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Szwarcwald CL, de Souza Junior PRB, de Carvalho TDG, de Queiroz RSB, de Castilho EA, Leal MDC. Using Respondent-Driven Sampling (RDS) to Identify the Healthcare Needs among Women of Reproductive Age Who Migrated from Venezuela to Brazil, 2018-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:811. [PMID: 38929057 PMCID: PMC11203649 DOI: 10.3390/ijerph21060811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
In 2021, an RDS survey was conducted among Venezuelan migrant women of reproductive age who migrated to two Brazilian cities (Manaus and Boa Vista) from 2018 to 2021. To start the RDS recruitment, we chose seeds non-randomly in both cities. The study variables were age, educational level, self-rated health, pregnancy, migratory status and use of health services. We estimated the prevalence, confidence intervals and homophily effects by variable category. We used a multivariate logistic regression model to identify the main factors associated with healthcare use. A total of 761 women were recruited in Manaus and 1268 in Boa Vista. Manaus showed more irregular migrants than Boa Vista. The main reasons for using health services were as follows: illness, disease prevention and prenatal care. The logistic regression model showed the use of health services was associated with educational level and healthcare needs but not with migratory status. The social inclusion of Venezuelan migrants is extremely relevant, although many challenges must be overcome. The strategy of the Brazilian Federal Government for providing humanitarian assistance to Venezuelan migrants should be expanded to include and facilitate their integration into labor markets, access to healthcare and education, benefiting both migrants and the Brazilian people by reducing social inequality.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Av. Brasil, 4365 Manguinhos, Rio de Janeiro 21040-900, RJ, Brazil;
| | - Paulo Roberto Borges de Souza Junior
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Av. Brasil, 4365 Manguinhos, Rio de Janeiro 21040-900, RJ, Brazil;
| | - Thaiza Dutra Gomes de Carvalho
- National School of Public Health, Oswaldo Cruz Foundation, Leopoldo Bulhões Street, 1480, 8° Floor, Bonsucesso, Rio de Janeiro 21041-210, RJ, Brazil; (T.D.G.d.C.); (M.d.C.L.)
| | - Rita Suely Bacuri de Queiroz
- Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Street Terezina, 476 Adrianópolis, Manaus 69057-070, AM, Brazil;
| | - Euclides Ayres de Castilho
- Department of Preventive Medicine, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, 2° Floor, São Paulo 01246-903, SP, Brazil;
| | - Maria do Carmo Leal
- National School of Public Health, Oswaldo Cruz Foundation, Leopoldo Bulhões Street, 1480, 8° Floor, Bonsucesso, Rio de Janeiro 21041-210, RJ, Brazil; (T.D.G.d.C.); (M.d.C.L.)
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Amboree TL, Kuo J, Sirak BA, Schneider JA, Nyitray AG, Hwang LY, Chiao EY, Giuliano AR, Fujimoto K. Anal human papillomavirus (HPV) disagreement by Linear Array compared to SPF10 PCR-DEIA-LiPA25 system in young sexual minority men. Heliyon 2024; 10:e32336. [PMID: 38933939 PMCID: PMC11200335 DOI: 10.1016/j.heliyon.2024.e32336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Young sexual minority men (SMM) bear the greatest burden of anal human papillomavirus (HPV) infections. We assessed anal HPV genotype discordance between the Linear Array (LA) and SPF10 PCR-DEIA-LiPA25 (LiPA25). Methods Discordance was assessed between LA and LiPA25 using self-collected anal swabs from 120 SMM aged 18-29 who were recruited in 2014-2016. Multiple-type infection was explored as a potential confounder of testing agreement, along with clinical and behavioral factors such as HIV status, syphilis status, incarceration history, health insurance coverage, having 3 or more sex partners in the past 6 months, and co-infection with HPV-16. Results Significant discordance was found for HPV-6, -11, -16, -31, -42, -54, and -59. Exploratory analyses suggest higher prevalence of genotype discordance in those living with HIV, those with 3 or more sex partners, and those who were positive for 4 or more HPV types. Conclusions Our results highlight the importance of HPV detection methods which may inform different interpretations of research assessing anal HPV natural history among SMM at highest risk for HPV.
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Affiliation(s)
- Trisha L. Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, 6620 Main St., Houston, TX, 77030, USA
| | - Jacky Kuo
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX, 77030, USA
| | - Bradley A. Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - John A. Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, Chicago, IL, 60637, USA
- Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Clinical Cancer Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Lu-Yu Hwang
- Center of Infectious Diseases, Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St., Houston, TX, 77030, USA
| | - Elizabeth Y. Chiao
- The University of Texas MD Anderson Cancer Center, Departments of Epidemiology and Medical Oncology, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX, 77030, USA
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Salyards M, Nijhawan AE, Kuo J, Knights SM, Lazarte S, Labo N, Miley W, Whitby D, Hwang LY, Kornberg AW, Fujimoto K, Chiao EY. Prevalence, Incidence, and Predictors of Kaposi Sarcoma-Associated Herpesvirus Infection Among Young Men Who Have Sex With Men in the Southern United States. J Infect Dis 2024; 229:1387-1392. [PMID: 37711067 PMCID: PMC11095543 DOI: 10.1093/infdis/jiad384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Kaposi sarcoma (KS) continues to cause substantial morbidity and mortality in populations at risk in the southern United States. Utilizing biospecimens from the Houston site of the Young Men's Affiliate Project, 351 men who have sex with men had blood tested for KS-associated herpesvirus (KSHV) IgG. Seroprevalence, seroconversion between time points, and demographic and clinical correlates were measured. KSHV prevalence was 36.7% and incidence was 8.9 per 100 person-years. Furthermore, prevalence and incidence were higher among Black individuals, people living with HIV, and those with a history of syphilis. Further research on KSHV risk may improve health disparities in KS diagnosis and outcomes.
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Affiliation(s)
- Maverick Salyards
- Institute of Behavioral Research, Texas Christian University, Fort Worth
| | - Ank E Nijhawan
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern
- Parkland Health, Dallas
| | - Jacky Kuo
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston
| | - Sheena M Knights
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern
- Parkland Health, Dallas
| | - Susana Lazarte
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern
- Parkland Health, Dallas
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc, Frederick National Laboratory for Cancer Research, Maryland
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc, Frederick National Laboratory for Cancer Research, Maryland
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc, Frederick National Laboratory for Cancer Research, Maryland
| | - Lu-Yu Hwang
- Center for Infectious Diseases, School of Public Health, The University of Texas Health Science Center at Houston
| | - Anna-William Kornberg
- Division of Cancer Prevention, Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston
| | - Elizabeth Y Chiao
- Division of Cancer Prevention, Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston
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Amboree TL, Nyitray AG, Schneider J, Gargurevich N, Kuo J, Chiao EY, Hwang LY, Fujimoto K. Are human papillomavirus knowledge and vaccine uptake associated with HIV status and social determinants of health in young sexual minority men? Prev Med Rep 2023; 32:102132. [PMID: 36798795 PMCID: PMC9925951 DOI: 10.1016/j.pmedr.2023.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
This brief report examines the relationship, if any, between human immunodeficiency virus (HIV) status, and individual-level and socio-sexual partner-level factors of social determinants of health (SDOH) that are associated with human papillomavirus (HPV) knowledge and vaccine uptake in young sexual minority men (YSMM). We used data from 126 YSMM recruited by network-based sampling during 2015-2016 in Houston, Texas. Descriptive statistics and regression analyses were conducted to test the association between HIV status, SDOH, and HPV knowledge and vaccine uptake. Those living with HIV had lower odds of knowledge of HPV-associated anal cancer (OR: 0.43, 95% CI: 0.18-0.97) and knowledge of HPV spreading via sexual contact (OR: 0.11, 95% CI: 0.01-0.64), and higher odds of HPV vaccine uptake (OR: 2.90, 95% CI: 1.11-8.02). HPV knowledge and vaccine uptake in YSMM was not associated with partner's attributes or individuals' SDOH factors in our study yet was significantly associated with HIV status. Future interventions are needed to increase HPV knowledge among individuals living with HIV and vaccine uptake particularly among YSMM living without HIV that are not engaged in healthcare.
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Affiliation(s)
- Trisha L. Amboree
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, 6620 Main St, Houston, TX 77030, USA,Corresponding author.
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA,Clinical Cancer Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - John Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, Chicago, IL 60637, USA,Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, Chicago, IL 60637 USA
| | - Nick Gargurevich
- Department of Statistics, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Jacky Kuo
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Elizabeth Y. Chiao
- The University of Texas MD Anderson Cancer Center, Departments of Epidemiology and Medical Oncology, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Lu-Yu Hwang
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Kayo Fujimoto
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
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Awareness and use of HIV pre-exposure prophylaxis and factors associated with awareness among MSM in Beijing, China. Sci Rep 2023; 13:554. [PMID: 36631515 PMCID: PMC9834337 DOI: 10.1038/s41598-023-27485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Human immunodeficiency virus (HIV) sexual transmission among men who have sex with men (MSM) has increased markedly in Beijing, China in the past decade. Pre-exposure prophylaxis (PrEP) is a highly efficacious biomedical prevention strategy that remarkably reduces HIV-transmission risk. This study examined PrEP awareness among MSM and the factors influencing it. From April to July 2021, respondent-driven sampling was used to conduct a cross-sectional survey among MSM in Beijing, China. Demographic, behavior, and awareness data regarding PrEP were collected. The factors influencing PrEP awareness were assessed using univariate and multivariable logistic regression. In total, 608 eligible responders were included in the study. Among the respondents, 27.9% had PrEP awareness, 3.3% had taken PrEP, and 57.9% expressed interest in receiving PrEP, if required. Greater odds of PrEP awareness were associated with higher education level (adjusted odds ratio [aOR] 3.525, 95% confidence interval [CI] 2.013-6.173, P < 0.0001), greater HIV-related knowledge (aOR 3.605, 95% CI 2.229-5.829, P < 0.0001), HIV testing (aOR 2.647, 95% CI 1.463-4.788, P = 0.0013), and sexually transmitted infections (aOR 2.064, 95% CI 1.189-3.584, P = 0.0101). Lower odds of PrEP awareness were associated with higher stigma score (aOR 0.729, 95% CI 0.591-0.897, P = 0.0029). The findings indicate sub-optimal awareness and low utilization of PrEP in Beijing and highlight PrEP inequities among MSM with stigma. Strengthening the training of peer educators in disseminating PrEP knowledge and reducing stigma are critical for improving PrEP awareness.
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Lee F, Khanna AS, Hallmark CJ, Lavingia R, McNeese M, Zhao J, McNeese ML, Khuwaja S, Ardestani BM, Collier N, Ozik J, Hotton AL, Harawa NT, Schneider JA, Fujimoto K. Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas: Insights From a Modeling Study. Med Care 2023; 61:12-19. [PMID: 36477617 PMCID: PMC9733589 DOI: 10.1097/mlr.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021. METHODS An agent-based model that incorporated the sexual networks of YBMSM was used to simulate improved antiretroviral treatment and pre-exposure prophylaxis (PrEP) engagement through Medicaid expansion in Houston, TX. Analyses considered the HIV incidence (number of new infections and as a rate metric) among YBMSM over the next 10 years under Medicaid expansion as the primary outcome. Additional scenarios, involving viral suppression and PrEP uptake above the projected levels achieved under Medicaid expansion, were also simulated. RESULTS The baseline model projected an HIV incidence rate of 4.96 per 100 person years (py) and about 368 new annual HIV infections in the 10th year. Improved HIV treatment and prevention continua engagement under Medicaid expansion resulted in a 14.9% decline in the number of annual new HIV infections in the 10th year. Increasing viral suppression by an additional 15% and PrEP uptake by 30% resulted in a 44.0% decline in new HIV infections in the 10th year, and a 27.1% decline in cumulative infections across the 10 years of the simulated intervention. FINDINGS Simulation results indicate that Medicaid expansion has the potential to reduce HIV incidence among YBMSM in Houston. Achieving HIV elimination objectives, however, might require additional effective measures to increase antiretroviral treatment and PrEP uptake beyond the projected improvements under expanded Medicaid.
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Affiliation(s)
- Francis Lee
- Chicago Center for HIV Elimination,Department of Medicine, The University of Chicago, Chicago, IL
| | - Aditya S. Khanna
- Center for Alcohol and Addiction Studies,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | | | - Richa Lavingia
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas
| | - Marlene McNeese
- Division of Disease Prevention and Control, Houston Health Department
| | - Jing Zhao
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas
| | | | - Salma Khuwaja
- Division of Disease Prevention and Control, Houston Health Department
| | - Babak M. Ardestani
- Chicago Center for HIV Elimination,Department of Medicine, The University of Chicago, Chicago, IL
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL
| | - Anna L. Hotton
- Chicago Center for HIV Elimination,Department of Medicine, The University of Chicago, Chicago, IL
| | - Nina T. Harawa
- Departments of Medicine and Epidemiology, University of California,Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - John A. Schneider
- Chicago Center for HIV Elimination,Department of Medicine, The University of Chicago, Chicago, IL
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
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Fujimoto K, Nyitray AG, Kuo J, Zhao J, Hwang LY, Chiao E, Giuliano AR, Schneider JA, Khanna A. Social networks, high-risk anal HPV and coinfection with HIV in young sexual minority men. Sex Transm Infect 2022; 98:557-563. [PMID: 35184046 PMCID: PMC9388701 DOI: 10.1136/sextrans-2021-055283] [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: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Young sexual minority men (SMM) exhibit a high prevalence and incidence of high-risk genotypes of human papillomavirus (hrHPV) anal infections and a confluence of a high prevalence of HIV and rectal STIs. Social determinants of health (SDOHs) are linked to social network contexts that generate and maintain racial disparities in HIV and STIs. A network perspective was provided to advance our knowledge of drivers of genotype-specific hrHPV infection and coinfection with HIV. The study also examined whether socially connected men are infected with the same high-risk HPV genotypes and, if so, whether this tendency is conditioned on coinfection with HIV. METHODS Our sample included 136 young SMM of predominantly black race and their network members of other races and ethnicities, aged 18-29 years, who resided in Houston, Texas, USA. These participants were recruited during 2014-2016 at the baseline recruitment period by network-based peer referral, where anal exfoliated cells and named social and sexual partners were collected. Exponential random graph models were estimated to assess similarity in genotype-specific hrHPV anal infection in social connections and coinfection with HIV in consideration of the effects of similarity in sociodemographic, sexual behavioural characteristics, SDOHs and syphilis infection. RESULTS Pairs of men socially connected to each other tend to be infected with the same hrHPV genotypes of HPV-16, HPV-45 and HPV-51 or HPV-16 and/or HPV-18. The tendency of social connections between pairs of men who were infected with either HPV-16 or HPV-18 were conditioned on HIV infection. CONCLUSIONS Networked patterns of hrHPV infection could be amenable to network-based HPV prevention interventions that engage young SMM of predominantly racial minority groups who are out of HIV care and vulnerable to high-risk HPV acquisition.
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Affiliation(s)
- Kayo Fujimoto
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacky Kuo
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jing Zhao
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lu-Yu Hwang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Epidemiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - John A Schneider
- Department of Medicine and Health Studies, University of Chicago, Chicago, Illinois, USA
| | - Aditya Khanna
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
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Stimulant use interventions may strengthen 'Getting to Zero' HIV elimination initiatives in Illinois: Insights from a modeling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103628. [PMID: 35218990 PMCID: PMC9058209 DOI: 10.1016/j.drugpo.2022.103628] [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: 09/22/2021] [Revised: 02/02/2022] [Accepted: 02/12/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) Getting to Zero (GTZ) is an Illinois-based HIV elimination initiative. GTZ identifies younger Black men who have sex with men (YBMSM) as a population who have experienced disproportionate HIV incidence. Rising stimulant use among YBMSM has been determined to impede engagement in the HIV prevention and treatment continua for reducing onward HIV transmission. Given the limited development of dedicated or culturally appropriate interventions for this population, this modeling study explores the impact of stimulant use on HIV incidence among YBMSM and assesses the impact of interventions to treat stimulant use on downstream HIV transmission to achieve GTZ goals. METHODS A previously developed agent-based network model (ABNM), calibrated using data for YBMSM in Illinois, was extended to incorporate the impact of stimulant use (methamphetamines, crack/cocaine, and ecstasy) on sexual networks and engagement in HIV treatment and prevention continua. The model simulated the impact of a residential behavioral intervention (BI) for reducing stimulant use and an outpatient biomedical intervention (mirtazapine) for treating methamphetamine use. The downstream impact of these interventions on population-level HIV incidence was the primary intervention outcome. RESULTS Baseline simulated annual HIV incidence in the ABNM was 6.93 [95% Uncertainty Interval (UI): 6.83,7.04] per 100 person years (py) and 453 [95% UI: 445.9,461.2] new infections annually. A residential rehabilitation intervention targeted to 25% of stimulant using persons yielded a 27.1% reduction in the annual number of new infections. Initiating about 50% of methamphetamine using persons on mirtazapine reduced the overall HIV incidence among YBMSM by about 11.2%. A 30% increase in antiretroviral treatment (ART) and preexposure prophylaxis (PrEP) uptake in the non-stimulant using YBMSM population combined with a 25% uptake of BI for stimulant using persons produces an HIV incidence consistent with HIV elimination targets (about 200 infections/year) identified in the GTZ initiative. CONCLUSIONS Behavioral and biomedical interventions to treat stimulant use, in addition to expanding overall ART and PrEP uptake, are likely to enhance progress towards achieving GTZ goals.
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Fujimoto K, Paraskevis D, Kuo JC, Hallmark CJ, Zhao J, Hochi A, Kuhns LM, Hwang LY, Hatzakis A, Schneider JA. Integrated molecular and affiliation network analysis: Core-periphery social clustering is associated with HIV transmission patterns. SOCIAL NETWORKS 2022; 68:107-117. [PMID: 34262236 PMCID: PMC8274587 DOI: 10.1016/j.socnet.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study investigates the two-mode core-periphery structures of venue affiliation networks of younger Black men who have sex with men (YBMSM). We examined the association between these structures and HIV phylogenetic clusters, defined as members who share highly similar HIV strains that are regarded as a proxy for sexual affiliation networks. Using data from 114 YBMSM who are living with HIV in two large U.S. cities, we found that HIV phylogenetic clustering patterns were associated with social clustering patterns whose members share affiliation with core venues that overlap with those of YBMSM. Distinct HIV transmission patterns were found in each city, a finding that can help to inform tailored venue-based and network intervention strategies.
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Affiliation(s)
- Kayo Fujimoto
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jacky C. Kuo
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | | | - Jing Zhao
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Andre Hochi
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital, and Northwestern University, Feinberg School of Medicine, Department of Pediatrics, 225 E. Chicago Avenue, #161, Chicago, IL 60611
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue MC 5065, Chicago, IL 60637
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XIANG Y, FUJIMOTO K, LI F, WANG Q, DEL VECCHIO N, SCHNEIDER J, ZHI D, TAO C. Identifying influential neighbors in social networks and venue affiliations among young MSM: a data science approach to predict HIV infection. AIDS 2021; 35:S65-S73. [PMID: 33306549 PMCID: PMC8058230 DOI: 10.1097/qad.0000000000002784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Young MSM (YMSM) bear a disproportionate burden of HIV infection in the United States and their risks of acquiring HIV may be shaped by complex multilayer social networks. These networks are formed through not only direct contact with social/sex partners but also indirect anonymous contacts encountered when attending social venues. We introduced a new application of a state-of-the-art graph-based deep learning method to predict HIV infection that can identify influential neighbors within these multiple network contexts. DESIGN AND METHODS We used empirical network data among YMSM aged 16-29 years old collected from Houston and Chicago in the United States between 2014 and 2016. A computational framework GAT-HIV (Graph Attention Networks for HIV) was proposed to predict HIV infections by identifying influential neighbors within social networks. These networks were formed by multiple relations constituted of social/sex partners and shared venue attendances, and using individual-level variables. Further, GAT-HIV was extended to combine multiple social networks using multigraph GAT methods. A visualization tool was also developed to highlight influential network members for each individual within the multiple social networks. RESULTS The multigraph GAT-HIV models obtained average AUC values of 0.776 and 0.824 for Chicago and Houston, respectively, performing better than empirical predictive models (e.g. AUCs of random forest: 0.758 and 0.798). GAT-HIV on single networks also delivered promising prediction performances. CONCLUSION The proposed methods provide a comprehensive and interpretable framework for graph-based modeling that may inform effective HIV prevention intervention strategies among populations most vulnerable to HIV.
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Affiliation(s)
- Yang XIANG
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kayo FUJIMOTO
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fang LI
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Qing WANG
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Natascha DEL VECCHIO
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - John SCHNEIDER
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Degui ZHI
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cui TAO
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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11
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Xiang Y, Fujimoto K, Schneider J, Jia Y, Zhi D, Tao C. Network context matters: graph convolutional network model over social networks improves the detection of unknown HIV infections among young men who have sex with men. J Am Med Inform Assoc 2021; 26:1263-1271. [PMID: 31197365 DOI: 10.1093/jamia/ocz070] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/11/2019] [Accepted: 04/28/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE HIV infection risk can be estimated based on not only individual features but also social network information. However, there have been insufficient studies using n machine learning methods that can maximize the utility of such information. Leveraging a state-of-the-art network topology modeling method, graph convolutional networks (GCN), our main objective was to include network information for the task of detecting previously unknown HIV infections. MATERIALS AND METHODS We used multiple social network data (peer referral, social, sex partners, and affiliation with social and health venues) that include 378 young men who had sex with men in Houston, TX, collected between 2014 and 2016. Due to the limited sample size, an ensemble approach was engaged by integrating GCN for modeling information flow and statistical machine learning methods, including random forest and logistic regression, to efficiently model sparse features in individual nodes. RESULTS Modeling network information using GCN effectively increased the prediction of HIV status in the social network. The ensemble approach achieved 96.6% on accuracy and 94.6% on F1 measure, which outperformed the baseline methods (GCN, logistic regression, and random forest: 79.0%, 90.5%, 94.4% on accuracy, respectively; and 57.7%, 80.2%, 90.4% on F1). In the networks with missing HIV status, the ensemble also produced promising results. CONCLUSION Network context is a necessary component in modeling infectious disease transmissions such as HIV. GCN, when combined with traditional machine learning approaches, achieved promising performance in detecting previously unknown HIV infections, which may provide a useful tool for combatting the HIV epidemic.
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Affiliation(s)
- Yang Xiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois, USA.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Yuxi Jia
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Medical Informatics, School of Public Health, Jilin University, Jilin, China
| | - Degui Zhi
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cui Tao
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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12
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Amith M, Fujimoto K, Mauldin R, Tao C. Friend of a Friend with Benefits ontology (FOAF+): extending a social network ontology for public health. BMC Med Inform Decis Mak 2020; 20:269. [PMID: 33319708 PMCID: PMC7737278 DOI: 10.1186/s12911-020-01287-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Dyadic-based social networks analyses have been effective in a variety of behavioral- and health-related research areas. We introduce an ontology-driven approach towards social network analysis through encoding social data and inferring new information from the data. METHODS The Friend of a Friend (FOAF) ontology is a lightweight social network ontology. We enriched FOAF by deriving social interaction data and relationships from social data to extend its domain scope. RESULTS Our effort produced Friend of a Friend with Benefits (FOAF+) ontology that aims to support the spectrum of human interaction. A preliminary semiotic evaluation revealed a semantically rich and comprehensive knowledge base to represent complex social network relationships. With Semantic Web Rules Language, we demonstrated FOAF+ potential to infer social network ties between individual data. CONCLUSION Using logical rules, we defined interpersonal dyadic social connections, which can create inferred linked dyadic social representations of individuals, represent complex behavioral information, help machines interpret some of the concepts and relationships involving human interaction, query network data, and contribute methods for analytical and disease surveillance.
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Affiliation(s)
- Muhammad Amith
- grid.267308.80000 0000 9206 2401School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St Suite 600, Houston, TX 77030 USA
| | - Kayo Fujimoto
- grid.267308.80000 0000 9206 2401School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Suite 2514, Houston, TX 77030 USA
| | - Rebecca Mauldin
- grid.267315.40000 0001 2181 9515The University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
| | - Cui Tao
- grid.267308.80000 0000 9206 2401School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St Suite 600, Houston, TX 77030 USA
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13
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Fujimoto K, Wang P, Li DH, Kuhns LM, Amith M, Schneider JA. Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk. HEALTH EDUCATION & BEHAVIOR 2020; 47:202-212. [PMID: 32090656 DOI: 10.1177/1090198119876240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the social environment that are not often described, that is, the places and spaces or "venues" where YBMSM socialize or where they receive HIV prevention services. In particular, we identify the structural features of avoidance of these venues as an indicator of negative experiences, using bipartite exponential random graph models. Our study theorizes that YBMSM avoid certain venues en masse through information diffusion among social network members. We specify two social mechanisms of collective venue avoidance-(1) homophily (i.e., ego-alter similarity in venue avoidance) and (2) popular opinion leaders (as early adopters)-and test the corresponding hypotheses that (Hypothesis 1) socially connected individuals avoid venues together and that (Hypothesis 2) popular individuals would be more likely to avoid venues. Based on data collected from YBMSM aged 16 to 29 years between 2014 and 2016 in Houston, Texas (N = 227) and Chicago, Illinois (N = 241), results indicate that Hypothesis 1 was supported in both cities but that Hypothesis 2 was supported only in Chicago. The findings suggest that the structural patterns of venue avoidance are different between cities and may inform dissemination of prevention messages and delivery of venue- and social influence-based HIV interventions.
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Affiliation(s)
- Kayo Fujimoto
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peng Wang
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Lisa M Kuhns
- Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Muhammad Amith
- The University of Texas Health Science Center at Houston, Houston, TX, USA
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14
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Social Networks and Its Impact on Women's Awareness, Interest, and Uptake of HIV Pre-exposure Prophylaxis (PrEP): Implications for Women Experiencing Intimate Partner Violence. J Acquir Immune Defic Syndr 2019; 80:386-393. [PMID: 30570528 DOI: 10.1097/qai.0000000000001935] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the United States, women represent less than 5% of all pre-exposure prophylaxis (PrEP) users. Social networks may promote and/or inhibit women's PrEP awareness, which could influence PrEP intentions. Furthermore, women experiencing intimate partner violence (IPV) may have smaller, less supportive networks, which could deter or have no impact on PrEP care engagement. This study examined associations between network characteristics and women's PrEP awareness, interest, uptake, and perceived candidacy and analyzed IPV as an effect modifier. SETTING/METHODS From 2017 to 2018, data were collected from a prospective cohort study of 218 PrEP-eligible women with (n = 94) and without (n = 124) IPV experiences in Connecticut. Women completed surveys on demographics, IPV, social networks, and PrEP care continuum outcomes. RESULTS Adjusted analyses showed that PrEP awareness related to having more PrEP-aware alters. PrEP intentions related to having more alters with favorable opinions of women's potential PrEP use and a smaller network size. Viewing oneself as an appropriate PrEP candidate related to having more PrEP-aware alters and more alters with favorable opinions of women's potential PrEP use. IPV modified associations between network characteristics and PrEP care. Having members who were aware of and/or used PrEP was positively associated with PrEP care engagement for women without IPV experiences but had either no effect or the opposite effect for women experiencing IPV. CONCLUSION Improving PrEP attitudes might improve its utilization among women. Social network interventions might be one way to increase PrEP uptake among many US women but may not be as effective for women experiencing IPV.
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15
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Fujimoto K, Wang P, Flash CA, Kuhns LM, Zhao Y, Amith M, Schneider JA. Network Modeling of PrEP Uptake on Referral Networks and Health Venue Utilization Among Young Men Who Have Sex with Men. AIDS Behav 2019; 23:1698-1707. [PMID: 30430341 DOI: 10.1007/s10461-018-2327-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study is to identify individual-level factors and health venue utilization patterns associated with uptake of pre-exposure prophylaxis (PrEP) and to evaluate whether PrEP uptake behavior is further diffused among young men who have sex with men (YMSM) through health venue referral networks. A sample of 543 HIV-seronegative YMSM aged 16-29 were recruited in 2014-2016 in Chicago, IL, and Houston, TX. Stochastic social network models were estimated to model PrEP uptake. PrEP uptake was associated with more utilization of health venues in Houston and higher levels of sexual risk behavior in Chicago. In Houston, both Hispanic and Black YMSM compared to White YMSM were less likely to take PrEP. No evidence was found to support the spread of PrEP uptake via referral networks, which highlights the need for more effective PrEP referral network systems to scale up PrEP implementation among at-risk YMSM.
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Affiliation(s)
- Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX, 77030-5401, USA.
| | - Peng Wang
- Faculty of Business and Law, Centre for Transformative Innovation, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Charlene A Flash
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, BCM 285, Houston, TX, 77030, USA
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, and Northwestern University, 225 E. Chicago Avenue, #161, Chicago, IL, 60611, USA
| | - Yucheng Zhao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX, 77030-5401, USA
| | - Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St Suite 600, Houston, TX, 77030, USA
| | - John A Schneider
- Departments of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue MC 5065, Chicago, IL, 60637, USA
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16
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Imahashi M, Fujimoto K, Kuhns LM, Amith M, Schneider JA. Network overlap and knowledge of a partner's HIV status among young men who have sex with men. AIDS Care 2019; 31:1533-1539. [PMID: 30935221 DOI: 10.1080/09540121.2019.1601672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
For individuals living with HIV, disclosure of HIV status to their partners can be a source of psychological and emotional stress. Minimal information about serostatus disclosure is available for young men who have sex with men (YMSM). This study examined the disclosure of HIV status to social and sexual partners among YMSM using social and sexual network data. Respondent-driven sampling was used to collect data from YMSM aged 16-29 in Houston, Texas and Chicago, Illinois. Social network data from 746 respondents and 2035 social and/or sexual partners were collected from 2014 to 2016, of whom 27.9% were HIV seropositive, with 9.4% of their partners being both sexually and socially connected to respondents (overlapping network status), and 90.6% either sexually or socially connected. Generalized estimating equation analysis was conducted based on respondents' knowledge of their sexual partners' HIV status. Results showed that respondents with overlapping sexual and social relationships with their partners were less likely to not know their partners' HIV status (AOR = 0.26 95% CI: 0.18-0.40). Results highlight the association between overlapping partnership and knowledge of partner's HIV status among YMSM. These findings are useful when selecting potential network members to disclose HIV status and support YMSM's health and well-being.
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Affiliation(s)
- Mayumi Imahashi
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas, Health Science Center at Houston , Houston , TX , USA.,National Hospital Organization, Nagoya Medical Center , Nagoya , Aichi , Japan
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas, Health Science Center at Houston , Houston , TX , USA
| | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - John A Schneider
- The Chicago Center for HIV Elimination, University of Chicago , Chicago , IL , USA
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