Spirituality/religiosity, substance use, and HIV testing among young black men who have sex with men

Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort

BACKGROUND

Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk.

METHODS

We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis.

RESULTS

Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)).

CONCLUSION

PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.

Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial

BACKGROUND

Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum.

OBJECTIVE

PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP.

METHODS

A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US $50) and filling a PrEP prescription (US $50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions.

RESULTS

Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing.

CONCLUSIONS

Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48459.

Latent class analysis of substance use typologies associated with mental and sexual health outcomes among sexual and gender minority youth

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.

Using a Measurement Model to Reconceptualize the Church Experiences of Black Men who have Sex with Men

Religious spaces have proven to be effective sites of health intervention among Black Americans. Less is known about how religious environments impact the health of subgroups of Black Americans, specifically Black men who have sex with men (MSM). Using data from the Promoting Our Worth, Equality, and Resilience study, we explored the factor structure of a 10-item religious environment scale among Black MSM (N = 2,482). Exploratory factor analysis revealed three distinct factors: (1) visibility of MSM, (2) structural support, and (3) structural homonegativity. The relationship between Black MSM and their religious environments is complex and should be investigated using measures that accurately reflect their lived experiences.

Randomized Controlled Trial of Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants

Background

Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men (SMM) who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex in this population, but these motivational enhancement interventions require adaptation to promote engagement along the PrEP care continuum.

Methods

PRISM is a pilot sequential multiple assignment randomized trial (SMART) testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender SMM who use stimulants that are not currently taking PrEP. A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with non-reactive HIV results are randomized to receive either: 1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or condomless anal sex (session 2); or 2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider ($50) and filling a PrEP prescription ($50). At the 3-month follow-up assessment, participants who report they have not filled a prescription for PrEP are randomized a second time to either: 1) Switch to a second-stage intervention (i.e., MI + CM or CM + MI); or 2) Continue with assessments only. Outcomes for both responders and non-responders are reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription. Self-reported, secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and condomless anal sex. Qualitative exit interviews are conducted with a sub-group of responders and non-responders to characterize their experiences with the MI and CM interventions.

Discussion

Implementation of this pilot SMART underscores the challenges in reaching SMM who use stimulants to optimize HIV prevention efforts such that approximately one in ten (104/1,060) eligible participants enrolled. However, 85% (70/82) of enrolled participants with non-reactive HIV results were randomized. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in SMM who use stimulants.

Trial Registration

This protocol was registered on clinicaltrials.gov (NCT04205487) on December 19, 2019.

Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men

Purpose of Review

Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum.

Recent Findings

SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care).

Summary

SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.

Nursing and Health Care Preferences Among Opioid and Stimulant Using Black Sexual Minority Men: An Exploratory Study

ABSTRACT

Black sexual minority men (BSMM) experience the worst HIV treatment outcomes in the United States. Drug use increases HIV transmission risks and reduces health care engagement. Perceived health care provider stigma and medical mistrust minimizes treatment efforts. This study identified nursing and health care preferences among drug-using BSMM. In-depth qualitative interviews were conducted among 30 BSMM who reported drug use in Baltimore City, MD, from December 2018 to March 2019. Analysis identified themes as client preferences for nursing practices and gaps in clinical services. Participants' ages ranged from 23 to 63 years (M = 41.1). Most (91%) reported living with HIV. The following themes were identified as nursing and health care preferences: (a) being genuine, (b) knowing drug treatment and social services, (c) understanding drug use effects, (d) providing mental health services, and (e) clarifying treatment recommendations. Nurses and health care facilities can improve cultural competency for drug-using BSMM. Future research should identify the impact of these preferences on HIV care outcomes among BSMM.

Methamphetamine Use, Syphilis, and Specific Online Sex Partner Meeting Venues Are Associated With HIV Status Among Urban Black Gay and Bisexual Men Who Have Sex Men

BACKGROUND

In the context of increasing syphilis rates, particularly among Black men who have sex men (MSM), the objectives were to determine the associations between methamphetamine (meth) use and syphilis and HIV positivity, and to identify sex partner meeting venues as potential intervention access points among Black MSM in a mid-Atlantic US city.

METHODS

This study is an ongoing longitudinal cohort study. Participants were recruited from clinical and nonclinical settings and included sexually active MSM aged 18 to 45 years. The baseline visit included a behavioral survey and testing for syphilis, HIV, gonorrhea, and chlamydia. Logistic regression analyses were used for hypothesis testing.

RESULTS

Among 359 MSM completing baseline, 74.4% (268) Black MSM were included; 31% (84) were aged 24 to 29 years, 43.7% (117) reported unprotected anal intercourse at last sex, and 15.3% (41) reported meth use in the past 3 months. Sixteen percent (43) had syphilis, 46.6% (125) were living with HIV, and 19.0% (51) had gonorrhea and/or chlamydia. Meth use was associated with sexual and drug risk behaviors and HIV, but not syphilis. In adjusted analyses, meth use increased the odds of HIV positivity by 6.43 (95% confidence interval, 2.30-17.98) and syphilis positivity by 2.57 (95% confidence interval, 1.23-5.37). Four online sex partner meeting venues were associated with meth use and HIV, whereas syphilis was associated with one.

CONCLUSIONS

Among Black MSM, meth use and syphilis positivity were associated with more than 6-fold and almost 3-fold increased adjusted odds of HIV positivity, respectively. Four specific sex partner meeting venues may be important access points for HIV/sexually transmitted infection and substance use prevention.

Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: The P18 Cohort Study

INTRODUCTION

Knowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood.

METHODS

A prospective cohort study was conducted in two waves: 2009-2014 (Wave I) and 2014-2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18-19 years were recruited for Wave I. A total of 665 SMM ages 22-23 years were recruited for Wave II, of which 41.2% (n = 274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit.

RESULTS

A total of 5.4% of participants of between the ages of 18-27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F = 4.34, p = 0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I.

CONCLUSION

We have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM.

Religious and Spiritual Development from Adolescence to Early Adulthood in the U.S.: Changes over Time and Sexual Orientation Differences

Adolescence is a critical time in the U.S. for religious development in that many young people eschew their religious identity as they enter adulthood. In general, religion is associated with a number of positive health outcomes including decreased substance use and depression. The current study compared the developmental patterns of religiosity and spirituality in heterosexual and sexual minority youth. The design was a secondary data analysis of the first five waves of the Longitudinal Study of Adolescent Health and Wellness (N = 337, 71.8% female). Using multilevel linear (for spirituality) and quadratic (for religiosity) growth models, the initial level and change over time in religiosity and spirituality, as well as the correlations between growth processes, were compared between heterosexual and sexual minority individuals. The heterosexual group had significantly higher initial religiosity levels than the sexual minority group. Religiosity decreased over time at a similar rate for the heterosexual and sexual minority groups. Spirituality significantly increased over time for the sexual minority group but not for the heterosexual youth. The change over time in religiosity and spirituality were significantly and positively correlated for heterosexual individuals but were uncorrelated for sexual minority individuals. Results indicate there are differences in religious development based on sexual minority status. Future research should take into account how these differential religious and spiritual developmental patterns seen in heterosexual and sexual minority youth might predict various health outcomes.

Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study

BACKGROUND

The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms - such as social media websites and dating apps - is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined.

OBJECTIVE

This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake.

METHODS

Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake.

RESULTS

Recruitment was completed in July 2020.

CONCLUSIONS

Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20417.

Spirituality and Social Media: The Search for Support Among Black Men Who Have Sex With Men in Tennessee

Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.

Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse

This study reviews the voluminous empirical evidence on faith's contribution to preventing people from falling victim to substance abuse and helping them recover from it. We find that 73% of addiction treatment programs in the USA include a spirituality-based element, as embodied in the 12-step programs and fellowships initially popularized by Alcoholics Anonymous, the vast majority of which emphasize reliance on God or a Higher Power to stay sober. We introduce and flesh out a typology of faith-based substance abuse treatment facilities, recovery programs, and support groups. This typology provides important background as we then move on to make an economic valuation of nearly 130,000 congregation-based substance abuse recovery support programs in the USA. We find that these faith-based volunteer support groups contribute up to $316.6 billion in savings to the US economy every year at no cost to tax payers. While negative experiences with religion (e.g., clergy sex abuse and other horrendous examples) have been a contributory factor to substance abuse among some victims, given that more than 84% of scientific studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed, we conclude that the value of faith-oriented approaches to substance abuse prevention and recovery is indisputable. And, by extension, we also conclude that the decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern.

Sexual Orientation, Religious Coping, and Drug Use in a Sample of HIV-Infected African-American Men Living in the Southern USA

Religiosity and spirituality are associated with reduced drug use in the general population, but it is unclear whether this relationship generalizes to sexual minorities. This study investigated the relationship between religious coping, drug use, and sexual orientation in a sample of HIV-infected African-American men (40 heterosexuals; 64 sexual minorities). Most participants (76%) reported being "moderately" or "very" religious. We found no main effect of religious coping or sexual orientation on frequency of drug use. However, there was an interaction between positive religious coping and sexual orientation. Among heterosexuals, positive religious coping was inversely associated with frequency of drug use. However, this relationship was not significant among sexual minorities. Findings suggest HIV-infected African-American sexual minorities living in the South may need additional coping resources to decrease vulnerability to drug use.

Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis

BACKGROUND

The continuum of HIV care among black men who have sex with men (BMSM) continues to be the least favorable in the United States. BMSM are disproportionally HIV-infected-but-unaware, despite expanded HIV testing efforts among this subgroup.

METHODS

We meta-analytically analyzed various HIV testing patterns [lifetime, after 24 months, after 12 months, after 6 months, and frequent (every 3-6 months) testing] among BMSM using the PRISMA guideline. PubMed, MEDLINE, Web of Science, and PsycINFO were searched for relevant articles, reports, conference proceedings, and dissertations published between January 1, 1996, and April 25, 2018. Two independent investigators reviewed and abstracted data into a standardized form. We used the DerSimonian-Laird random-effect model to pool the HIV testing prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger tests were used to assess for publication bias. We also performed subgroup and meta-regression analyses to explore aggregate-level characteristics that explain the heterogeneity across studies.

RESULTS

Our meta-analysis includes a total of 42,074 BMSM pooled from 67 studies. Lifetime HIV testing prevalence was high, 88.2% [95% confidence interval (CI): 86.2% to 90.1%], but recent (after 6 months = 63.4%; 95% CI: 59.3% to 67.4%) and frequent (42.2%, 95% CI: 34.1% to 50.3%) HIV testing prevalence was low. Meta-regression suggests that younger age (borderline significant), lower annual income, and homelessness were correlated with lower lifetime/recent HIV testing prevalence; while ever having condomless insertive/receptive sex, alcohol consumption, and illicit drug use were associated with higher lifetime/recent HIV testing prevalence.

CONCLUSIONS

Recent and frequent HIV testing remains suboptimal among BMSM. Future testing programs should prioritize strategies to enhance self-initiated, regular HIV testing among BMSM.

The associations between subdimensions of religiosity and illicit substance use among latino sexual minority men

BACKGROUND

Latino sexual minority men (SMM) may be a group disproportionately at risk for substance use than heterosexual Latino men and non-Latino SMM. As religiosity may be a culturally relevant factor, the current study aimed to explore the association of three subcomponents of religiosity: organizational religious activity (ORA; i.e., public religious activity), non-organizational religious activity (NORA; i.e., private religious activity), and intrinsic religiosity (IR; i.e., personal commitment to one's religion) in predicting illicit substance use.

METHOD

Participants were 151 Latino SMM recruited from San Diego County (M = 24.18 years of age, SD = 3.19), who completed online self-report questionnaires in English or Spanish. Binary outcome variables represented use of illicit substances in the past month vs. no use. Religiosity was assessed using the three subscales (ORA, NORA, and IR) of the Duke University Religion Index (DUREL). Acculturation was controlled for using the Bidimensional Acculturation Scale for Hispanics.

RESULTS

ORA was associated with opiates (OR = 1.53, p = .04). NORA was associated with cocaine (OR = 1.69, p = .01), opiates (OR = 1.56, p = .04), amphetamines (OR = 1.67, p = .02), and sedatives (OR = 2.33, p = .001). IR was associated with amphetamines (OR = 1.34, p = .03).

CONCLUSION

NORA is positively associated with multiple illicit substances, and may represent greater internalization of anti-gay religious doctrines compared to other components of religiosity in Latino SMM. An intersectional approach addressing religious and sexual minority identity may be useful in substance use treatment for Latino SMM.

The Influence of Religion and Spirituality on HIV Prevention Among Black and Latino Men Who Have Sex with Men, New York City

The influence of religion and spirituality (R/S) on HIV prevention has been understudied, especially for Black and/or Latino men who have sex with men (BLMSM), who bear a disproportionate burden of HIV, and who are part of racial/ethnic communities with high engagement in R/S. The specific aim of this study was to explore perspectives about R/S among BLMSM to inform HIV prevention strategies and reduce HIV-related health disparities. Data from 105 qualitative interviews with BLMSM were analyzed; 58 (55%) stated that R/S had no personal influence on HIV prevention. For those reporting any R/S influence, main themes were: (1) R/S positively influenced decision-making and self-respect, (2) perceived judgment and stigma by religious communities, (3) belief in a higher power, and (4) altruism. These findings can inform faith-based HIV prevention interventions for BLMSM.