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Knox J, Shiau S, Kutner B, Reddy V, Dolezal C, Sandfort TGM. Information, Motivation and Behavioral Skills as Mediators Between Sexual Minority Stigma and Condomless anal Sex Among Black South African Men Who have Sex with Men. AIDS Behav 2022; 27:1587-1599. [PMID: 36318425 PMCID: PMC10149565 DOI: 10.1007/s10461-022-03892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.
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Affiliation(s)
- Justin Knox
- Department of Psychiatry, Columbia University, New York, US. .,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US. .,Department of Sociomedical Sciences, Columbia University, New York, US. .,, 722 West 168th street, 10032, New York, US.
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Bryan Kutner
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Curtis Dolezal
- HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Theo G M Sandfort
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US.,Department of Sociomedical Sciences, Columbia University, New York, US.,Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Daniels J, Struthers H, Maleke K, Lane T, McIntyre J, Coates T. 'My Tablets are on Top of the Fridge': The Roles of Relationship Desire and Medical Mistrust in ART Adherence for HIV-Positive MSM and Transgender Women Living in Rural South Africa. AIDS Behav 2019; 23:2849-2858. [PMID: 31402416 DOI: 10.1007/s10461-019-02628-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Given the high HIV prevalence for men who have sex with men (MSM) and transgender women in South Africa, there is limited understanding of social determinants that influence antiretroviral treatment (ART) adherence. Although universal testing and treatment (UTT) is available, ART adherence remains suboptimal. We conducted focus groups with MSM and transgender women in order to understand factors influencing their ART adherence in Mpumalanga, South Africa. All focus groups were audio-recorded, transcribed and translated for analysis using a constant comparison approach, guided by the concept of Therapeutic Citizenship. We found there is medical mistrust of ART based on differing interpretations of HIV cure that may influence treatment adherence behaviors within social networks, and relationship desire had a significant influence on optimal ART adherence. Our findings suggest that clinics must provide interventions that integrate HIV disclosure and relationship skill-building to support optimal ART adherence for MSM and transgender women under UTT.
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Affiliation(s)
- Joseph Daniels
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, USA.
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- University of Cape Town, Cape Town, South Africa
| | | | - Tim Lane
- Equal International, San Francisco, CA, USA
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Tom Coates
- UCLA Center for World Health at the David Geffen School of Medicine, Los Angeles, CA, USA
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Knox J, Schneider J, Greene E, Nicholson J, Hasin D, Sandfort T. Using social network analysis to examine alcohol use among adults: A systematic review. PLoS One 2019; 14:e0221360. [PMID: 31437257 PMCID: PMC6705782 DOI: 10.1371/journal.pone.0221360] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/05/2019] [Indexed: 12/26/2022] Open
Abstract
Background Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characteristics influence adult alcohol consumption, but this literature has never been systematically reviewed and summarized. The current paper systematically reviews empirical studies that used social network analysis to assess the influence of social network characteristics on drinking behaviors in adults. Methods A literature search of PubMed/MEDLINE, EMBASE, PsycINFO and Web of Science databases and a review of the reference lists of retrieved articles was conducted in March 2019. Two reviewers independently screened 5,510 non-duplicate records, and further screened the full text of 150 articles to determine their eligibility for inclusion. Seventeen articles were judged eligible and included. Results Most studies were conducted among young adults (mean age<30), in university settings or follow up visits with adolescent networks moving into adulthood. The objectives and methods of the included studies were heterogeneous. All included studies reported a statistically significant association between a social network characteristic and an alcohol consumption-related outcome. Social network members drinking behaviors were associated with participants’ drinking behaviors in multiple ways. Discussion In young adults, among whom the majority of identified studies were conducted, with whom they socialize and how they socialize appears to be associated with alcohol consumption; this was observed across methodologies and settings. We still know very little about the relationship of social networks to drinking in older age groups, and in populations most impacted by alcohol. As social networks appear to play a role in the consumption of alcohol in young adulthood, interventions that utilize social networks to help reduce harmful alcohol consumption should be considered.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
- * E-mail:
| | - John Schneider
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States of America
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States of America
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Emily Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Joey Nicholson
- Health Sciences Library, New York University School of Medicine, New York, New York United States of America
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
- Department of Psychiatry, NYS Psychiatric Institute and Columbia University, New York, New York United States of America
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, New York United States of America
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Knox J, Reddy V, Lane T, Lovasi GS, Hasin D, Sandfort T. Safer sex intentions modify the relationship between substance use and sexual risk behavior among black South African men who have sex with men. Int J STD AIDS 2019; 30:786-794. [PMID: 31142222 DOI: 10.1177/0956462418825333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Due to the global burden of HIV, a better understanding of the relationship between substance use and HIV risk behavior is a public health priority, particularly among populations with high rates of HIV infection. The current study explored the moderating effects of psychosocial factors on the relationship between substance use and sexual risk behavior. Among 480 black South African men who have sex with men recruited using respondent-driven sampling, a cross-sectional survey was conducted that included questions about their last sexual event that involved anal sex. Substance use was not associated with unprotected anal intercourse (UAI) ( P = 0.97). The effect of substance use on UAI was modified by safer sex intentions ( P = 0.001). Among those with higher safer sex intentions, substance use was positively associated with UAI (aOR = 5.8, 95%CI = 1.6–21.3, P < 0.01). This study found that among men who have sex with men with high intentions to engage in safer sex, substance use was associated with increased risky sexual behavior.
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Affiliation(s)
- Justin Knox
- 1 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Vasu Reddy
- 2 Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Tim Lane
- 3 Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Gina S Lovasi
- 4 Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Deborah Hasin
- 1 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Theo Sandfort
- 5 HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA.,6 Department of Psychology, University of Pretoria, Pretoria, South Africa
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Daniels J, Struthers H, Lane T, Maleke K, McIntyre J, Coates T. "Booze is the main factor that got me where I am today": alcohol use and HIV risk for MSM in rural South Africa. AIDS Care 2018; 30:1452-1458. [PMID: 29807437 DOI: 10.1080/09540121.2018.1475626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Excessive alcohol consumption has been shown to increase HIV risk for men who have sex with men (MSM) and compromise HIV prevention behaviors. However, there is limited contextual understanding of alcohol use for MSM in rural sub-Saharan African settings, which can inform and direct HIV interventions. Applying an adaptation of PhotoVoice, we worked with 35 HIV-positive MSM who created photo-essays about alcohol and HIV in Mpumalanga. A semi-structured protocol was used in focus group discussions that were audio-recorded, translated and transcribed. Transcript data and visual data of 24 photo-essays were analyzed using a constant comparison approach. We found that participants used alcohol to build and sustain social networks, meet sexual partners, and enhance sexual experience. Excessive alcohol use was common, which was associated with increased HIV risk behaviors within a community of MSM who maintained multiple partnerships. Our study suggests that HIV interventions need to address excessive alcohol use to mitigate the associated HIV risk at both the individual and community levels.
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Affiliation(s)
- Joseph Daniels
- a Lehman College, The City University of New York , New York , USA
| | | | - Tim Lane
- c Center for AIDS Prevention Science , University of California San Francisco , San Francisco , USA
| | - Kabelo Maleke
- b Anova Health Institute , Johannesburg , South Africa
| | | | - Tom Coates
- d Center for World Health , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , USA
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