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Muessig KE, Vecchio AC, Hanshaw BD, Soberano Z, Knudtson KA, Claude KF, Larsen MA, Hightow-Weidman LB. Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention. AIDS Behav 2024; 28:3283-3299. [PMID: 38951455 PMCID: PMC11427151 DOI: 10.1007/s10461-024-04406-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: 05/30/2024] [Indexed: 07/03/2024]
Abstract
Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.
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Affiliation(s)
- Kathryn E Muessig
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA.
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA.
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA.
| | - Alyssa C Vecchio
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Brady D Hanshaw
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Harvard Medical School, Harvard University, Boston, USA
| | - Zachary Soberano
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | - Kelly A Knudtson
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
| | - Kristina Felder Claude
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
| | | | - Lisa B Hightow-Weidman
- University of North Carolina-Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, USA
- University of North Carolina-Chapel Hill, Gillings School of Global Public Health Chapel Hill, Chapel Hill, USA
- Florida State University, College of Nursing, Institute on Digital Health and Innovation, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32306-4310, USA
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Payton IK, Starkweather AR, Canidate SS, Westmoreland DA, Lyon DE. Psychosocial Distress Among Young Men Who Have Sex With Men: A Scoping Review. J Psychosoc Nurs Ment Health Serv 2024; 62:11-17. [PMID: 38537109 DOI: 10.3928/02793695-20240322-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE Psychosocial distress negatively impacts coping and adaptation among young men (aged 18 to 44 years) who have sex with men (YMSM) with, or at risk of acquiring, HIV. However, the stressors and risky behaviors associated with psychosocial distress that impair viral suppression have not been clearly explicated. The current scoping review was conducted to explore the extant literature and identify research gaps. METHOD PubMed and CINAHL were searched for peer-reviewed publications, with a total of eight articles meeting inclusion criteria. RESULTS Stressors that contributed to psychosocial distress included HIV+ status, stigma, discrimination, insufficient resources, exposure to community violence, and incarceration. Risky behaviors impacting viral suppression were condomless anal sex, drug use, and medication nonadherence. CONCLUSION Understanding and addressing psychosocial distress is imperative for providing holistic care tailored to the unique health care needs of YMSM. A better understanding of stressors and associated risky behaviors will aid efforts to mitigate psychosocial distress and reduce viral load among YMSM. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 11-17.].
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3
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Pepper N, Zúñiga ML, Corliss HL. Use of poppers (nitrite inhalants) among young men who have sex with men with HIV: A clinic-based qualitative study. BMC Public Health 2024; 24:1741. [PMID: 38951768 PMCID: PMC11218135 DOI: 10.1186/s12889-024-19284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 06/26/2024] [Indexed: 07/03/2024] Open
Abstract
Nitrite inhalants (poppers) are associated with HIV transmission and commonly used among young men who have sex with men (YMSM), a group at increased risk for HIV. Significant research gaps exist in understanding the context in which YMSM use poppers. Qualitative interviews were conducted with 15 YMSM (22-31 years) with HIV to better understand the context in which poppers are used and their impacts on HIV care outcomes, such as care retention and antiretroviral adherence. The Social Ecological Model was applied to understand intrapersonal, interpersonal, community, and system level influences on popper use. Factors influencing popper use included: ubiquity of popper use in sexual settings, introduction to poppers by casual sexual partners, patient-HIV provider communication surrounding poppers, neighborhood, substance use and HIV care systems, and the legal status of poppers. Implications for clinical care, public health, policy, and future research are discussed.
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Affiliation(s)
- Nicole Pepper
- University of California San Diego, Pediatrics, San Diego, CA, USA.
| | | | - Heather L Corliss
- School of Public Health, San Diego State University, San Diego, CA, USA
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Psaros C, Hill-Rorie J, Quint M, Horvitz C, Dormitzer J, Biello KB, Krakower DS, Safren SA, Mimiaga MJ, Sullivan P, Hightow-Weidman LB, Mayer KH. A qualitative exploration of how to support PrEP adherence among young men who have sex with men. AIDS Care 2024; 36:732-743. [PMID: 37748111 PMCID: PMC10961251 DOI: 10.1080/09540121.2023.2240070] [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: 02/23/2023] [Accepted: 07/18/2023] [Indexed: 09/27/2023]
Abstract
New HIV infections disproportionately affect young men who have sex with men (YMSM). PrEP is effective in preventing HIV acquisition; however, adherence is critical and is often suboptimal among YMSM. Interventions addressing the unique PrEP adherence challenges faced by YMSM are needed. We conducted qualitative interviews with 20 HIV-negative, YMSM (ages 15-24) with a PrEP indication and 11 healthcare professionals to inform adaption of a PrEP adherence intervention (Life-Steps for PrEP) for YMSM. We explored environmental, healthcare, and individual factors influencing uptake, adherence, attitudes, and perspectives (including desired modifications) on the Life-Steps intervention. Interviews were analyzed using content analysis. Of YMSM study participants (mean age 21.6) 55% were White, 15% Hispanic, and 5% Black. Most YMSM were PrEP-experienced (70%). Healthcare professionals (6 prescribers, 1 nurse, 2 health educators, 2 other/unspecified) averaged 6.9 years of experience caring for YMSM. All described stigma as a barrier to PrEP; YMSM expressed concern around being perceived as "risky" and concern about inadvertent PrEP disclosure if family/friends found their medication, or if parental insurance was used. Difficulty with planning for potential adherence challenges were identified by both groups. YMSM highlighted benefits of a nurse-led intervention (i.e., adding "legitimacy"), but stressed need for nonjudgmental, "savvy" interventionists. YMSM expressed a desire for comprehensive YMSM-specific sexual health information. These findings informed modification and expansion of Life-Steps content. Results highlight key potential barriers, many of which center around privacy. Content that addresses PrEP stigma, disclosing PrEP use, navigating insurance, and planning ahead in a nonjudgmental environment by trusted providers emerged as important components of a YMSM-focused delivery of Life-Steps for PrEP.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | | | - Meg Quint
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Casey Horvitz
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, United States
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, United States
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa B. Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States
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5
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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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Chang K, D'Anna LH, Owens J, Wood J. The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes. AIDS Behav 2024; 28:1741-1751. [PMID: 38367163 DOI: 10.1007/s10461-024-04267-5] [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: 01/04/2024] [Indexed: 02/19/2024]
Abstract
Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.
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Affiliation(s)
- Kyle Chang
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA.
| | - Laura Hoyt D'Anna
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
| | - Jaelen Owens
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
| | - Jefferson Wood
- Center for Health Equity Research, California State University Long Beach, 1250 Bellflower Blvd., FO5 Rm. 120, Long Beach, CA, 90840, USA
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7
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Jaramillo J, Reyes N, Atuluru P, Payen N, Taylor K, Safren SA, Saber R, Harkness A. Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida. AIDS Care 2024; 36:569-579. [PMID: 38157344 PMCID: PMC10932813 DOI: 10.1080/09540121.2023.2287736] [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: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nequiel Reyes
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, FL, USA
| | - Naomie Payen
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Kayla Taylor
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Del Pino HE, Harawa NT, Shoptaw SJ, Schrode K, Karlamangla A. Drug Use, Family Support, and Depressive Symptoms Among Latinx Sexual Minority Men: A Longitudinal Analysis. AIDS Behav 2023; 27:3844-3851. [PMID: 37306844 PMCID: PMC10598152 DOI: 10.1007/s10461-023-04098-w] [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: 05/23/2023] [Indexed: 06/13/2023]
Abstract
Family rejection has negative health consequences for Latinx sexual minority men (LSMM). However, LSMM often reconcile with their families, a phenomenon cross-sectional studies miss. We analyzed longitudinal data from the Healthy Young Men's Study in Los Angeles. We used individual fixed-effects Poisson regression to model changes over time in the associations among family support, drug use, and depressive symptoms. We found that (1) the initiation of drug use was associated with a 7.2% (Ratio=1.072, 95% CI 1.006 - 1.142, p = 0.03) increase in family support among LSMM who reported high depressive symptoms (depression subscale T-score ≥ 63) in at least one data wave; (2) a 1-unit increase in family support was associated with a 4.7% (RR = ;0.953, 95% CI 0.931 - 0.976, p < 0.001) decrease in the probability of high depressive symptoms; and (3) no significant association between a change in drug use and a change in high depressive symptoms. Over time, LSMM appear to benefit from the health effects of family support associated with Latinx family structures.
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Affiliation(s)
- Homero E Del Pino
- Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA.
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
- VA Greater Los Angeles Healthcare System (Geriatric Research, Education, and Clinical Center), Los Angeles, CA, 90073, USA.
| | - Nina T Harawa
- Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Steven J Shoptaw
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Katrina Schrode
- Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Arun Karlamangla
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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Watson RJ, Caba AE, Layland EK, Simon K, Morgan E, Edelman EJ, Chan PA, Eaton L. Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals. J Behav Med 2023; 46:986-995. [PMID: 37407904 DOI: 10.1007/s10865-023-00433-7] [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: 08/17/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA.
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Eric K Layland
- College of Education & Human Development, University of Delaware, Newark, DE, USA
| | - Kay Simon
- College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - E Jennifer Edelman
- Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence Rhode, Island
| | - Lisa Eaton
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
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10
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Carney T, Choi SK, Stephenson R, Bauermeister JA, Carrico AW. Latent class analysis of substance use typologies associated with mental and sexual health outcomes among sexual and gender minority youth. PLoS One 2023; 18:e0290781. [PMID: 37768906 PMCID: PMC10538794 DOI: 10.1371/journal.pone.0290781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/16/2023] [Indexed: 09/30/2023] Open
Abstract
Little is known about sexual and gender minority youth (SGMY) who have sex with men's unique patterns of substance use, even though they are at risk for substance use and adverse mental and other health outcomes. We used latent class analysis to examine typologies of substance use and multinomial logistic regression to investigate mental health outcomes (depression and anxiety) and HIV/STI testing correlates associated with different classes of substance use in a sample of SGMY who have sex with men in the USA and use substances (n = 414) who participated in an online survey. The average age was 22.50 years old (SD = 3.22). A four-class solution was identified representing: 'depressant and stimulant use' (3.4%), 'high polysubstance use' (4.6%), 'low substance use with moderate cannabis use' (79.2%), and 'high cannabis, stimulant and alcohol use' (12.8%). Membership to a specified substance use class varied by age, previous arrest, gender identity, anxiety, and lifetime HIV testing. Multivariate logistic regression results indicated that participants in the high polysubstance use (AOR = 5.48, 95% CI 1.51, 19.97) and high cannabis use class (AOR = 3.87, 95% CI 1.25, 11.94) were significantly more likely than those in the low substance use with moderate cannabis use class to report previous arrest. Those in the high polysubstance use class were also significantly less likely to have been tested for HIV than those in the low substance use with moderate cannabis use class (AOR = 0.21, 95% CI 0.05, 0.93). Findings will guide the development and implementation of tailored approaches to addressing the intersection of substance use and HIV risk among SGMY.
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Affiliation(s)
- Tara Carney
- Mental Health, Alcohol, Substance Use and Tobacco Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Seul Ki Choi
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jose A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Adam W. Carrico
- Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
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11
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Lozano A, Jaramillo J, Prado G, Safren SA, Harkness A. Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men. AIDS Care 2023; 35:1329-1337. [PMID: 37232132 PMCID: PMC10524698 DOI: 10.1080/09540121.2023.2216009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.
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Affiliation(s)
- Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL 33146
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
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Zhang X, Zhou Y, Zhang K. Social capital, perceived stress, and mental health of men who have sex with men in China: A cross-sectional study. Front Psychol 2023; 14:1134198. [PMID: 37063552 PMCID: PMC10098019 DOI: 10.3389/fpsyg.2023.1134198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundMental health problems are prevalent among men who have sex with men (MSM). Social capital and perceived stress may affect the mental health of MSM. The purpose of this study was to understand the current status of mental health, social capital, and perceived stress among MSM and to explore which variables are influential factors of mental health.MethodsThis study adopted a convenience sampling method and posted recruitment information through online social platforms (Blued, QQ, and WeChat) from January 2022 to June 2022 to recruit participants. The questionnaire included a demographic questionnaire, Social Capital Questionnaire (SCQ), Perceived Stress Scale (PSS), and Self-Reporting Questionnaire 20 (SRQ-20). Descriptive analyses of demographic characteristics, social capital, perceived stress, and mental health were conducted using percentages, median, interquartile range, means, and standard deviations. One-way ANOVA and independent-samples t-test were used to test the relationship between demographic characteristics and mental health, and multiple linear regression was used to analyze which variables were influencing factors of mental health. SPSS 24.0 was used for data analysis, and significant differences were found at p < 0.05.ResultsA total of 546 MSM participated in this study. Total social capital score was 18.59 ± 2.62, cognitive social capital, social participation, and social network scores were 6.53 ± 1.05, 4.15 ± 0.97, and 7.91 ± 1.57. PSS score was 26.91 ± 6.44, and SRQ-20 score was 7.5 (3, 11). Education level, relationship status, employed information, monthly income, sexual orientation, perceived stress, and three dimensions of social capital were included in the multiple linear regression based on the results of One-way ANOVA, t-test, and correlation analysis. Multiple linear regression analysis showed that relationship status (in a relationship), sexual orientation (heterosexual, bisexual, other), perceived stress, social participation, and social network had a significant effect on mental health.ConclusionSex with men have poorer mental health. Relationship status, sexual orientation, perceived stress, social networks, and social participation are important factors influencing mental health. The general public should be called upon to treat them with a more tolerant attitude, improve the social environment, and promote their identification with their sexual orientation, thereby reducing perceived stress and promoting the mental health of this population. In addition, from the perspective of social capital, promoting MSM social participation and expanding social networks may also be an important way to promote MSM mental health.
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Mains-Mason JB, Ufomata E, Peebles JK, Dhar CP, Sequeira G, Miller R, Folb B, Eckstrand KL. Knowledge Retention and Clinical Skills Acquisition in Sexual and Gender Minority Health Curricula: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1847-1853. [PMID: 35703197 PMCID: PMC9837881 DOI: 10.1097/acm.0000000000004768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD). METHOD The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees. The final searches were run in March 2019 and rerun before final analyses in June and October 2020. RESULTS Of 670 full-text articles reviewed, 7 met the inclusion criteria. Five of the 7 studies assessed trainee knowledge retention alone, 1 evaluated clinical skills acquisition alone, and 1 evaluated both outcomes. Studies covered education relevant to transgender health, endocrinology for patients born with DSDs, and HIV primary care. Only 1 study fully mapped to the Association of American Medical Colleges (AAMC) SGM/DSD competency recommendations. Six studies reported institutional funding and development support. No studies described teaching SGM/DSD health care for individuals with multiply minoritized identities or engaging the broader SGM/DSD community in medical education curriculum development and implementation. CONCLUSIONS Curriculum development in SGM/DSD health care should target knowledge retention and clinical skills acquisition in line with AAMC competency recommendations. Knowledge and skill sets for responsible and equitable care are those that account for structures of power and oppression and cocreate curricula with people who are SGM and/or born with DSDs.
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Affiliation(s)
- Janke B Mains-Mason
- J.B. Mains-Mason is a senior research associate, Department of Pathology, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Eloho Ufomata
- E. Ufomata is assistant professor, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-2175-806X
| | - J Klint Peebles
- J.K. Peebles is a dermatologist, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Washington, DC
| | - Cherie P Dhar
- C.P. Dhar is assistant professor, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-1994-3722
| | - Gina Sequeira
- G. Sequeira is assistant professor, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; ORCID: http://orcid.org/0000-0001-5906-869X
| | - Rebekah Miller
- R. Miller is a research and instruction librarian, Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-9783-8234
| | - Barbara Folb
- B. Folb is a public health informationist, Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0001-5531-980X
| | - Kristen L Eckstrand
- K.L. Eckstrand is assistant professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ORCID: http://orcid.org/0000-0002-6506-3649
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Azucar D, Rusow JA, Slay L, Taiwo M, Rodriguez A, Johnson A, Calvetti S, Wright D, Wu S, Bray B, Goldbach JT, Kipke MD. Combining the HYM (Healthy Young Men's) Cohort Study and the TRUTH (A Trans Youth of Color Study): Protocol for an Expanded Mixed Methods Study Renewal. JMIR Res Protoc 2022; 11:e39232. [PMID: 36326811 PMCID: PMC9672995 DOI: 10.2196/39232] [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: 05/03/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND As we enter the fifth decade of the AIDS epidemic, health researchers and AIDS activists reflect both on the progress that has been made and the importance of continued prevention efforts for those most at risk. As HIV infection rates continue to fluctuate across communities, a trend has emerged with new HIV infections becoming increasingly concentrated-with cascading effects-among people aged <30 years, from marginalized racial and ethnic groups, and who are sexual or gender minorities. OBJECTIVE In this paper, we discuss the renewal of the Healthy Young Men's (HYM) Cohort Study and the addition of a subcohort-TRUTH: A Transgender Youth of Color Study. The overarching aim of our renewed study was to inform new intervention strategies; understand linkage to care; and examine changes over time with respect to minority-related stress and intersectional identities and their relationship with substance use, mental health, and HIV risk. Findings from this study will help to inform the development of new interventions designed to engage African American and Black and Latino young men who have sex with men (YMSM) and transgender and gender minority youth in the HIV prevention and care continua and to reduce risk by addressing pathways of minority-related stress and intersectional stigma. METHODS Longitudinal study (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with reconsented cohort from the last iteration of HYM Cohort Study. This study protocol includes self-report survey, collection of urine to assess recent use of illicit drugs, and collection of blood and rectal and throat swabs to test for current sexually transmitted infection and HIV infection. An additional sample of blood and plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM Cohort Study biorepository for future studies. This mixed methods study design includes collection of triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, sexually transmitted infection and HIV testing, and adherence to antiretroviral therapy among participants who are HIV+) at baseline and every 6 months. RESULTS As of February 2022, participants from the past 4 years of the HYM Cohort Study and TRUTH: A Transgender Youth of Color Study Cohort have been reconsented and enrolled into the renewal period of longitudinal data collection, which is projected from summer of 2020 until summer of 2025. Recruitment is ongoing to reach our target enrollment goal of YMSM and transgender minority youth. CONCLUSIONS The findings from this study are being used to inform the development of new, and adaptation of existing, evidence-based HIV prevention interventions designed to engage populations of transgender and gender minority youth and YMSM in the HIV prevention and care continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39232.
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Affiliation(s)
- Danny Azucar
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joshua A Rusow
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Mariam Taiwo
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Aracely Rodriguez
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ali Johnson
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sam Calvetti
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Deja Wright
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Su Wu
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Bethany Bray
- Institute for Health Research Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Jeremy T Goldbach
- Brown School of Social Work, Washington University in St. Louis, Missouri, MO, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Hussen SA, Drumhiller K, Emerenini S, Moore SJ, Jones MD, Camacho-González A, Ransome Y, Elopre L, Del Río C, Harper GW. Understanding social capital among young black gay and bisexual men living with HIV: a qualitative exploration. CULTURE, HEALTH & SEXUALITY 2022; 24:1498-1513. [PMID: 34506268 DOI: 10.1080/13691058.2021.1974561] [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] [Received: 01/21/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Social capital, defined as the sum of an individual's resource-containing, reciprocal and trustworthy social network connections, has been associated with improved engagement in care among people living with HIV globally. We conducted a qualitative interview study of social capital among 28 young Black gay, bisexual and other men who have sex with men ages 18-29 living with HIV in Atlanta, Georgia. We asked participants about bonding capital (relationships between individuals with similar demographic characteristics), bridging capital (relationships with individuals of different backgrounds), collective efficacy (involvement with community organisations) and satisfaction with their social networks. We found that participants described bonding capital from friends and family in depth, while more gaps were noted in bridging capital and collective efficacy. Bonding capital derived from families was especially critical to participants' satisfaction with their social capital. Findings suggest that interventions targeting young Black gay, bisexual and other men who have sex with men should build upon strong bonds with family and friends, and/or fill gaps in bridging capital and collective efficacy by connecting young men to mentors and organisations.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Sabina Emerenini
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shamia J Moore
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marxavian D Jones
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrés Camacho-González
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA
| | - Latesha Elopre
- Department of Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
| | - Carlos Del Río
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Azucar D, Hidalgo MA, Wright D, Slay L, Kipke MD. Development of an HIV Prevention Intervention for African American Young Men Who Have Sex With Men (Y2Prevent): Study Protocol. JMIR Res Protoc 2022; 11:e36718. [PMID: 36173675 PMCID: PMC9562086 DOI: 10.2196/36718] [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: 01/21/2022] [Revised: 07/01/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND African American young men who have sex with men (YMSM) possess many intersecting identities that may increase their vulnerability to social stigmatization and discrimination, which yields a negative influence on their well-being and behaviors. These experiences often manifest as increased general and sexual risk-taking behaviors that place this particular group at an increased risk for HIV. This scenario is exacerbated by the lack of HIV prevention interventions specifically designed for African American YMSM. OBJECTIVE In this paper, we discuss the development of research designed to refine, pilot, and evaluate the feasibility, acceptability, and preliminary efficacy of a behavioral intervention designed to build resilience and reduce substance use and HIV risk behaviors among African American YMSM. The overarching aim of this research, funded by the National Institutes of Health, is to further refine and pilot test an intervention called Young Men's Adult Identity Monitoring (YM-AIM). YM-AIM is a theory-driven, group-level intervention designed to help African American YMSM develop a healthy vision for their future (or possible future self) by defining a set of short-term and long-term goals in the areas of education, health, family, and intimate relationships. METHODS Through partnerships with community members and community-based organizations, we will further strengthen and refine YM-AIM to include 3 new components: biomedical HIV prevention strategies (pre-exposure prophylaxis and postexposure prophylaxis); HIV and sexually transmitted infection (STI) testing and HIV care referral, drug screening, and drug treatment referral; and a youth mentoring component. We will recruit African American YMSM, aged 18 to 24 years, into 2 working groups; each group will consist of 6 to 8 members and will convene on a weekly basis, and each meeting will focus on one specific YM-AIM topic. This feedback will be used to further refine the intervention, which will then be evaluated for its feasibility and acceptability. Intervention outcomes include drug use in the past 30 days and 3 months, alcohol use, condomless sex, number of sex partners, and increasing condom use intention, condom use self-efficacy, HIV and STI testing recency and frequency, and linkage to care. RESULTS As of June 2022, we completed phase 1 of Y2Prevent and launched phase 2 of Y2Prevent to begin recruitment for working group participants. Phase 3 of Y2Prevent is anticipated to be launched in September and is expected to be completed by the end of this project period in December 2022. CONCLUSIONS Few youth-focused interventions have sought to help youth identify and develop the skills needed to navigate the social and structural factors that contribute to individual-level engagement in prevention among sexual minority youth. This research seeks to promote young men's adoption and maintenance of HIV-protective behaviors (eg, safer sex, pre-exposure prophylaxis use, HIV and STI testing, and health care use). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36718.
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Affiliation(s)
- Danny Azucar
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Marco A Hidalgo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Medicine-Pediatrics Section, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Deja Wright
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Calvetti S, Rusow JA, Lewis J, Martinez A, Slay L, Bray BC, Goldbach JT, Kipke MD. A Trans Youth of Color Study (TRUTH) to Measure Health and Wellness: Protocol for a Longitudinal Observation Study (Preprint). JMIR Res Protoc 2022; 11:e39207. [PMID: 36342757 PMCID: PMC9679929 DOI: 10.2196/39207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Growing research on transgender youth is accounting for the variety of ways in which young people define their genders and sexualities. Because of this growing representation, more research is needed to understand how intersectional identities and stigma affect risk for HIV acquisition along the HIV care continuum and engagement in mental and physical health care. Little is known about accessibility to HIV-related prevention services of nonbinary and transmasculine youth, and further understanding of the impacts on transfeminine people-those who have historically faced the highest prevalence of HIV positivity-is crucial. OBJECTIVE The overarching aims of the Trans Youth of Color Study are to conduct longitudinal research with a cohort of transgender minority youth (TGMY), explore factors that aid in the prevention of new HIV infection and transmission, and reduce HIV- and AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage TGMY in the HIV prevention and care continua. METHODS Longitudinal research (baseline and follow-up assessments every 6 months for 3 waves of data collection) followed a cohort (N=108) of transgender youth of color recruited in Los Angeles, California, United States. Participants were recruited using multiple community-informed strategies, such as from local venues, social media, and participant referral. In addition to self-report surveys, urine was collected to assess recent use of illicit drugs, and blood, rectal, and throat swabs were collected to test for current sexually transmitted infection and HIV infection. Additional blood and plasma samples (10 mL for 4 aliquots and 1 pellet) were collected and stored for future research. RESULTS Participants in the Trans Youth of Color Study were recruited between May 25, 2018, and December 7, 2018. Baseline and longitudinal data are being analyzed as of August 2022. CONCLUSIONS The findings from this research will inform adaptations to existing evidence-based HIV prevention interventions and help to guide new interventions designed to engage TGMY, especially those who are Black, Indigenous, or people of color, in the HIV prevention and care continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39207.
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Affiliation(s)
- Sam Calvetti
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joshua A Rusow
- The Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Jacqueline Lewis
- Health Services, Los Angeles LGBT Center, Los Angeles, CA, United States
| | - Amarah Martinez
- HIV & Biomedical Department, Wesley Health Centers, JWCH Institute, Palmdale, CA, United States
| | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Jeremy T Goldbach
- The Brown School, Washington University in St Louis, St Louis, MO, United States
| | - Michele D Kipke
- Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Meyers-Pantele SA, Sullivan P, Mansergh G, Hirshfield S, Stephenson R, Horvath KJ. Race-Based Medical Mistrust, HIV-Related Stigma, and ART Adherence in a Diverse Sample of Men Who Have Sex with Men with HIV. AIDS Behav 2022; 26:1456-1466. [PMID: 34669061 PMCID: PMC9007843 DOI: 10.1007/s10461-021-03500-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
Disparities in antiretroviral treatment (ART) access by race for men who have sex with men (MSM) with HIV persist. We assessed whether race-based medical mistrust and HIV stigma impact ART adherence among MSM with HIV. Longitudinal data were drawn from a RCT of a messaging intervention to promote sexual health among MSM. Regression models tested associations between baseline race-based medical mistrust, HIV stigma, and ART adherence at follow-up. In multivariable models with the overall sample of MSM with HIV (n = 383), baseline medical mistrust was negatively associated with ART adherence 3-months post-baseline. Among participants of color (i.e., Black/African American, Hispanic/Latino, or another race; n = 301), HIV stigma was negatively associated with optimal ART adherence 6-months post-baseline. Medical mistrust was longitudinally associated with reduced ART adherence among racially and ethnically diverse MSM with HIV. HIV-related services might prioritize patients reporting medical mistrust for additional supports.
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Affiliation(s)
- Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities and the School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Boyd DT, Abubakari GM, Turner D, Ramos SR, Hill MJ, Nelson LE. The Influence of Family Bonding, Support, Engagement in Healthcare, on PrEP Stigma among Young Black and Latino Men Who Have Sex with Men: A Path Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030330. [PMID: 35327703 PMCID: PMC8947403 DOI: 10.3390/children9030330] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
This study employs the ecodevelopmental theory to examine the influence of mother and father bonding, family engagement in healthcare, and family support on PrEP stigma among BLMSM. We used a cross-sectional sample from wave five of the Healthy Young Men (HYM) study, with a survey sample of 399 participants aged 16−24 years. We conducted two-path analyses to test multiple hypotheses: (1) mother/father bonding is associated with an increase in family engagement in healthcare; (2) family engagement in healthcare is associated with family social support; and (3) family social support is associated with PrEP stigma. Family social support was negatively correlated with PrEP stigma (r = −0.15; p < 0.001). The findings show that families either led by a Black/Latino father or mother have a significant impact on the sexual health-seeking behavior of BLMSM and their perception of HIV and PrEP.
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Affiliation(s)
- Donte T. Boyd
- College of Social Work, The Ohio State University, Columbus, OH 43210, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- Correspondence:
| | - Gamji M’Rabiu Abubakari
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Public Health, Yale University, New Haven, CT 06510, USA
| | - DeAnne Turner
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- College of Nursing, University of South Florida, Tampa, FL 33612, USA
| | - S. Raquel Ramos
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Nursing, Yale University, New Haven, CT 06477, USA; (S.R.R.); (L.E.N.)
| | - Mandy J. Hill
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA; (G.M.A.); (D.T.)
- School of Nursing, Yale University, New Haven, CT 06477, USA; (S.R.R.); (L.E.N.)
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English D, Boone CA, Carter JA, Talan AJ, Busby DR, Moody RL, Cunningham DJ, Bowleg L, Rendina HJ. Intersecting Structural Oppression and Suicidality Among Black Sexual Minority Male Adolescents and Emerging Adults. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2022; 32:226-243. [PMID: 35166417 PMCID: PMC9047029 DOI: 10.1111/jora.12726] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 05/02/2023]
Abstract
This study examined associations between structural racism, anti-LGBTQ policies, and suicide risk among young sexual minority men (SMM). Participants were a 2017-2018 Internet-based U.S. national sample of 497 Black and 1536 White SMM (ages 16-25). Structural equation modeling tested associations from indicators of structural racism, anti-LGBTQ policies, and their interaction to suicide risk factors. For Black participants, structural racism and anti-LGBTQ policies were significantly positively associated with depressive symptoms, heavy drinking, perceived burdensomeness, thwarted belongingness, self-harm, and suicide attempt. There were significant interaction effects: Positive associations between structural racism and several outcomes were stronger for Black participants in high anti-LGBTQ policy states. Structural racism, anti-LGBTQ policies, and their interaction were not significantly associated with suicide risk for White SMM.
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Affiliation(s)
| | | | - Joseph A. Carter
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY)
| | | | | | | | | | | | - H. Jonathon Rendina
- Whitman-Walker Institute
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
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Abstract
Purpose of Review Sexual and gender minority (SGM) adults experience significant cardiovascular health disparities, yet little is known about diet and food insecurity in this population. This review summarizes recent literature on diet and food insecurity in SGM adults and their contribution to cardiovascular disease (CVD) risk in this population. Recent Findings Existing evidence on diet and food insecurity disparities among SGM adults is inconclusive and research examining their link with CVD risk in SGM adults is limited. The majority of existing studies lack standardized and validated assessments of diet and food insecurity. Correlates of unhealthy diet and food insecurity among SGM adults are poorly understood. Summary Research examining the associations between diet and food insecurity with CVD risk in SGM adults is limited. Longitudinal studies are needed to investigate whether diet and food insecurity contribute to the cardiovascular health disparities observed in SGM adults. Supplementary Information The online version contains supplementary material available at 10.1007/s11883-022-00991-2.
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22
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Trujillo L, Robbins T, Morris E, Sionean C, Agnew-Brune C. Material Hardship and Association With Sexual Risk Behavior Among Adolescent Sexual Minority Males in 3 US Cities-National HIV Behavioral Surveillance-Young Men Who Have Sex With Men, 2015. J Acquir Immune Defic Syndr 2022; 89:159-165. [PMID: 34620804 PMCID: PMC10206754 DOI: 10.1097/qai.0000000000002828] [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: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Adolescent sexual minority males (ASMMs) are disproportionately affected by HIV relative to other youth within the United States. Social determinants of health have been explored among this population; however, economic determinants, such as material hardship, remain understudied. We examined the relationship between material hardship and sexual behavior among ASMMs aged 13-18 years residing in 3 US cities using 2015 data from CDC's National HIV Behavioral Surveillance among Young Men Who Have Sex with Men. METHODS Young men ages 13-18 years residing in 3 US cities were recruited through venue-based, respondent-driven, or Facebook sampling. We estimated adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for condomless anal intercourse (CAI) with a male sex partner in the past 12 months and with having 4 or more male sex partners in the past 12 months. RESULTS Of 547 ASMMs, 27% reported experiencing material hardship in the past 12 months. After adjusting for demographics, household characteristics, and city, ASMMs who experienced material hardship were more likely to report CAI with a male partner in the past 12 months (aPR: 1.55, 95% CI: 1.25 to 1.93) and to have had 4 or more male sex partners in the past 12 months (aPR: 1.44, 95% CI: 1.08 to 1.91). DISCUSSION More than a quarter of ASMMs experienced material hardship that was associated with increased sexual risk behavior among ASMMs. Incorporating services that address all unmet needs is important to consider for HIV prevention efforts for ASMMs.
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Affiliation(s)
- Lindsay Trujillo
- Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN
| | - Taylor Robbins
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elana Morris
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catlainn Sionean
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christine Agnew-Brune
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Exploring Well-Being and Its Correlates among Young Men Using Sen’s Capability Approach: Results from the Young Adults Survey, Switzerland (YASS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031247. [PMID: 35162270 PMCID: PMC8835442 DOI: 10.3390/ijerph19031247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
Background: The range of options people have to do the things they value in life may have strong effects on their well-being. This is especially true for young adults, as their opportunities and choices may affect both their current and future lives. This study follows Sen’s capability approach (CA) to assess young people’s well-being in terms of capabilities and functionings. Methods: Repeated cross-sectional data from the Young Adult Survey Switzerland were used for the analysis (N = 58,615). Descriptive statistics were applied to analyze the distribution of capabilities and functionings according to individuals’ capital equipment. Finally, multivariate regression analyses were conducted to investigate associations between social, cultural, and economic capital; overall capabilities; and functionings. Results: Young men with lower capital equipment rated their capabilities and functionings lower than others. Capabilities and corresponding functionings differed in the domains of health, happiness, and intellectual stimulation. Multivariate analysis confirmed the effects of social, economic, and cultural capital on both overall capabilities and functionings. Conclusions: Young men differ in their perceived capabilities and functionings in different life domains according to their equipment with different forms of capital. To better understand the mechanisms underlying the transformation of capabilities into functionings, future studies should analyze issues of choice and adaptation to restricted living conditions.
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Layland EK, Maggs JL, Kipke MD, Bray BC. Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens. Soc Sci Med 2022; 293:114602. [PMID: 34933242 PMCID: PMC9020748 DOI: 10.1016/j.socscimed.2021.114602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 10/04/2021] [Accepted: 11/22/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE Applying an intersectional framework to quantitative public health research among Black and Latino sexual minority men requires analysis that considers interlocking, multidimensional systems of racist and homonegative oppression that fundamentally subvert health. In this study, person-centered methods reflected the complexity of intersecting stigma and how subgroups experience that intersection differently. METHODS Data were from a cohort of 435 Black and Latino sexual minority young men (mean age = 22.3 years) in the Healthy Young Men's Cohort Study in Los Angeles, United States. Participants provided data semiannually on five occasions spanning 24 months from 2016 to 2019. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violence, family rejection, identity concealment) during the transition to adulthood. Associations between sociostructural burdens (e.g., socioeconomic status, food insecurity, unstable housing) and class incidents were investigated. Prevalence of mental health care needs, chronic health conditions, and overall self-reported health were compared among classes. RESULTS Five latent classes were identified: Minimal Stigma (26% of person records), Select Social Stigma (22%), Homonegativism (17%), Multiform Racism (24%), and Compound Stigma (11%). Sociostructural burdens were generally associated with 1.69-3.75 times higher odds of Select Social Stigma, Homonegativism, Multiform Racism, and Compound Stigma class incidents relative to Minimal Stigma. The Compound Stigma class had the greatest sociostructural burden, highest mental health care needs, and highest odds of sleep and gastrointestinal disorders, but classes did not differ in overall self-reported health. CONCLUSION These results exemplify how sociostructural burdens are interconnected with intersectional stigma experiences that together erode the health of Black and Latino sexual minority young men.
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Affiliation(s)
- Eric K Layland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 220 E. 23rd Street, Suite 405, New York, NY, 10010, USA; Department of Human Development and Family Studies, The Pennsylvania State University, 208 Health and Human Development Building, University Park, PA, 16803, USA.
| | - Jennifer L Maggs
- Department of Human Development and Family Studies, The Pennsylvania State University, 208 Health and Human Development Building, University Park, PA, 16803, USA.
| | - Michele D Kipke
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA; Departments of Pediatrics and Preventive Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90027, USA.
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 S Wolcott Ave., Chicago, IL, 60612, USA.
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25
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Harawa NT, Schrode KM, Daniels J, Javanbakht M, Hotton A, Makgoeng S, Ragsdale A, Schneider J, Fujimoto K, Bolan R, Gorbach P. Factors predicting incarceration history and incidence among Black and Latino men who have sex with men (MSM) residing in a major urban center. PLoS One 2022; 17:e0265034. [PMID: 35259198 PMCID: PMC8903243 DOI: 10.1371/journal.pone.0265034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
We analyzed data from a cohort of Black and Latino men who have sex with men (MSM) in order to identify correlates of prevalent and incident incarceration, including potential predictors related to their status as sexual and gender minorities (SGMs). Baseline and follow-up self-administered survey data were examined from Los Angeles County participants' ages 18-45 years at enrollment who were either HIV negative or living with HIV, but recruited to over represent men who used drugs and men with unsuppressed HIV infection. Multivariable logistic regression models were developed to identify predictors of baseline incarceration history and of incident incarceration over study follow-up among 440 and 338 participants, respectively. Older age, Black race, low socioeconomic status, homelessness, stimulant use, and depression symptoms were associated with baseline incarceration history. The only SGM-related factor associated with baseline incarceration history was having experienced violence based on sexual orientation identity. Just one statistically significant, independent positive predictor of incident incarceration was identified: prior incarceration, whereas having four or more friends that could lend money was a statistically significant protective factor against incident incarceration. Fundamental Cause Theory provides a useful framework to explain identified predictors of incarceration. Addressing poverty, housing instability, inadequate access to health care, and their root causes is critical to reducing incarceration rates in this population, as is expanded access to both diversion and anti-recidivism programs and to evidence-based treatment for stimulant use disorders.
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Affiliation(s)
- Nina T. Harawa
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
- * E-mail:
| | - Katrina M. Schrode
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
| | - Joseph Daniels
- Department of Psychiatry and Human Behaviors, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States of America
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Anna Hotton
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Solomon Makgoeng
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Amy Ragsdale
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
- Chicago Center for HIV Elimination, Chicago, IL, United States of America
| | - Kayo Fujimoto
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Robert Bolan
- Department of Health Services, Los Angeles LGBT Center, Los Angeles, CA, United States of America
| | - Pamina Gorbach
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
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26
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Harkness A, Satyanarayana S, Mayo D, Smith-Alvarez R, Rogers BG, Prado G, Safren SA. Scaling Up and Out HIV Prevention and Behavioral Health Services to Latino Sexual Minority Men in South Florida: Multi-Level Implementation Barriers, Facilitators, and Strategies. AIDS Patient Care STDS 2021; 35:167-179. [PMID: 33960844 DOI: 10.1089/apc.2021.0018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latino sexual minority men (LSMM) are disproportionately affected by HIV in the United States. Concurrently, behavioral health disparities, including mental health and substance use concerns, worsen HIV disparities affecting LSMM. Yet, evidence-based HIV prevention and behavioral health services are insufficiently scaled up and out to this population, perpetuating health disparities, thwarting efforts to control the HIV epidemic, and highlighting the need for culturally relevant evidence-based implementation strategies that address these disparities. Participants included 28 LSMM with varying degrees of engagement in HIV prevention and behavioral health services, and 10 stakeholders with experience delivering HIV prevention and behavioral health services to LSMM in South Florida, an HIV epicenter in general and in particular for LSMM. Participants completed semistructured interviews (English/Spanish) regarding LSMM's barriers and facilitators to engaging in HIV prevention and behavioral health services. Interviews were audio recorded and analyzed using thematic analysis. The 16 themes that emerged from the qualitative analysis were consistent with the consolidated framework for implementation research, an implementation research framework that articulates barriers and facilitators to implementing clinical interventions. Findings suggested the need for implementation strategies that simplify and reduce costs of HIV prevention and behavioral health services, address syndemic challenges impacting service use among LSMM, reduce stigma about service utilization, leverage peer networks, increase provider and community knowledge about services, and build LSMM's readiness and motivation to engage in services. Such strategies may ultimately address HIV and behavioral health disparities among LSMM and facilitate achievement of ending the HIV epidemic goals in this disproportionally affected population.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
| | | | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, Florida, USA
| | | | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Guillermo Prado
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
- Department of Psychology, University of Miami, Miami, Florida, USA
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Miami, Florida, USA
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27
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Nelson LE. Awakening to an Intersectional Reality: Ending the HIV Epidemic in the USA Starts with Reducing Inequities among Black MSM. J Urban Health 2020; 97:589-591. [PMID: 33025307 PMCID: PMC7560685 DOI: 10.1007/s11524-020-00487-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/13/2023]
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