1
|
Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Leibowitz AS, Luu MN, Flamm JA, Hare CB, Dumoit Smith J, Iturralde E, Dilley J, Silverberg MJ, Satre DD. Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care. PLoS One 2023; 18:e0294483. [PMID: 38015975 PMCID: PMC10684077 DOI: 10.1371/journal.pone.0294483] [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: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.
Collapse
Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Mitchell N. Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jason A. Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, United States of America
| | - C. Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, United States of America
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| |
Collapse
|
2
|
Sang JM, Moore DM, Wang L, Chia J, Toy J, Montaner J, Skakoon-Sparling S, Cox J, Lambert G, Grace D, Hart TA, Lal A, Jollimore J, Lachowsky NJ. Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada. BMC Public Health 2023; 23:2124. [PMID: 37904163 PMCID: PMC10614320 DOI: 10.1186/s12889-023-17049-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] [Received: 01/31/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. METHODS Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. RESULTS Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). CONCLUSION There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.
Collapse
Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
- BC Centre on Substance Use, Vancouver, BC, Canada.
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Center, Montreal, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
- Institut national de santé publique du Québec, Quebec City, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University (formerly Ryerson), Toronto, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Nathan J Lachowsky
- Community Based Research Centre, Vancouver, Canada
- University of Victoria, Victoria, Canada
| |
Collapse
|
3
|
Stein O, Sang JM, Wang L, Cui Z, Zhu J, Lal A, Card KG, Lachowsky NJ, Hogg R, Moore DM. Factors associated with improvements in symptoms of anxiety and depression among gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada: A prospective cohort study. J Affect Disord 2023; 328:334-340. [PMID: 36806593 DOI: 10.1016/j.jad.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced among gay, bisexual and other men-who-have-sex-with-men (gbMSM). We explored factors associated with improvements in mental health symptoms among gbMSM with abnormal depression and anxiety scores over a period of four years, in Vancouver, Canada. METHODS Sexually active gbMSM ≥16 years of age were recruited using respondent-driven sampling from February 2012 to February 2015. Participants completed a computer-assisted questionnaire which included the Hospital Anxiety and Depression Scale (HADS), and psychometric scales to measure loneliness, self-esteem and social connectedness, every 6 months until July 2019. Generalized linear mixed models were used to assess factors associated with normal/borderline HADS scores (<11) following a previous abnormal score (≥11) for each of anxiety and depression subscales. RESULTS We recruited 694 participants, of whom 580 had at least one follow-up visit. Across all visits, 43.6 % of participants ever had abnormal anxiety scores and 16.2 % ever had abnormal depression scores. Among those with abnormal anxiety scores, 34.9 % of follow-up visits demonstrated reductions in anxiety scores. Among those with abnormal depression scores 51.0 % of follow-up visits demonstrated reductions in depression scores. Reductions in anxiety scores were associated with increased self-esteem, decreased loneliness and the number of gbMSM seen/spoken to in the previous month. Reductions in depression scores were associated with increased self-esteem, decreased loneliness and having a regular partner. CONCLUSION Improvements in mental health symptoms were frequently observed. Social connectedness was related with improved anxiety and depression symptoms. Interventions to improve social connectedness may help to improve mental health for gbMSM.
Collapse
Affiliation(s)
- Olivia Stein
- Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Faculty of Medicine, University of British Columbia, Canada
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Canada.
| |
Collapse
|
4
|
Card KG, Shen T, Barath J, Sang J, Lal A, Moore DM, Lachowsky NJ. Patterns of Event-Level Concurrent Substance Use During Sex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Metro Vancouver. AIDS Behav 2023:10.1007/s10461-023-04036-w. [PMID: 36943600 DOI: 10.1007/s10461-023-04036-w] [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] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
This study identified patterns of sexualized substance use among gay, bisexual, and other men who have sex with men (gbMSM) and examined associated risk factors for sexually transmitted and blood borne infections (STBBI). Data were from a longitudinal cohort recruited using respondent-driven sampling between Feb-2017 and Feb-2019. Participants reported on events with up to five of their most recent sexual partners. Latent class analysis examined patterns of concurrent substance use 2 h prior to or during sex. Multinomial regression identified demographic, partner-level, and event-level factors associated across 11,877 sexual events reported by 757 participants. Most combinations of substance use were rare, but most drugs were frequently combined with other drugs when they were used prior to or during a sexual event. Six latent classes of concurrent event-level substance use were identified. The referent class (58.8% of events) was characterized by limited use of any drugs. The Common Drug Use class (12.1%) was characterized by use of alcohol, cannabis, and poppers and the Licit Drug Use class (21.6%) was characterized by use of alcohol alone. The Party 'N' Play (PnP) class (2.3%) was characterized by use of crystal methamphetamine GHB, Poppers, and Erectile Drugs; The Multi-use (3.5%) class was characterized by the PnP substances plus alcohol and ecstasy; and the Cannabis + class was characterized by use of Cannabis, Erectile Drugs, and Ecstasy. Relative to the referent class, all other classes were associated with events with more behavioural and network risk factors for STBBIs-highlighting the need for harm reduction interventions for gbMSM who use these drugs.
Collapse
Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Tian Shen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| |
Collapse
|
5
|
He A, Bu H, Liao A, Mu W. What triggers depressive symptoms among gay and bisexual men? A sequential mediation model of sexual minority-related stigma and self-criticism. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2023; 62:1097-1113. [PMID: 36594229 DOI: 10.1111/bjso.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
A growing number of studies has shown that gay and bisexual men are more likely to experience adverse mental health status than their heterosexual counterparts. Stigma-related stress and self-criticism are believed likely to exacerbate depressive symptoms among gay and bisexual men. This research used cross-sectional findings to illustrate the mediating role of internalized self-stigma and self-criticism in the association between perceived public stigma and depressive symptoms. A total of 317 Chinese gay and bisexual men (267 gays and 50 bisexuals with a mean age of 25.29) were invited to participate in this study from October to November 2021. Sociodemographic characteristics, perceived public stigma, internalized self-stigma, self-criticism and depressive symptoms were measured through self-reported online questionnaires. The results indicated that the association between perceived public stigma and depressive symptoms was sequentially mediated by internalized self-stigma and self-criticism. The findings indicated that public stigma, as a distal stressor, was perceived and internalized as self-stigma by gay and bisexual men. This self-stigma may pose a risk for depressive symptoms via self-criticism (a maladaptive consequence of their attempts to reduce cognitive dissonance). These results highlight the necessity of reducing sexual minority-related stigma and self-criticism to reduce depressive symptoms. Our findings appeal to society to further decrease prejudice and stigma, increase tolerance, and focus on the negative mental health status of gay and bisexual men.
Collapse
Affiliation(s)
- Along He
- School of Journalism & Communication, Nanjing University, Nanjing, China
| | - He Bu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Ankang Liao
- School of Foreign Studies, Nanjing University, Nanjing, China
| | - Wenlong Mu
- School of Journalism and Communication, Wuhan University, Wuhan, China
| |
Collapse
|
6
|
Hart TA, Noor SW, Tavangar F, Berlin GW, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Jollimore J, Sang JM, Kirschbaum AL, Kanji R, Apelian H, Cox J, Moore DM, Lachowsky N. Crystal methamphetamine use and bacterial sexually transmitted infections (STIs) among gay, bisexual and other sexual minority men in Canada. Drug Alcohol Depend 2023; 242:109718. [PMID: 36516548 DOI: 10.1016/j.drugalcdep.2022.109718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors. METHODS We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables. RESULTS In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex. DISCUSSION Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.
Collapse
Affiliation(s)
- Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada; Louisiana State University Shreveport, Shreveport, LA, USA
| | - Farideh Tavangar
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada
| | | | | | - Darrell H S Tan
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada; Unity Health, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Montréal, QC, Canada; Direction régionale de santé publique - Montréal, Montréal, QC, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Rahim Kanji
- Toronto Metropolitan University, Toronto, Canada
| | | | - Joseph Cox
- Direction régionale de santé publique - Montréal, Montréal, QC, Canada; McGill University, Montreal, QC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan Lachowsky
- University of Victoria, Victoria, BC, Canada; Canadian Institute for Substance Use Research, Victoria, BC, Canada
| |
Collapse
|
7
|
Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148847. [PMID: 35886704 PMCID: PMC9323409 DOI: 10.3390/ijerph19148847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. Methods: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. Results: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23–28 age years (aOR = 1.86) and 29–33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. Conclusions: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders.
Collapse
|
8
|
Ouafik MR, Buret L, Scholtes B. Mapping the current knowledge in syndemic research applied to men who have sex with men: A scoping review. Soc Sci Med 2022; 306:115162. [PMID: 35779501 DOI: 10.1016/j.socscimed.2022.115162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022]
Abstract
Men who have sex with Men (MSM) represent a population affected by numerous health conditions. Syndemic theory has been used as a framework to study the health of MSM for nearly 20 years. However, the literature is plagued by a lack of consensus regarding what constitutes a synergy in a syndemic and recent reviews have shown that most of the papers published thus far have failed to demonstrate a synergy nor describe the bio-social interaction needed to account for a true syndemic. Moreover, to our knowledge, none of the existing reviews have focused specifically on MSM. This scoping review aims to fill this gap by mapping in detail how syndemic research on MSM has been conducted. A systematic database search was conducted between 2020 and 2021 and 115 studies were included. Our findings showed a lack of diversity regarding the location, design, subpopulation, and outcomes studied. In addition, the syndemic conditions, as well as their measurement, were not focused enough to ensure the robustness and reproducibility of the findings. Furthermore, our results support previous reviews showing a lack of empirical data to support disease interaction in syndemic research applied to MSM. Our review offers some important recommendations to help move the field forward in future work and describes some promising methodological advances.
Collapse
Affiliation(s)
- Maxence R Ouafik
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Laetitia Buret
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| |
Collapse
|
9
|
Buffel V, Reyniers T, Masquillier C, Thunissen E, Nöstlinger C, Laga M, Wouters E, Berghe WV, Deblonde J, Vuylsteke B. Awareness of, Willingness to Take PrEP and Its Actual Use Among Belgian MSM at High Risk of HIV Infection: Secondary Analysis of the Belgian European MSM Internet Survey. AIDS Behav 2022; 26:1793-1807. [PMID: 34817766 DOI: 10.1007/s10461-021-03526-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
We examined PrEP awareness, willingness to take it and early PrEP use among men who have sex with men (MSM) at increased risk of HIV acquisition in Belgium. This analysis of the Belgian EMIS online data of 2017-2018 adopts a cascade approach, with the following steps quantified as conditional probabilities: being eligible for, aware of, willing to take PrEP, and PrEP use. One out of three MSM was eligible to use PrEP according to the operationalized Belgian reimbursement criteria. PrEP awareness was lower among socioeconomically vulnerable MSM, MSM living outside large cities, MSM who were less open about their sexuality and those who did not identify as gay or homosexual. A lack of PrEP knowledge, a higher self-efficacy regarding safe sex, having a steady partner and reporting more symptoms of depression were related to unwillingness to use PrEP. Among those willing to take PrEP, less than one third were actually using PrEP. Not using PrEP was associated with living in small cities and experiencing financial problems.
Collapse
|
10
|
Moody RL, Chen YT, Schneider JA, Knox J, Timmins L, Hanson H, Koli K, Durrell M, Dehlin J, Eavou R, Martins SS, Duncan DT. Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak. Subst Abuse Treat Prev Policy 2022; 17:4. [PMID: 35090507 PMCID: PMC8796750 DOI: 10.1186/s13011-022-00433-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In response to COVID-19, the city of Chicago issued stay-at-home orders, which began on March 20, 2020, and restrictions meant to "flatten the curve" remained in effect until June 2, 2020. On June 3, 2020, Chicago entered the reopening phase. This study compares rates of polysubstance use by COVID-19 lockdown phase and across sociodemographic characteristics in a Chicago-based sample of Black cisgender sexual minority men (SMM) and transgender women. METHOD Data come from the Neighborhood and Networks (N2) cohort, an ongoing study of Black cisgender SMM and transgender women living in Chicago. Participants (N = 226) completed a survey between April 20, 2020, and July 30, 2020, during the initial peak of the COVID-19 pandemic in Chicago. We conducted chi-square tests of independence and modified Poisson regression models with robust error variance and estimated adjusted prevalence ratios. RESULTS Alcohol and marijuana were the most used substances, with 73.5% reporting at least one drinking day and 71.2% of the sample reporting marijuana use in the past 14 days. Tobacco was used by 41.6% of the sample, and illegal drug use, which does not include marijuana, was reported by 17.7% of the sample. Substance use was consistently associated with the use of other substances. As such, polysubstance use (i.e., using two or more substances) was common in this sample (63.7%). Few sociodemographic differences emerged, and substance use was not associated with lockdown phase. CONCLUSION Substance use, including polysubstance use, was high in our sample of Black SMM and transgender women during the initial peak of the COVID-19 pandemic. Continued monitoring is needed given the duration of the COVID-19 pandemic and the negative health consequences associated with substance use in this population.
Collapse
Affiliation(s)
- Raymond L Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, 300 Pompton Road, Wayne, New Jersey, 07470, USA
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Hillary Hanson
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Kangkana Koli
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Mainza Durrell
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Jessica Dehlin
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Rebecca Eavou
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| |
Collapse
|
11
|
Kennedy AJ, McGinnis KA, Merlin JS, Edelman EJ, Gordon AJ, Korthuis PT, Skanderson M, Williams EC, Wyse J, Oldfield B, Bryant K, Justice A, Fiellin DA, Kraemer KL. Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV. J Subst Abuse Treat 2022; 132:108509. [PMID: 34130128 PMCID: PMC8628025 DOI: 10.1016/j.jsat.2021.108509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. METHODS We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. RESULTS Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. CONCLUSION Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0.
Collapse
Affiliation(s)
- Amy J. Kennedy
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah, and Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - P. Todd Korthuis
- Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Emily C. Williams
- Department of Health Services, University of Washington, VA Puget Sound Healthcare System, Seattle, WA, USA,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Jessica Wyse
- VA Portland Healthcare System, Portland, OR, USA,School of Public Health, Oregon Health and Sciences University, Portland, OR, USA
| | - Benjamin Oldfield
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT, USA,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Kevin L. Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA,Corresponding author at: Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213; Telephone: 412-692-4843, Fax: 412-692-4838,
| |
Collapse
|
12
|
Doyle CM, Maheu-Giroux M, Lambert G, Mishra S, Apelian H, Messier-Peet M, Otis J, Grace D, Hart TA, Moore DM, Lachowsky NJ, Cox J. Combination HIV Prevention Strategies Among Montreal Gay, Bisexual, and Other Men Who Have Sex with Men in the PrEP Era: A Latent Class Analysis. AIDS Behav 2021; 25:269-283. [PMID: 32648063 PMCID: PMC7846508 DOI: 10.1007/s10461-020-02965-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pre-exposure prophylaxis (PrEP) became publicly available in Quebec for gay, bisexual and other men who have sex with men (GBM) in 2013. We used baseline data from Engage, a cohort of GBM recruited by respondent-driven sampling, to examine patterns of combination HIV prevention use among Montreal GBM since PrEP became available. Latent class analysis, stratified by HIV status, was used to categorize GBM by self-reported use of biomedical and behavioural prevention strategies. Correlates of resulting classes were identified using multinomial logistic regression. Among HIV-negative/unknown GBM (n = 968), we identified four classes: low use of prevention (32%), condoms (40%), seroadaptive behaviour (21%), and biomedical (including PrEP; 7%). Those using prevention (condoms, seroadaptive behaviour, and biomedical) had a higher number of anal sex partners and were more likely to report a recent sexually transmitted infection diagnosis. GBM using biomedical prevention also had a higher level of formal education. Among GBM living with HIV (n = 200), we identified three classes: mainly antiretroviral treatment (ART) with viral suppression (53%), ART with viral suppression and condoms (19%), and ART with viral suppression and seroadaptive behaviour (18%). Again, the number of anal sex partners was higher among those using condoms and seroadaptive behaviours. Our findings show antiretroviral-based prevention, either alone or in combination with other strategies, is clearly a component of the HIV prevention landscape for GBM in Montreal. Nevertheless, PrEP uptake remains low, and there is a need to promote its availability more widely.
Collapse
Affiliation(s)
- Carla M Doyle
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Sharmistha Mishra
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Herak Apelian
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Marc Messier-Peet
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Joanne Otis
- Département de Sexologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Division of Social & Behavioural Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada.
- Clinical Outcomes Research and Evaluation, Research Institute - McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
13
|
Drug Use Among Adolescents and Young Adults with Unsuppressed HIV Who Use Alcohol: Identifying Patterns of Comorbid Drug Use and Associations with Mental Health. AIDS Behav 2020; 24:2975-2983. [PMID: 32246358 DOI: 10.1007/s10461-020-02848-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Youth living with HIV (YLWH; aged 16-24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporting ART non-adherence and alcohol use, were recruited at five Adolescent Trials Network clinics in urban areas of the US between November 2014 and August 2017. Participants completed the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) to assess substance use involvement scores, and the Brief Symptom Inventory. Latent Profile Analysis identified three substance use patterns: minimal illicit drug use (15.1%), cannabis only (56.4%), and global polysubstance use (28.5%). Global polysubstance users experienced more mental health problems compared to the minimal illicit drug use group. The co-occurrence of drug use with alcohol was common among these YLWH-all of whom reported ART adherence problems-indicating the importance of interventions capable of addressing multiple substance use rather than alcohol alone.
Collapse
|
14
|
Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
Collapse
Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
15
|
Leibowitz AA, Desmond KA. The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS. AIDS Behav 2020; 24:1621-1631. [PMID: 31493277 PMCID: PMC7058503 DOI: 10.1007/s10461-019-02663-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.
Collapse
|
16
|
Chandler CJ, Bukowski LA, Matthews DD, Hawk ME, Markovic N, Egan JE, Stall RD. Examining the Impact of a Psychosocial Syndemic on Past Six-Month HIV Screening Behavior of Black Men who have Sex with Men in the United States: Results from the POWER Study. AIDS Behav 2020; 24:428-436. [PMID: 30887191 DOI: 10.1007/s10461-019-02458-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Syndemic production theory has been used to explore HIV transmission risk or infections but has not been used to investigate prevention behavior, or with large samples of non-Whites. This analysis is the first to explore the impact of syndemic factors on previous six-month HIV screening behavior among US Black MSM. Data from Promoting Our Worth, Equality and Resilience (POWER) were analyzed from 3294 participants using syndemic variable counts and measures of interaction/synergy. Syndemic variables included: past three-month poly-drug use, depression, last year intimate partner violence, HIV risk and problematic binge drinking. BMSM reporting two syndemic factors were more likely to report screening (AOR = 1.37, 95% CI 1.04-1.80; p = 0.028) with no significant associations for three or more conditions. Measures of joint effect revealed that there were synergies among depression, problematic binge drinking and poly-drug use but these psychosocial factors cannot entirely explain testing patterns and excess disease burden among BMSM.
Collapse
|
17
|
Card KG, Fournier AB, Sorge JT, Morgan J, Grace D, Ham D, Lachowsky NJ, Trussler T. Substance use patterns and awareness of biomedical HIV prevention strategies among sexual and gender minority men in Canada. AIDS Care 2020; 32:1506-1514. [PMID: 31983233 DOI: 10.1080/09540121.2020.1719026] [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: 12/14/2022]
Abstract
Sexual and gender minority men (SGMM) who use drugs are frequently cited as at-risk for HIV. Fortunately, biomedical prevention can greatly reduce transmission, provided individuals are aware of and interested in the uptake of these strategies. We examined associations between substance use patterns and biomedical prevention among SGMM in Canada. Latent class analysis identified patterns of substance use. Demographic-adjusted logistic regression models assessed the associations between latent classes and key biomedical prevention indicators. Among 669 participants living with HIV (PLWH) and 7,184 HIV-negative participants, six substance use classes characterized "limited" (46.0%; infrequent/low use of drugs), "common" (31.9%; alcohol, cannabis, and tobacco), "club" (5.2%; alcohol, cocaine, and psychedelics), "sex" (4.8%; alcohol, crystal methamphetamine, GHB, poppers, and erectile drugs), "prescription" (11.0%; alcohol and prescription drugs), and "polydrug" (1.1%; most drugs) use. HIV-negative men in the "prescription" and "sex" substance use classes were more likely to know about the preventive benefits of HIV treatment. All non-"limited use" HIV-negative men were more likely to report interest in taking pre-exposure prophylaxis (PrEP). For PLWH, substance use patterns were not associated with detectable viral loads or treatment awareness. While PLWH exhibited high levels of undetectability and treatment awareness regardless of substance use class, a variety of substance use patterns were associated with increased awareness, interest, and uptake of risk management strategies among HIV-negative participants.
Collapse
Affiliation(s)
- Kiffer G Card
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada.,Canadian HIV Trials Network, Vancouver, Canada
| | | | - Justin T Sorge
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada
| | - Jeffrey Morgan
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,British Columbia Centre on Substance Use, Vancouver, Canada
| | - Daniel Grace
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Ham
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada
| | - Nathan J Lachowsky
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada
| | - Terry Trussler
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada
| |
Collapse
|
18
|
Card KG, Armstrong HL, Wang L, Bacani N, Moore DM, Roth EA, Hogg RS, Lachowsky NJ. Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men. AIDS Care 2019; 32:1489-1497. [PMID: 31851524 DOI: 10.1080/09540121.2019.1705961] [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: 10/25/2022]
Abstract
McKirnan's Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan's Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV-related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escape.
Collapse
Affiliation(s)
- Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| |
Collapse
|
19
|
Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017). ACTA ACUST UNITED AC 2019; 45:271-282. [PMID: 31755878 DOI: 10.14745/ccdr.v45i11a01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background In 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time. Objective To provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM). Methods The EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive. Results Of the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%). Conclusion gbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low.These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.
Collapse
|
20
|
Hu Y, Zhong XN, Peng B, Zhang Y, Liang H, Dai JH, Zhang J, Zhong XH, Huang AL. Comparison of depression and anxiety between HIV-negative men who have sex with men and women (MSMW) and men who have sex with men only (MSMO): a cross-sectional study in Western China. BMJ Open 2019; 9:e023498. [PMID: 30610021 PMCID: PMC6326305 DOI: 10.1136/bmjopen-2018-023498] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To compare the prevalence of depression, anxiety and comorbidity between HIV-negative men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) and examine the associated factors with depression and anxiety separately. DESIGN A cross-sectional study. SETTING The study was conducted in Western China. PARTICIPANTS From April 2013 to October 2014, 2422 participants aged 18-65 years, who were male at birth, had engaged in sex with male partners in the past 6 months, self-reported negative or unknown HIV status, were willing to participate and provided informed consent were recruited using non-probability sampling. An anonymous self-administered questionnaire was used to collect the data. A total of 1809 HIV-negative men who have sex with men (MSM) were eligible for the final analysis. RESULTS Of 1809 MSM, 16.1% were MSMW and 83.9% were MSMO. The prevalence of depression, anxiety and comorbidity was 50.86%, 36.43% and 32.65%, respectively, for MSMW; these results were higher than those for MSMO (35.18%, 23.52% and 18.91%, respectively). After adjusting for potential confounding factors, the prevalence of depression and anxiety was higher among MSMW than among MSMO. The prevalence of depression and/or anxiety was associated with young age, lower educational level, lower monthly income, lower HIV score and some risky sexual behaviour (had never engaged in HIV counselling, had obtained commercial sexual services in the past 6 months and sometimes/always looked for sexual partners through the internet). The prevalence of depression and anxiety was lower for those who drank less than once a week than for those who never drank. CONCLUSION Our findings suggest the need to address mental health among MSMW. Future health intervention strategies should integrate mental health services and traditional HIV prevention programmes and should consider the differences between MSMW and MSMO. TRIAL REGISTRATION NUMBER ChiCTR-TRC-13003849; Pre-results.
Collapse
Affiliation(s)
- Ying Hu
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiao-Ni Zhong
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Bin Peng
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yan Zhang
- Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Jiang-Hong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Sichuan, China
| | - Xiao-Hua Zhong
- Hospital of Sichuan International Studies University, Chongqing, China
| | - Ai-Long Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| |
Collapse
|
21
|
W Hawkins B, Armstrong HL, Kesselring S, Rich AJ, Cui Z, Sereda P, Howard T, Forrest JI, Moore DM, Lachowsky NJ, Hogg RS, Roth EA. Substance Use as a Mechanism for Social Inclusion among Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada. Subst Use Misuse 2019; 54:1945-1955. [PMID: 31142175 PMCID: PMC7055638 DOI: 10.1080/10826084.2019.1621901] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Previous research demonstrates that substance use preferences and social-sexual environments are highly interrelated for gay, bisexual, and other men who have sex with men (gbMSM). Objective: We conducted a qualitative study to explore the socio-cultural context of substance use among local gbMSM communities in Metro Vancouver, Canada. Methods: Twenty gbMSM were purposively sampled from the larger Momentum Health Study cohort, a sexual health study of gbMSM in Greater Vancouver. Participants were demographically diverse in terms of HIV serostatus, age, income, ethnicity, and area of residence within the city and neighboring suburbs. Community maps generated by participants during formative research served as prompts for semi-structured interviews which were audio recorded and transcribed verbatim. Thematic analysis identified three themes of common experience. Results: First, participants indicated that substance use is intrinsically social in Vancouver gbMSM communities and that it functions as both a means of social inclusion and exclusion. Second, a distinction was made between types of substances and the location and context of their use, with specific substances having particular uses and meanings. Third, analysis suggested that gbMSM change their substance use over the life course and that this is affected by shifting priorities as people age. Discussion: For Vancouver gbMSM communities, substance use serves several social-cultural functions and can simultaneously serve as both a potential facilitator and barrier for community connection. Future research and health programing should consider venue and context specific messaging and recognize the heterogeneity of substance use within the larger gbMSM population.
Collapse
Affiliation(s)
- Blake W Hawkins
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia , Vancouver , British Columbia , Canada
| | - Heather L Armstrong
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Sarah Kesselring
- Population Data BC, University of British Columbia , Vancouver , British Columbia , Canada
| | - Ashleigh J Rich
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Zishan Cui
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Paul Sereda
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study , Vancouver , British Columbia , Canada
| | - Jamie I Forrest
- Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - David M Moore
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Nathan J Lachowsky
- School of Public Health & Social Policy, University of Victoria , Victoria , British Columbia , Canada.,Centre for Addictions Research BC , Victoria , British Columbia , Canada
| | - Robert S Hogg
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,Faculty of Health Sciences, Simon Fraser University , Burnaby , British Columbia , Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria , Victoria , British Columbia , Canada
| |
Collapse
|