapy (ART) has increased in potency, and treatment as prevention (TasP) is an important component of ending the epidemic. Syndemic theory has informed modelling of HIV risk but has yet to inform modelling of HIV transmissions. METHODS Data were from 61,198 primary HIV care visits for 14,261 PLWH receiving care through the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) at seven United States (U.S.) sites from 2007 to 2017. Patient-reported outcomes and measures (PROs) of syndemic conditions - depressive symptoms, anxiety symptoms, drug use (opiates, amphetamines, crack/cocaine) and alcohol use - were collected approximately four to six months apart along with sexual behaviours (mean = 4.3 observations). Counts of syndemic conditions, HIV sexual risk group and time in care were modelled to predict estimated HIV transmissions resulting from sexual behaviour and viral suppression status (HIV RNA < 400/mL) using hierarchical linear modelling. RESULTS Patients averaged 0.38 estimated HIV transmissions/100 patients/year for all visits with syndemic conditions measured (down from 0.83, first visit). The final multivariate model showed that per 100 patients, each care visit predicted 0.05 fewer estimated transmissions annually (95% confidence interval (CI): 0.03 to 0.06; p < 0.0005). Cisgender women, cisgender heterosexual men and cisgender men of undisclosed sexual orientation had, respectively, 0.47 (95% CI: 0.35 to 0.59; p < 0.0005), 0.34 (95% CI: 0.20 to 0.49; p < 0.0005) and 0.22 (95% CI: 0.09 to 0.35; p < 0.005) fewer estimated HIV transmissions/100 patients/year than cisgender men who have sex with men (MSM). Each within-patient syndemic condition predicted 0.18 estimated transmissions/100 patients/year (95% CI: 0.12 to 0.24; p < 0.0005). Each between-syndemic condition predicted 0.23 estimated HIV transmissions/100 patients/year (95% CI: 0.17 to 0.28; p < 0.0005). CONCLUSIONS Estimated HIV transmissions among PLWH receiving care in well-resourced U.S. clinical settings varied by HIV sexual risk group and decreased with time in care, highlighting the importance of TasP efforts. Syndemic conditions remained a significant predictor of estimated HIV transmissions notwithstanding the effects of HIV sexual risk group and time in care.
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Affiliation(s)
| | - Steven A Safren
- Department of PsychologyUniversity of MiamiCoral GablesFLUSA
- The Fenway Institute at Fenway HealthBostonMAUSA
| | - Brooke G Rogers
- Department of PsychologyUniversity of MiamiCoral GablesFLUSA
- Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | | | | | - Rob J Fredericksen
- Department of MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | | | | | | | | | - Adam W Carrico
- Department of Public Health SciencesUniversity of Miami School of MedicineMiamiFLUSA
| | - Matthew J Mimiaga
- The Fenway Institute at Fenway HealthBostonMAUSA
- UCLA Center for LGBTQ Advocacy, Research, and Health (C‐LARAH)Los AngelesCAUSA
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCAUSA
- Department of Psychiatry and Biobehavioral SciencesUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Kenneth H Mayer
- The Fenway Institute at Fenway HealthBostonMAUSA
- Massachusetts General Hospital Center for Global HealthBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Heidi M Crane
- Department of MedicineUniversity of Washington School of MedicineSeattleWAUSA
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37
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Quinn KG, Spector A, Takahashi L, Voisin DR. Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States. AIDS Behav 2021; 25:758-772. [PMID: 32944841 PMCID: PMC7886964 DOI: 10.1007/s10461-020-03040-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Antoinette Spector
- Medical College of Wisconsin, Institute for Health Equity, Milwaukee, USA
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Barrett BW, Abraham AG, Dean LT, Plankey MW, Friedman MR, Jacobson LP, Teplin LA, Gorbach PM, Surkan PJ. Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men. Soc Psychiatry Psychiatr Epidemiol 2021; 56:259-272. [PMID: 32780176 PMCID: PMC7870462 DOI: 10.1007/s00127-020-01940-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 08/07/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors-such as social inequalities-contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM). METHODS Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity. RESULTS At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms. CONCLUSION Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.
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Grants
- U54 AG062334 NIA NIH HHS
- U01 HL146205 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01-HL146242-01 National Heart, Lung, and Blood Institute (US)
- P30-CA006973 Sidney Kimmel Comprehensive Cancer Center
- U01-HL146333-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146240 NHLBI NIH HHS
- U01-HL146192-01 National Heart, Lung, and Blood Institute (US)
- R25-MH083620 NIMH NIH HHS
- U01 HL146241 NHLBI NIH HHS
- U01 HL146333 NHLBI NIH HHS
- R38 AI140299 NIAID NIH HHS
- U01-HL146208-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146245 NHLBI NIH HHS
- U01-HL146241-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146240-01 National Heart, Lung, and Blood Institute (US)
- P30 CA006973 NCI NIH HHS
- P30 AI094189 NIAID NIH HHS
- R25 MH083620 NIMH NIH HHS
- U01-HL146204-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146245-01 National Heart, Lung, and Blood Institute (US)
- K01 CA184288 NCI NIH HHS
- U01-HL146202-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146192 NHLBI NIH HHS
- U01 AI035041 NIAID NIH HHS
- K01-CA184288 NCI NIH HHS
- U01-HL146193-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146242 NHLBI NIH HHS
- P30-AI094189 Johns Hopkins University Center for AIDS Research
- R03-MH103961 NIMH NIH HHS
- U01-HL146203-01 National Heart, Lung, and Blood Institute (US)
- R01 DA022936 NIDA NIH HHS
- R21 AG059505 NIA NIH HHS
- R01-DA022936 NIDA NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01-HL146194-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146193 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01-HL146205-01 National Heart, Lung, and Blood Institute (US)
- R03 MH103961 NIMH NIH HHS
- U01-HL146201-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146203 NHLBI NIH HHS
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Alison G Abraham
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael W Plankey
- Department of Medicine, Medical Center, Georgetown University, Washington, DC, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamela J Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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40
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Myers K, Li T, Baum M, Ibanez G, Fennie K. The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care. Int J STD AIDS 2021; 32:184-193. [PMID: 33323072 DOI: 10.1177/0956462419890727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we sought to assess the individual, syndemic, and interactive associations between individual-level factors and retention in care. The sample was derived from the Miami Adult Studies on human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) cohort from 2009 to 2014. The variables were entered into a multiple logistic regression with retention as the outcome. Backward regression, adjusting for all main effects, was conducted to determine which two-way interactions were associated with retention. Multivariable logistic regression was used to test which number of factors were associated with retention. Non-Hispanic Black race/ethnicity was associated with improved retention (odds ratio [OR] = 2.44, 95% confidence interval [CI]: 1.06-5.75, p ≤ 0.05) when compared to Non-Hispanic White persons. Black-Hispanic and Other racial/ethnic identities were associated with increased retention (OR = 4.84, 95%CI: 1.16-25.79, p ≤ 0.05 and OR = 7.24, 95%CI: 1.54-54.05, p ≤ 0.05, respectively) when compared to Non-Hispanic White persons. The interaction between depressive symptoms and Alcohol Use Disorder Identification Test (AUDIT, a test that assesses alcohol use disorder) score was significantly and negatively associated with retention in HIV care (OR = 0.14, 95%CI: 0.01-1.11, p ≤ 0.10). The interaction between age and male gender was also negatively associated with retention (OR = 0.95, 95%CI: 0.88-1.01, p ≤ 0.10), and the interaction between male gender and depression was positively associated with retention (OR = 7.17, 95%CI: 0.84-98.49, p ≤ 0.10). In conclusion, multiple races/ethnicities, specifically Non-Hispanic Black, Black-Hispanic, and Other racial/ethnic identification, were associated with increased odds of retention. Multiple interactions, specifically depressive symptoms * alcohol use disorder and male gender * age, were negatively associated with retention. The male gender * depression interaction was positively associated with retention in HIV care.
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Affiliation(s)
- Kristopher Myers
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Epidemiology and Biostatistics, University of South Florida, Miami, FL, USA
| | - Marianna Baum
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Gladys Ibanez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Kristopher Fennie
- Department of Epidemiology, Florida International University, Miami, FL, USA
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41
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Maiorana A, Kegeles SM, Brown S, Williams R, Arnold EA. Substance use, intimate partner violence, history of incarceration and vulnerability to HIV among young Black men who have sex with men in a Southern US city. CULTURE, HEALTH & SEXUALITY 2021; 23:37-51. [PMID: 31944158 PMCID: PMC7363521 DOI: 10.1080/13691058.2019.1688395] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/30/2019] [Indexed: 05/23/2023]
Abstract
In this longitudinal qualitative study we explored the lived experiences of young Black men who have sex with men in Dallas, Texas in relation to methamphetamine use, intimate partner violence and a history of incarceration as syndemic conditions that may contribute to their risk of transmitting or acquiring HIV. We conducted a total of 106 interviews (four repeat interviews every six months) with a cohort of 30 participants. Some reported condomless sex and no discussion about condom use or HIV status with sexual partners. Fifteen participants reported that they were living with HIV. Methamphetamine use contributed to participants' unstable housing, job loss, destructive relationships and HIV risk. One third of participants reported a history of intimate partner violence. About half had a history of incarceration resulting from intimate partner violence, substance use/dealing and/or other activities. Post-release, having a criminal record limited job opportunities and impacted financial stability. Consequently, some men engaged in survival work involving HIV risk (sex work, organising/participating in sex parties). Methamphetamine use, intimate partner violence and incarceration may constitute syndemic conditions that increase young Black men who have sex with men's risk for HIV acquisition and transmission. HIV prevention interventions must address syndemics and include structural factors and the wider social environment.
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Affiliation(s)
- Andres Maiorana
- Center for AIDS Prevention Studies, University of
California, San Francisco, CA, USA
| | - Susan M. Kegeles
- Center for AIDS Prevention Studies, University of
California, San Francisco, CA, USA
| | - Stephen Brown
- Community, Prevention, and Intervention Unit, University of Texas, Southwestern
| | - Robert Williams
- Center for AIDS Prevention Studies, University of
California, San Francisco, CA, USA
| | - Emily A. Arnold
- Center for AIDS Prevention Studies, University of
California, San Francisco, CA, USA
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42
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Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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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, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
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43
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Dangerfield DT, Heidari O, Cooper J, Allen S, Lucas GM. Motivations for opioid and stimulant use among drug using black sexual minority men: A life course perspective. Drug Alcohol Depend 2020; 215:108224. [PMID: 32777690 PMCID: PMC7502465 DOI: 10.1016/j.drugalcdep.2020.108224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION HIV-related disparities persist among U.S. Black sexual minority men (BSMM). Generational differences in drug use trends and the HIV/AIDS epidemic have created different risk trajectories for BSMM. This study explored age-related differences in the profiles, motivations, and contexts of opioid and stimulant use among drug using BSMM. METHODS Participants were recruited using active and passive strategies and in-depth qualitative interviews were conducted among 30 BSMM in Baltimore, MD from December 2018 to March 2019. Exploratory drug testing was conducted to confirm drug use and identify the presence of synthetic materials. Thematic analysis was conducted guided by Life Course theoretical domains. RESULTS Participants' ages ranged from 25-63 (mean age 41, SD = 12.4); 40 % were under age 35, 60 % were age 35 and older. Most (86.7 %) were living with HIV. Older BSMM attributed drug use initiation to social trends and sexual partners; younger men shared that prescription painkiller use led to misuse to address emotional pain. Across age groups, childhood sexual abuse and other major events along the life course increased BSMM's drug use as a coping strategy. DISCUSSION AND CONCLUSION HIV and drug use interventions should support BSMM through targeted mental health services and trauma-informed healthcare models.
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Cassels S, Meltzer D, Loustalot C, Ragsdale A, Shoptaw S, Gorbach PM. Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles. J Urban Health 2020; 97:609-622. [PMID: 32996024 PMCID: PMC7560688 DOI: 10.1007/s11524-020-00481-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 01/21/2023]
Abstract
The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.
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Affiliation(s)
- Susan Cassels
- Department of Geography, University of California, Santa Barbara, CA, USA.
| | - Dan Meltzer
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Colin Loustalot
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Amy Ragsdale
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Syndemic latent transition analysis in the HPTN 061 cohort: Prospective interactions between trauma, mental health, social support, and substance use. Drug Alcohol Depend 2020; 214:108106. [PMID: 32652374 PMCID: PMC7423755 DOI: 10.1016/j.drugalcdep.2020.108106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Substance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. METHODS Using a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. RESULTS Our analysis identified four statuses: A "low-risk" status characterized by the lowest proportions of syndemic factors, and 3 "high-risk" statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with "high-risk status C" (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). CONCLUSIONS Our findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.
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Han BH, Duncan DT, Arcila-Mesa M, Palamar JJ. Co-occurring mental illness, drug use, and medical multimorbidity among lesbian, gay, and bisexual middle-aged and older adults in the United States: a nationally representative study. BMC Public Health 2020; 20:1123. [PMID: 32746891 PMCID: PMC7401198 DOI: 10.1186/s12889-020-09210-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/05/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Older lesbian, gay, and bisexual (LGB) adults are an underserved and understudied population that experience specific health disparities. The intersection of aging and chronic medical disease with a higher risk for substance use and mental illness may place older LGB adults at risk for co-occurring conditions and resulting comorbidity. Understanding multimorbidity among older LGB adults may help inform interventions to reduce disparities in health outcomes. METHODS Data come from the 2015 to 2017 National Surveys on Drug Use and Health (n = 25,880). We first determined whether sexual orientation was associated with reporting: past-year drug use, mental illness, and/or 2 or more chronic medical diseases. We then determined whether sexual orientation was associated with reporting co-occurrence of these conditions. This was done using multivariable logistic regression. Analyses were stratified by gender. RESULTS Compared to heterosexual men, gay men were at increased odds for reporting 2 or more chronic medical diseases (adjusted odds ratio [aOR] = 2.18, 95% confidence interval [CI] = 1.48, 3.21), and gay (aOR = 1.79, 95% CI = 1.09, 2.93) and bisexual men (aOR = 3.53, 95% CI = 2.03, 6.14) were at increased odds for reporting mental illness. Gay men (aOR = 2.95, 95CI = 1.60, 5.49) and bisexual men (aOR = 2.84, 95% CI = 1.58, 5.08) were at increased odds of reporting co-occurring conditions. Compared to heterosexual women, bisexual women were at increased odds for past-year drug use (aOR = 4.20, 95% CI = 2.55, 6.93), reporting mental illness (aOR = 1.94, 95% CI = 1.03, 3.67), and reporting co-occurring conditions (aOR = 3.25, 95% = 1.60, 6.62). CONCLUSIONS Middle-aged and older LGB adults in the United States are at high risk for experiencing co-occurring drug use, mental illness, and/or medical multimorbidity. Interventions for older sexual minority populations are needed to reduce disparities.
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Affiliation(s)
- Benjamin H Han
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Mauricio Arcila-Mesa
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Joseph J Palamar
- Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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Walters SM, Braksmajer A, Coston B, Yoon I, Grov C, Downing MJ, Teran R, Hirshfield S. A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1965-1978. [PMID: 31965453 PMCID: PMC7321855 DOI: 10.1007/s10508-020-01628-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 05/18/2023]
Abstract
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, 380 2nd Ave., Suite 306, NY 10010, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | | | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Irene Yoon
- Research and Advisory, Gartner L2, New York, NY, USA
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy and the CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | | | - Richard Teran
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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48
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Pearson CR, Kaysen D, Huh D, Bedard-Gillgan M, Walker D, Marin R, Saluskin K. A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: The Healing Seasons protocol. Contemp Clin Trials 2020; 95:106070. [PMID: 32561467 DOI: 10.1016/j.cct.2020.106070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Abstract
Native Americans (NA) experience interrelated risks of trauma exposure, substance use, and HIV risk behaviors that put them at increased risk for HIV infection. Despite these known risk factors, there are very few published randomized trials testing interventions to reduce trauma-related symptoms and substance misuse among NA. METHODS The Healing Seasons study is a randomized comparsion trial of two counseling strategies, Narrative Exposure Therapy (NET) addressing PTSD or Motivational interviewing with cognitive behavioral therapy skills training (MIST) addressing substance misuse as a means to prevent HIV among NA. Using a community-based participatory research approach, we adapted both evidence-based interventions to be specific to the risk contexts and realities of NA and to include psychoeducational and skill-building components that include cultural-specific stories, virtues, and traditional treatment strategies. Participants, 16 years and older, were recruited from a Pacific Northwest tribal community, screened over the phone, enrolled in person, and randomized in equal numbers to NET or MIST. We stratified by age (16-29 years and 30 or older) and gender (male or female identified) to ensure balance between treatment arms. The primary outcomes were number of sex partners and frequency of sexual acts (with and without condoms), sex under the influence of substances, frequency of substance use, and PTSD severity. DISCUSSION Behavioral interventions for NA are needed to prevent HIV risk behaviors when faced with trauma symptoms and substance misuse. This study will provide evidence to determine feasibility and efficacy of addressing related risk factors as part of counseling-based HIV prevention intervention to reduce sexual risk among this population. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03112369, registered April 12, 2017.
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Affiliation(s)
- C R Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA.
| | - D Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - D Huh
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - M Bedard-Gillgan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - D Walker
- Innovative Programs Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - R Marin
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - K Saluskin
- Yakama Nation Behavioral Health Services, Toppenish, WA, USA
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Poteat T, Millett GA, Nelson LE, Beyrer C. Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics. Ann Epidemiol 2020; 47:1-3. [PMID: 32419765 PMCID: PMC7224650 DOI: 10.1016/j.annepidem.2020.05.004] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
Black communities in the United States are bearing the brunt of the COVID-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which black Americans experience the lethal force of COVID-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and health care provider bias). Improving racial disparities in COVID-19 will require that we implement policies that address structural racism at the root of these disparities.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill
- Corresponding author. Department of Social Medicine, University of North Carolina Chapel Hill, 333 South Columbia Street, CB#7240, Chapel Hill, NC 27599. Tel.: +1-919-445-6364; fax: +1-919-966-7499.
| | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend 2020; 207:107770. [PMID: 31841750 PMCID: PMC6981056 DOI: 10.1016/j.drugalcdep.2019.107770] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.
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Affiliation(s)
- Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
| | - Ron Brookmeyer
- UCLA Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | | | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
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