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Lu W, Vu TT, Wilton L, Paige M, Nandi V, Greene E, Frye V. Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City. Am J Mens Health 2024; 18:15579883231218580. [PMID: 38700239 PMCID: PMC11069334 DOI: 10.1177/15579883231218580] [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: 04/22/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 05/05/2024] Open
Abstract
Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Mark Paige
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Vijay Nandi
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Emily Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Victoria Frye
- School of Social Work, Columbia University, New York, NY, USA
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Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders. SSM Popul Health 2022; 19:101153. [PMID: 35813187 PMCID: PMC9260617 DOI: 10.1016/j.ssmph.2022.101153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09–7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2–3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors. Social and economic stressors are understudied in transgender persons with SUD. Social and economic stressors were greater in persons with SUD than those without. Concurrent stressors and SUD were 2–3x higher for trans-than cis-gender patients. Transphobia may be a fundamental cause of disparities in SUD and stressors. SUD treatment should address social and economic stressors.
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Cotaina M, Peraire M, Boscá M, Echeverria I, Benito A, Haro G. Substance Use in the Transgender Population: A Meta-Analysis. Brain Sci 2022; 12:brainsci12030366. [PMID: 35326322 PMCID: PMC8945921 DOI: 10.3390/brainsci12030366] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
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Affiliation(s)
- Miriam Cotaina
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Marc Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Mireia Boscá
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Iván Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Ana Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain
- Correspondence:
| | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
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Johnson EEH, Wilder SMJ, Andersen CVS, Horvath SA, Kolp HM, Gidycz CA, Shorey RC. Trauma and Alcohol Use Among Transgender and Gender Diverse Women: An Examination of the Stress-Buffering Hypothesis of Social Support. J Prim Prev 2021; 42:567-581. [PMID: 34546505 DOI: 10.1007/s10935-021-00646-z] [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] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
Transgender and gender diverse (TGD) women (i.e., individuals who were assigned male at birth and identify as women or trans women) experience trauma at disproportionate rates compared to cisgender populations. While trauma is associated with increased alcohol use among TGD women, research regarding factors that are protective of this association is scant. The stress-buffering hypothesis of social support suggests that perceived social support, defined as the judgment that social network members will be helpful when individuals experience stress, may buffer and reduce the association between trauma symptoms and alcohol use. However, this relationship has not been examined among TGD women. We examined whether perceived social support moderates the association between trauma and alcohol use among 89 TGD women. Exploratory multiple regression analyses provided support for this hypothesis, insofar as trauma symptoms were related to alcohol use by individuals with low, relative to high levels of perceived social support. Exploratory analyses demonstrated that this finding was driven by perceived social support from friends and family. Our results are the first to suggest that social support reduces alcohol use among TGD women and add to the literature on their trauma and alcohol use.
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Affiliation(s)
| | | | | | | | - Haley M Kolp
- Department of Psychology, University of Wisconsin-Milwaukee, 238B Garland Hall, Milwaukee, WI, USA
| | | | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, 238B Garland Hall, Milwaukee, WI, USA.
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Nguyen LH, Nguyen HLT, Larsson M, Tran BX, L Stein M, Rocha LEC, Strömdahl S. An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam. BMC Public Health 2020; 20:1387. [PMID: 32917157 PMCID: PMC7488431 DOI: 10.1186/s12889-020-09449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) interventions are promising in HIV and sexually transmitted infections (STIs) prevention among men who have sex with men (MSM), given a high rate of the Internet use in this population. This study determined the preferences for eHealth interventions to prevent HIV and STIs among MSM in Hanoi, Vietnam to guide the development of future eHealth interventions. METHODS Five focus group discussions (FGD) were conducted with 35 MSM recruited by purposive sampling in January 2018 in Hanoi, Vietnam. The FGDs addressed attitudes towards the feasibility and uptake of HIV/STI interventions via online modalities such as smartphone applications (apps, social network sites, or emails); preferences and concerns regarding an online HIV/STI intervention. FGDs were audio-recorded and transcribed verbatim. Content analysis was used to determine themes. RESULTS MSM reported that they commonly searched for information regarding HIV/STI and sexual health on Facebook and a variety of mobile apps. They perceived a lack of reliable online sources, a high need, and interest for an online intervention. Most of them preferred short and concise messages without perceived sensitive words such as "HIV" or "STI". Diversity of online modalities were preferred with information from credible sources about HIV/STI symptoms, testing and treatment, safe sex practices and testing locations with a focus on safe MSM-friendly clinics. Concerns about the need to trust the organization behind the online information and interventions, and the importance of confidentiality when participating in online interventions were raised. CONCLUSION High acceptance and perceived need for an online HIV/STI intervention were reported. The importance of establishing trust within the MSM community as a reliable source of information was emphasized, as well as the importance of confidentiality.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
| | | | - Mattias Larsson
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mart L Stein
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Susanne Strömdahl
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Maza M, Meléndez M, Herrera A, Hernández X, Rodríguez B, Soler M, Alfaro K, Masch R, Conzuelo-Rodríguez G, Obedin-Maliver J, Cremer M. Cervical Cancer Screening with Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador. LGBT Health 2020; 7:174-181. [PMID: 32407149 DOI: 10.1089/lgbt.2019.0202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: Sexual and gender minority persons in low-income countries have very limited access to routine health services. This study evaluated the feasibility of using a self-sampled human papillomavirus (HPV) test to increase access to screening for cervical cancer among transgender men in El Salvador. Methods: We partnered with a local advocacy organization for recruitment. A total of 24 transgender men (men assigned female at birth) ages 19-55 were enrolled and provided consent. Questionnaires assessed sociodemographics, health and sexual histories, and knowledge about HPV and cervical cancer. Screening was performed with a self-sampled HPV test. Participants with a positive test were offered colposcopy and cryotherapy treatment, if appropriate. Those with a negative test were advised to return in 5 years for rescreening. Results: Out of 24 consenting participants, 23 (95.83%) agreed to conduct HPV self-sampling, and 22/23 (95.65%) expressed willingness to self-sample in the future. Among self-sampled individuals, 3/23 (13%) tested positive and accepted colposcopy and biopsy. Analyses of biopsied tissue revealed one case of cervical intraepithelial neoplasia grade 1. Conclusion: HPV self-sampling and subsequent procedures were accepted by the majority of participants. This screening method may be a viable alternative to cytology among transgender men in El Salvador.
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Affiliation(s)
- Mauricio Maza
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Mario Meléndez
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Alejandra Herrera
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Xavier Hernández
- Asociación Generación Hombres Trans El Salvador, San Salvador, El Salvador
| | - Bryan Rodríguez
- Asociación Generación Hombres Trans El Salvador, San Salvador, El Salvador
| | - Montserrat Soler
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador.,Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karla Alfaro
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Rachel Masch
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Gabriel Conzuelo-Rodríguez
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Standford School of Medicine, Palo Alto, California, USA
| | - Miriam Cremer
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador.,Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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7
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Yi S, Chann N, Chhoun P, Tuot S, Mun P, Brody C. Social marginalization, gender-based violence, and binge drinking among transgender women in Cambodia. Drug Alcohol Depend 2020; 207:107802. [PMID: 31846846 DOI: 10.1016/j.drugalcdep.2019.107802] [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: 10/26/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transgender women experience disproportionate social stigma that may lead to behavioral risks and poor psychological wellbeing. This study examines social and behavioral factors associated with binge drinking among transgender women in Cambodia. METHODS A cross-sectional survey was conducted in 2016 among 1039 transgender women recruited from 13 provinces using the Respondent Driven Sampling method. A structured questionnaire was used for face-to-face interviews. Weighted multivariable logistic regression analysis was conducted to identify risk factors associated with binge drinking. RESULTS The prevalence of binge drinking was 43.3 %. After adjustment, the odds of binge drinking were significantly higher among participants in the age group of 25-34 compared to those in the age group of 18-24 and lower among participants in job categories such as hairdresser or beautician, office workers, and self-employed compared to those who were unemployed. The odds of binge drinking were significantly higher in participants who dropped out of school and thought it was because of their transgender identity, had transactional sex in the past three months, used amphetamine-type stimulants in the past three months, and reported experience of verbal abuse by family members during childhood. Regarding mental health, the odds of binge drinking were significantly lower among participants who had depressive symptoms over the past week. CONCLUSIONS These findings highlight the intersections between social marginalization, gender-based violence, HIV risks, and alcohol abuse. We recommend further exploration of the structural factors that may be modifiable through workplace policies or occupational health interventions among transgender women.
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Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; KHANA Center for Population Health Research, Phnom Penh, Cambodia; Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.
| | - Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, USA.
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McKay T, Watson RJ. Gender expansive youth disclosure and mental health: Clinical implications of gender identity disclosure. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 7:66-75. [PMID: 33855103 DOI: 10.1037/sgd0000354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Some healthcare providers work with gender expansive youth, and preliminary evidence notes that many of these youth do not disclose their gender identity to all of their healthcare providers. No previous research focused on youth has explored gender identity disclosure to healthcare providers, nor linked youth disclosure to negative mental health outcomes (e.g., symptoms of depression). Data were drawn from the LGBTQ National Teen Survey in order to test the relationship between gender identity disclosure, symptoms of depression, and self-esteem among 5,637 13- to 17-year old (M age = 15.6) participants who identified as transgender boys, transgender girls, non-binary youth who were assigned female at birth (AFAB), or assigned male non-binary youth who were assigned male at birth (AMAB). Transgender boys reported the highest symptoms of depression and the lowest levels of self-esteem in comparison to other groups. Among the full sample, 66.8% had not disclosed their gender identity healthcare providers-non-binary AMAB youth were least likely to disclose (77.6%). Symptoms of depression were the highest and self-esteem was the lowest for transgender boys with mixed levels of disclosure. Transgender girls reported the lowest symptoms of depression - these youth had also disclosed their identities the most. Findings suggest that mixed disclosure to healthcare providers is problematic for gender expansive youth, especially transgender boys. Findings suggest a need to better prepare health professionals to understand not all gender expansive youth may feel comfortable disclosing their gender identities in medical contexts. Future research should explore gender affirmative healthcare as a potential protective factor in combatting negative mental health outcomes.
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania. AIDS Behav 2019; 23:1612-1622. [PMID: 30465107 DOI: 10.1007/s10461-018-2340-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than one month, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.
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Mimiaga MJ, Suarez N, Garofalo R, Frank J, Ogunbajo A, Brown E, Bratcher A, Pardee D, Hidalgo MA, Hoehnle S, Restar A, Wimbly T, Thai J, Sullivan PS, Stephenson R. Relationship Dynamics in the Context of Binge Drinking and Polydrug Use Among Same-Sex Male Couples in Atlanta, Boston, and Chicago. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1171-1184. [PMID: 30806868 PMCID: PMC6458086 DOI: 10.1007/s10508-018-1324-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 06/09/2023]
Abstract
An estimated one- to two-thirds of incident HIV infections among U.S. men who have sex with men (MSM) occur within the context of a primary relationship. The existing, yet limited, literature on sexual risk behavior among same-sex couples suggests that MSM with main partners are more often to report having lower perceived HIV risk, higher unrecognized HIV infection, and increased frequency of condomless anal intercourse with their primary partner. Furthermore, numerous studies document the strong relationship between polydrug use and binge drinking with HIV infection among MSM. However, more research is needed that identifies how individual- and relationship-level factors are related to polydrug use and binge drinking in the context of same-sex male relationships. We used baseline data collected as part of a prospective randomized controlled trial of 160 same-sex male couples (total N = 320 individuals). In 2015, recruitment commenced in three U.S. cities: Atlanta, GA, Boston, MA, and Chicago, IL. Participants completed a self-report assessment using an audio-computer-assisted self-interview system during their baseline enrollment visit. We collected information on participants' sociodemographic characteristics, drug and alcohol use, individual- and relationship-level variables of interest, as well as relationship quality. Multinomial logistic regression models were fit for three different categories of polydrug use and of binge drinking for which (1) both partners exhibited the behavior, (2) only the respondent exhibited the behavior, or (3) only the partner exhibited the behavior. Participants' age ranged from 18 to 69 (M = 35.9). The sample majority (77.5%) was White (248/320), with 12.2% Black (39/320) and 10.3% Multiracial (33/320); 68.4% had completed a college degree; and 9.6% were unemployed. A high proportion (62.2%) reported any drug use, including marijuana; 45% reported using drugs other than marijuana; and 18.1% reported polydrug use. Overall, 22.2% reported current binge drinking. Age discordance and being in a long-term relationship (6 or more years) were associated with a decreased odds of polydrug use among couples; being in an interracial dyad, recent history of arrest, living with HIV, and self-reported clinically significant depressive symptoms were associated with an increased odds of polydrug use. Additionally, being the older partner and reporting higher levels of internalized homophobia decreased odds for binge drinking, while recent history of arrest, living with HIV, and feeling more loved in their relationship were associated with an increased odds of binge drinking. Findings have implications for developing interventions to reduce substance use and promote health among same-sex male couples. Future research would benefit by using longitudinal study designs to understand the individual-, relationship-, and structural-level factors that potentiate polydrug use and binge drinking among same-sex male couples.
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Affiliation(s)
- Matthew J Mimiaga
- Center for Health Equity Research, Brown University, 121 South Main Street, Floor 8, Providence, RI, 02903, USA.
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
| | - Nicolas Suarez
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Robert Garofalo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - John Frank
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Adedotun Ogunbajo
- Center for Health Equity Research, Brown University, 121 South Main Street, Floor 8, Providence, RI, 02903, USA
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Emily Brown
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Anna Bratcher
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dana Pardee
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Marco A Hidalgo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sam Hoehnle
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, 121 South Main Street, Floor 8, Providence, RI, 02903, USA
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Taylor Wimbly
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennie Thai
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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12
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Feinstein BA, Dyar C, Li DH, Whitton SW, Newcomb ME, Mustanski B. The Longitudinal Associations Between Outness and Health Outcomes Among Gay/Lesbian Versus Bisexual Emerging Adults. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1111-1126. [PMID: 30519838 PMCID: PMC6458057 DOI: 10.1007/s10508-018-1221-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 05/18/2023]
Abstract
Sexual minorities are at increased risk for substance use and mental health problems. Although previous studies have examined the associations between outness and health outcomes, few have used longitudinal designs or examined differences across subgroups of sexual minorities. To address these gaps, the current study examined sexual orientation and gender as moderators of the longitudinal associations between outness and substance use (cigarettes, marijuana, illicit drugs, and alcohol) and mental health (depression and anxiety). Data were from a sample of 169 sexual minority emerging adults (98 women and 71 men) who provided self-report data at four times over 3.5 years. Results indicated that sexual orientation moderated the within-person associations between outness and changes in health. For bisexual individuals, being more out was associated with increases in marijuana use, illicit drug use, and depression. In contrast, for gay/lesbian individuals, being more out was associated with decreases in illicit drug use and it was not significantly associated with changes in marijuana use or depression. Additionally, outness was not significantly associated with changes in cigarette use, alcohol use, or anxiety for gay/lesbian or bisexual individuals, and gender did not moderate any of the associations. In sum, being more open about one's sexual orientation had negative consequences for bisexual individuals but not for gay/lesbian individuals. Professionals who work with sexual minorities need to be aware of the potential risks of being open about one's sexual orientation for bisexual individuals. Interventions are needed to facilitate disclosure decisions and to promote the health of sexual minorities.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Christina Dyar
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave., #14-047, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave., #14-047, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave., #14-047, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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14
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Relationship Characteristics and Dyadic Approaches to HIV Health-Enhancing Behaviours Among a Sample of Same-Sex Male Couples From Three U.S. Cities. ACTA ACUST UNITED AC 2018. [DOI: 10.1017/jrr.2018.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recent modelling estimates up to two-thirds of new HIV infections among men who have sex with men occur within partnerships, indicating the importance of dyadic HIV prevention efforts. Although new interventions are available to promote dyadic health-enhancing behaviours, minimal research has examined what factors influence partners’ mutual engagement in these behaviours, a critical component of intervention success. Actor-partner interdependence modelling was used to examine associations between relationship characteristics and several dyadic outcomes theorised as antecedents to health-enhancing behaviours: planning and decision making, communication, and joint effort. Among 270 male-male partnerships, relationship satisfaction was significantly associated with all three outcomes for actors (p = .02, .02, .06 respectively). Latino men reported poorer planning and decision making (actor p = .032) and communication (partner p = .044). Alcohol use was significantly and negatively associated with all outcomes except actors’ planning and decision making (actors: p = .11, .038, .004 respectively; partners: p = .03, .056, .02 respectively). Having a sexual agreement was significantly associated with actors’ planning and decision making (p = .007) and communication (p = .008). Focusing on interactions between partners produces a more comprehensive understanding of male couples’ ability to engage in health-enhancing behaviours. This knowledge further identifies new and important foci for the tailoring of dyadic HIV prevention and care interventions.
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Suarez NA, Mimiaga MJ, Garofalo R, Brown E, Bratcher AM, Wimbly T, Hidalgo MA, Hoehnle S, Thai J, Kahle E, Sullivan PS, Stephenson R. Dyadic Reporting of Intimate Partner Violence Among Male Couples in Three U.S. Cities. Am J Mens Health 2018; 12:1039-1047. [PMID: 29749299 PMCID: PMC6131425 DOI: 10.1177/1557988318774243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Intimate partner violence (IPV) is a prevalent and pressing public health concern
that affects people of all gender and sexual identities. Though studies have
identified that male couples may experience IPV at rates as high as or higher
than women in heterosexual partnerships, the body of literature addressing this
population is still nascent. This study recruited 160 male–male couples in
Atlanta, Boston, and Chicago to independently complete individual surveys
measuring demographic information, partner violence experience and perpetration,
and individual and relationship characteristics that may shape the experience of
violence. Forty-six percent of respondents reported experiencing IPV in the past
year. Internalized homophobia significantly increased the risk for reporting
experiencing, perpetrating, or both for any type of IPV. This study is the first
to independently gather data on IPV from both members of male dyads and
indicates an association between internalized homophobia and risk for IPV among
male couples. The results highlight the unique experiences of IPV in male–male
couples and call for further research and programmatic attention to address the
exorbitant levels of IPV experienced within some of these partnerships.
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Affiliation(s)
- Nicolas A Suarez
- 1 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Mimiaga
- 3 Center for Health Equity Research, Brown University, Providence, RI, USA.,4 Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.,5 Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.,6 The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Robert Garofalo
- 7 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,8 Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Brown
- 6 The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Anna Marie Bratcher
- 9 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Taylor Wimbly
- 9 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marco A Hidalgo
- 10 Center for Trans Youth Health and Development, Children's Hospital Los Angeles, Los Angeles, CA, USA.,11 Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Hoehnle
- 7 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,8 Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jennie Thai
- 7 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Erin Kahle
- 2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.,12 Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Patrick S Sullivan
- 9 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- 2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.,12 Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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16
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Gilbert PA, Pass LE, Keuroghlian AS, Greenfield TK, Reisner SL. Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies. Drug Alcohol Depend 2018; 186:138-146. [PMID: 29571076 PMCID: PMC5911250 DOI: 10.1016/j.drugalcdep.2018.01.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research. METHODS We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990-2017, and extracted key details (e.g., sample composition, alcohol measures, results). RESULTS Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods. CONCLUSION Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.
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Affiliation(s)
- Paul A. Gilbert
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Pass
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alex S. Keuroghlian
- Harvard Medical School, Boston, MA, USA,The Fenway Institute, Fenway Health, Boston, MA, USA,Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Tom K. Greenfield
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sari L. Reisner
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
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17
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Hidalgo MA, Suarez NA, Garofalo R, Hoehnle S, Thai J, Mimiaga MJ, Brown E, Sullivan PS, Bratcher A, Wimbly T, Stephenson R. Clinically significant depressive symptoms among a diverse sample of same-sex male couples in Atlanta, Boston, and Chicago: An analysis of individual- and dyadic-level factors. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018; 22:327-347. [PMID: 35847160 DOI: 10.1080/19359705.2018.1476278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Psychosocial and relationship factors are associated with depression outcomes in heterosexual couples. No known research has examined these relationships statistically among both partners within a same-sex male dyad. This study examined how socio-demographics, psychosocial and relationship factors influence depressive symptoms in a large sample of same-sex male couples in Atlanta, Boston, and Chicago. Linear and logistic regression models indicated that, at the individual level, age, polydrug use, relationship length, perceived love, and partner communication were associated with depression scores. Multinomial logistic regression models showed that couples with no sexual agreement or an agreement with restrictions were likely to exhibit depressive symptoms.
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Affiliation(s)
- Marco A Hidalgo
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nicolas A Suarez
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Center for Sexual and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samuel Hoehnle
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jennie Thai
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Matthew J Mimiaga
- Departments of Behavioral and Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Center for Health Equity Research, Brown University, Providence, Rhode Island, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Emily Brown
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anna Bratcher
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Taylor Wimbly
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rob Stephenson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Behaviors and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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18
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Wang Z, Lau JTF, Yang X, Cai Y, Gross DL, Ma T, Liu Y. Acceptability of Daily Use of Free Oral Pre-exposure Prophylaxis (PrEP) Among Transgender Women Sex Workers in Shenyang, China. AIDS Behav 2017; 21:3287-3298. [PMID: 28752354 DOI: 10.1007/s10461-017-1869-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study investigated the acceptability of daily use of free oral pre-exposure prophylaxis (PrEP) and associated factors among transgender women sex workers in Shenyang, China, following a briefing on PrEP. A total of 183 HIV negative or sero-status unknown participants completed the cross-sectional survey. The prevalence of acceptability of daily use of free oral PrEP was 61.2%. Adjusting for education level and monthly income, variables on negative attitudes toward PrEP (i.e., having concerns about the side-effects of PrEP) [Adjusted odds ratios (AOR): 0.26], perceived subjective norms (i.e., perceiving support from male partners to take PrEP) (AOR: 2.08), and perceived behavioral control (e.g., perceiving complete control over using PrEP) (AOR: 2.10-16.72) were significantly associated with acceptability of daily use of free oral PrEP. In addition, experiencing violence during sex work, perceived risk of contracting HIV from clients and probable anxiety were also significant. Future PrEP promotion campaigns should consider these factors.
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Chard AN, Metheny N, Stephenson R. Perceptions of HIV Seriousness, Risk, and Threat Among Online Samples of HIV-Negative Men Who Have Sex With Men in Seven Countries. JMIR Public Health Surveill 2017. [PMID: 28634155 PMCID: PMC5497068 DOI: 10.2196/publichealth.7546] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual’s perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM. Objective The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM. Methods Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV—measured as their confidence in being able to stay HIV-negative throughout their lifetimes—on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country. Results Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring HIV in five countries (Australia: odds ratio, OR 0.97, 95% CI 0.94-0.99; Brazil: OR 0.95, 95% CI 0.91-0.98; Canada: OR 0.96, 95% CI 0.93-0.98; South Africa: OR 0.96, 95% CI 0.94-0.98; United Kingdom: OR 0.95, 95% CI 0.92-0.98). Being in a male-male sexual relationship was associated with significantly lower perceived risk of HIV in four countries (Australia: OR 0.47, 95% CI 0.30-0.75; Canada: OR: 0.54, 95% CI 0.35-0.86; United Kingdom: OR 0.38, 95% CI 0.24-0.60; United States: OR 0.5, 95% CI 0.31-0.82). Drug use in the previous year was associated with greater threat of contracting HIV in two countries (Canada: OR 1.81, 95% CI 1.13-2.91; United Kingdom: OR 1.7, 95% CI 1.06-2.74). Conclusions Few measures of behavioral or sexual risk-taking were significantly associated with perceived HIV seriousness, risk, or threat across countries. Overall, low levels of reported risk were identified, and results illustrate important gaps in the understanding of risk among MSM across societies that could be addressed through culturally-tailored prevention messaging.
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Affiliation(s)
- Anna N Chard
- Department of Environmental HealthRollins School of Public HealthEmory UniversityAtlanta, GAUnited States
| | - Nicholas Metheny
- Department of Health Behavior and Biological SciencesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States.,Center for Sexuality and Health DisparitiesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States
| | - Rob Stephenson
- Department of Health Behavior and Biological SciencesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States.,Center for Sexuality and Health DisparitiesSchool of NursingUniversity of MichiganAnn Arbor, MIUnited States
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20
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Tupler LA, Zapp D, DeJong W, Ali M, O'Rourke S, Looney J, Swartzwelder HS. Alcohol-Related Blackouts, Negative Alcohol-Related Consequences, and Motivations for Drinking Reported by Newly Matriculating Transgender College Students. Alcohol Clin Exp Res 2017; 41:1012-1023. [PMID: 28324915 DOI: 10.1111/acer.13358] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 02/13/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many transgender college students struggle with identity formation and other emotional, social, and developmental challenges associated with emerging adulthood. A potential maladaptive coping strategy employed by such students is heavy drinking. Prior literature has suggested greater consumption and negative alcohol-related consequences (ARCs) in transgender students compared with their cisgender peers, but little is known about their differing experiences with alcohol-related blackouts (ARBs). We examined the level of alcohol consumption, the frequency of ARBs and other ARCs, and motivations for drinking reported by the largest sample of transgender college students to date. METHODS A Web survey from an alcohol-prevention program, AlcoholEdu for College™, assessed student demographics and drinking-related behaviors, experiences, and motivations of newly matriculating first-year college students. A self-reported drinking calendar was used to examine each of the following measures over the previous 14 days: number of drinking days, total number of drinks, and maximum number of drinks on any single day. A 7-point Likert scale was used to measure ARCs, ARBs, and drinking motivations. Transgender students of both sexes were compared with their cisgender peers. RESULTS A total of 989 of 422,906 students (0.2%) identified as transgender. Over a 14-day period, transgender compared with cisgender students were more likely to consume alcohol over more days, more total drinks, and a greater number of maximum drinks on a single day. Transgender students (36%) were more likely to report an ARB than cisgender students (25%) as well as more negative academic, confrontation-related, social, and sexual ARCs. Transgender respondents more often cited stress reduction, social anxiety, self-esteem issues, and the inherent properties of alcohol as motivations for drinking. For nearly all measures, higher values were yielded by male-to-female than female-to-male transgender students. CONCLUSIONS Transgender compared with cisgender first-year students engage in higher-risk drinking patterns and experience more ARBs and other negative ARCs. Broad institutional efforts are required to address the unique circumstances of transgender men and women and to reduce negative ARCs in college students, regardless of their sex or gender identity.
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Affiliation(s)
- Larry A Tupler
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Daniel Zapp
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,EverFi, Inc., Washington, District of Columbia
| | - William DeJong
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Maryam Ali
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Sarah O'Rourke
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - John Looney
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - H Scott Swartzwelder
- Consortium for the Study of the American College Student, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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21
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Glynn TR, van den Berg JJ. A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action. Transgend Health 2017; 2:45-59. [PMID: 28861547 PMCID: PMC5549596 DOI: 10.1089/trgh.2016.0037] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work.
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Affiliation(s)
- Tiffany R. Glynn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
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Poteat T, German D, Flynn C. The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Glob Public Health 2016; 11:835-48. [PMID: 26785751 PMCID: PMC4957661 DOI: 10.1080/17441692.2015.1134615] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Historically, HIV studies have conflated men who have sex with men (MSM) with transgender (trans) women, explicitly excluded trans individuals, or included sample sizes of trans people that are too small to reach meaningful conclusions. Despite the heavy burden of HIV among trans women, conflation of this population with MSM has limited the information available on the social and behavioural factors that increase HIV vulnerability among trans women and how these factors may differ from MSM. Using data sets from quantitative studies among MSM (n = 645) and trans women (n = 89), as well as qualitative in-depth interviews with 30 trans women in Baltimore, we explore what these data tell us about similarities and differences in HIV vulnerability between the two groups and where they leave gaps in our understanding. We conclude with implications for data collection and intervention development.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colin Flynn
- HIV Surveillance, Epidemiology and Evaluation, Maryland Department of Health and Mental Hygiene, Prevention and Health Promotion Administration, Baltimore, MD, USA
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Martinez O, Wu E, Levine EC, Muñoz-Laboy M, Spadafino J, Dodge B, Rhodes SD, Rios JL, Ovejero H, Moya EM, Baray SC, Carballo-Diéguez A, Fernandez MI. Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City. ADDICTION RESEARCH & THEORY 2016; 24:466-476. [PMID: 28077938 PMCID: PMC5222534 DOI: 10.3109/16066359.2016.1167191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors - clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination - reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.
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Affiliation(s)
- Omar Martinez
- Temple University School of Social Work, Philadelphia, PA, USA
| | - Elwin Wu
- School of Social Work at Columbia University, New York, NY, USA
| | - Ethan C. Levine
- Department College of Liberal Arts at Temple University, Philadelphia, PA, USA
| | | | | | - Brian Dodge
- School of Public Health at Indiana University - Bloomington, Bloomington, IN, USA
| | | | - Javier López Rios
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Hugo Ovejero
- Lutheran Family Health Center, Brooklyn, NY, USA
| | - Eva M. Moya
- School of Social Work at the University of Texas at El Paso, El Paso, TX, USA
| | - Silvia Chavez Baray
- School of Social Work at the University of Texas at El Paso, El Paso, TX, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - M. Isabel Fernandez
- Department of Public Health at Nova Southeastern University, Fort Lauderdale, FL, USA
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