1
|
Takenaka BP, Kirklewski SJ, Griffith FJ, Gibbs JJ, Lauckner CK, Nicholson E, Tengatenga C, Hansen NB, Kershaw T. "It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak. BMC Public Health 2024; 24:1574. [PMID: 38862933 PMCID: PMC11167942 DOI: 10.1186/s12889-024-19062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework. METHODS Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak. RESULTS We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities. CONCLUSION GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.
Collapse
Affiliation(s)
- Bryce Puesta Takenaka
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA.
| | - Sally J Kirklewski
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Frances J Griffith
- Yale School of Medicine, Division of Prevention and Community Research, 389 Whitney Avenue, New Haven, CT, 06516, USA
| | - Jeremy J Gibbs
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA
| | - Carolyn K Lauckner
- College of Medicine, Department of Behavioral Sciences, University of Kentucky, 800 Rose Street MN 150, Lexington, KY, 40506, USA
| | - Erin Nicholson
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Cecil Tengatenga
- School of Medicine, University of Connecticut, 200 Academic Wy, Farmington, CT, 06032, USA
| | - Nathan B Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, 100 Foster Road, Athens, GA, 30606, USA
| | - Trace Kershaw
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| |
Collapse
|
2
|
Cannas Aghedu F, Blais M, Philibert M, Côté I, Samoilenko M, Chamberland L. Social resource patterns and health outcomes among Canadian LGBTQ2+ adults: A latent class analysis. Soc Sci Med 2022; 314:115476. [PMID: 36327629 DOI: 10.1016/j.socscimed.2022.115476] [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: 11/03/2021] [Revised: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Decades of research have shown a strong association between wellbeing, health, and social resources. LGBTQ2+ communities are among those who historically have been excluded from accessing quality social resources. However, little is known about how access to different types of resources influences mental health and wellbeing. METHOD Data were drawn from an online sample of 3890 LGBTQ2+ people aged 18 years and older in Quebec, Canada. We identified key social resource patterns (from family of origin, friends, partner, neighbourhood, and LGBTQ2+ community) and investigated differences in socio-demographic and health outcomes across classes. RESULTS A five-class solution best fitted the data, highlighting distinctive patterns in access to five key social resources: moderate friend support access (42.14%), overall high support access (23.51%), high friend support access (18.06%), only close ties support access (10.90%) and overall low support access (5.39%). Marginalized groups (trans and non-binary people, racialized or disabled people, immigrants) were less likely to access diverse, high-quality social resources. Accessing diverse social resources, particularly close ties (e.g., family of origin), was associated with better health outcomes. In the absence of close ties, having at least one other social resource was associated with better health outcomes compared to having limited access to all resources. CONCLUSIONS We found a major imbalance in social resource access among LGBTQ2+ people. Creating safe spaces for LGBTQ2+ people and ensuring access to high-quality social resources is important in sustaining their health and wellbeing.
Collapse
Affiliation(s)
- Fabio Cannas Aghedu
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada.
| | - Martin Blais
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada; Département de Sexologie, Université Du Québec à Montréal, Canada
| | | | - Isabel Côté
- Département de Travail Social, Chaire de Recherche Du Canada sur La Procréation pour Autrui et Les Liens Familiaux, Université Du Québec en Outaouais, Québec, Canada
| | - Mariia Samoilenko
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada
| | - Line Chamberland
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada; Département de Sexologie, Université Du Québec à Montréal, Canada
| |
Collapse
|
3
|
Takada S, Gorbach P, Brookmeyer R, Shoptaw S. Associations of social capital resources and experiences of homophobia with HIV transmission risk behavior and HIV care continuum among men who have sex with men in Los Angeles. AIDS Care 2020; 33:663-674. [PMID: 33050712 DOI: 10.1080/09540121.2020.1828798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For men who have sex with men (MSM) in the US, the positive and negative aspects of social capital - access to resources within their social networks and experiences of homophobia - may explain their disproportionate burden of HIV infection. We analyzed data from 379 HIV seronegative and seropositive MSM in Los Angeles, collected between May 2017 and February 2018. Dependent variables were HIV transmission risk behaviors and care continuum outcomes. We used multivariable logistic regression to estimate the association between social capital resources and experiences of homophobia with dependent variables, adjusting for sociodemographics and drug use. Most participants were under age 40 and 41% identified as Black/African American and 36% as Hispanic/Latino. Social capital resources associated with likelihood of new sexually transmitted infections (-5.5% per standard deviation (SD), 95%CI -10.3, 0.7%) and HIV testing (5% per SD, 95%CI 0.8, 9.2%). Experiences of homophobia associated with likelihood of methamphetamine use during sex (10% per SD, 95%CI 7, 14%), receiving (4.3% per SD, 95%CI 1.9, 6.7%) and giving (7.2% per SD, 95%CI 4.5, 9.9%) exchange sex, and missing appointments (7.2% per SD, 95%CI 0.8, 13.6%). Findings that social capital associated with HIV transmission risk behaviors and HIV testing suggest interventions to increase social capital resources would impact the HIV-prevention continuum.
Collapse
Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA.,VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Kim B, Regan SD, Callander D, Goedel WC, Chaix B, Duncan DT. Associations of spatial mobility with sexual risk behaviors among young men who have sex with men in New York City: A global positioning system (GPS) study. Soc Sci Med 2020; 258:113060. [PMID: 32473485 DOI: 10.1016/j.socscimed.2020.113060] [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] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Spatial contexts and spatial mobility are important factors of the HIV epidemic and sexually transmitted infections. Using global positioning system (GPS) devices, we examined the associations of objectively measured spatial mobility with sexual risk behaviors among gay, bisexual and other men who have sex with men (MSM) in New York City. This observational study included a subgroup of 253 HIV-negative MSM from the Project 18 Cohort Study, who participated in the GPS monitoring sub-study. Spatial mobility was measured as (1) distance traveled and (2) activity space size defined as daily path area during 2-week of GPS tracking. We examined the associations of these measures with numbers of male sexual partners and condomless anal intercourse (CAI) acts during last six months using quasi-Poisson models, adjusting for socio-demographics. Results demonstrated that spatial mobility was positively associated with sexual risk behaviors, for example, with CAI (incidence rate ratio [IRR] = 1.01 for a 10 km increase in distance traveled and IRR = 1.04 for a 1 km2 increase in 50 m-buffer activity space size). Our findings may enhance the understanding of spatial contexts of HIV risk. Future studies should be conducted to examine the mechanisms for the associations between spatial mobility behaviors with sexual risk behaviors as well as the influence of neighborhood characteristics in various neighborhood contexts, which may guide the place-based HIV prevention services.
Collapse
Affiliation(s)
- Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| |
Collapse
|
5
|
Martinez O, Brady KA, Levine E, Page KR, Zea MC, Yamanis TJ, Grieb S, Shinefeld J, Ortiz K, Davis WW, Mattera B, Martinez-Donate A, Chavez-Baray S, Moya EM. Using Syndemics Theory to Examine HIV Sexual Risk Among Latinx Men Who Have Sex with Men in Philadelphia, PA: Findings from the National HIV Behavioral Surveillance. EHQUIDAD 2020; 13:217-236. [PMID: 32095789 PMCID: PMC7039620 DOI: 10.15257/ehquidad.2020.0009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Latinx men who have sex with men (MSM) continue to be disproportionately impacted by HIV/AIDS. Identifying the role of multiple syndemic factors associated with sexual risk behaviors is imperative in order to develop effective prevention and treatment strategies. Cross-sectional data for this study were derived from three cycles of the Philadelphia portion of the National HIV Behavioral Surveillance System. This study explored the impact of syndemic factors - heavy drinking, exchange sex, and homophobic discrimination - on sexual HIV risk behaviors, operationalized as number of male partners, and condomless anal intercourse (CAI) with main and casual partners among Latinx MSM (n=464). Analyses took two forms: a syndemic approach, using the cumulative number of conditions as an independent variable; and a non-syndemic approach, incorporating each condition as a unique factor. In multivariable syndemic analyses, participants with two or more factors reported more male partners and more CAI casual male partners than those with none. In non-syndemic models, homophobic discrimination and exchange sex were significantly positively associated with total number of male partners, while heavy drinking was associated with more casual CAI partners. Quantitative results indicate that syndemic and non-syndemic approaches vary in their relative capacity to account for sexual risk among Latinx MSM.
Collapse
|
6
|
Quinn KG. Applying an intersectional framework to understand syndemic conditions among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med 2019; 295:112779. [PMID: 31898991 DOI: 10.1016/j.socscimed.2019.112779] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
Syndemic theory has been useful in illuminating the co-existence and reinforcing nature of multiple health and social conditions that contribute to HIV risk. However, little research has examined syndemics among young Black gay, bisexual, and other men who have sex with men (GBM) or situated syndemics within the context of racism, homonegativity, and other intersecting social inequities. Applying an intersectional framework to syndemics can help demonstrate how social and structural inequities and oppression facing young Black GBM contribute to and reinforce syndemic health conditions. In 2018, we conducted 45 in-depth qualitative interviews with young Black GBM in Milwaukee and Cleveland. Our analyses examined how intersectional stigma contributes to syndemics and HIV disparities facing young Black GBM. Our findings demonstrate that broader systems of oppression and disadvantage facing young Black GBM contribute to syndemic conditions. Future conceptualizations and measurements of syndemics must capture these experiences to strengthen our understanding of syndemics among young Black GBM.
Collapse
Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
7
|
Castle B, Wendel M, Kerr J, Brooms D, Rollins A. Public Health’s Approach to Systemic Racism: a Systematic Literature Review. J Racial Ethn Health Disparities 2018; 6:27-36. [DOI: 10.1007/s40615-018-0494-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
|
8
|
McConnell EA, Janulis P, Phillips G, Truong R, Birkett M. Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2018; 5:1-12. [PMID: 29546228 DOI: 10.1037/sgd0000265] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minority stress theory has widespread research support in explaining health disparities experienced by sexual and gender minorities. However, less is known about how minority stress impacts multiply marginalized groups, such as lesbian, gay, bisexual, and transgender people of color (LGBT POC). Also, although research has documented resilience in the face of minority stress at the individual level, research is needed that examines macro-level processes such as community resilience (Meyer, 2015). In the current study, we integrate minority stress theory and intersectionality theory to examine multiple minority stress (i.e., racial/ethnic stigma in LGBT spaces and LGBT stigma in one's neighborhood) and community resilience (i.e., connection to LGBT community) among sexual minority men of different racial/ethnic groups who use a geosocial networking application for meeting sexual partners. Results showed that Black sexual minority men reported the highest levels of racial/ethnic stigma in LGBT spaces and White sexual minority men reported the lowest levels, with Asian and Hispanic/Latino men falling in between. Consistent with minority stress theory, racial/ethnic stigma in LGBT spaces and LGBT stigma in one's neighborhood were associated with greater stress for sexual minority men of all racial/ethnic groups. However, connection to LGBT community played more central role in mediating the relationship between stigma and stress for White than POC sexual minority men. Results suggest that minority stress and community resilience processes may differ for White and POC sexual minority men. Potential processes driving these differences and implications for minority stress theory are discussed.
Collapse
Affiliation(s)
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roky Truong
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
9
|
New to New York: Ecological and Psychological Predictors of Health Among Recently Arrived Young Adult Gay and Bisexual Urban Migrants. Ann Behav Med 2017; 50:692-703. [PMID: 27094938 DOI: 10.1007/s12160-016-9794-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Young gay and bisexual men might move to urban enclaves to escape homophobic environments and achieve greater sexual and social freedom, yet little is known about the health risks that these young migrants face. PURPOSE Drawing on recent qualitative depictions of gay and bisexual men's urban ecologies and psychological research on motivation and goal pursuit, we investigated migration-related motivations, experiences, health risks, and their associations among young gay and bisexual men in New York City. METHOD Gay and bisexual men (n = 273; ages 18-29) who had moved to New York City within the past 12 months completed an online survey regarding their hometowns, new urban experiences, migration motivations, and health risks. RESULTS Not having a college degree, HIV infection, hometown stigma, within-US migration, and moving to outside a gay-dense neighborhood were associated with moving to escape stress; hometown structural stigma and domestic migration were associated with moving for opportunity. Migrating from larger US-based hometowns, having recently arrived, and moving for opportunity predicted HIV transmission risk. Social isolation predicted lower drug use but more mental health problems. Higher income predicted lower HIV and mental health risk but higher alcohol risk. Hometown interpersonal discrimination predicted all health risks, but hometown structural stigma protected against drug risk. CONCLUSION Findings offer a comprehensive picture of young gay and bisexual male migrants' experiences and health risks and help build a theory of high-risk migration. Results can inform structural- and individual-level interventions to support the health of this sizeable and vulnerable segment of the urban population.
Collapse
|
10
|
Ferlatte O, Salway T, Hankivsky O, Trussler T, Oliffe JL, Marchand R. Recent Suicide Attempts Across Multiple Social Identities Among Gay and Bisexual Men: An Intersectionality Analysis. JOURNAL OF HOMOSEXUALITY 2017; 65:1507-1526. [PMID: 28885100 DOI: 10.1080/00918369.2017.1377489] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study draws from intersectionality to describe variations in recent suicide attempts (RSA) among gay and bisexual men (GBM) across sociodemographics. Using survey data, logistic regression modeling explored RSA in two analytical stages: (1) the individual effects of each sociodemographic were measured; (2) two-way interaction terms between sociodemographics were tested and added to the models created in stage A. In stage A, only education and income achieved significance. In stage B, the study found that (a) education and income interacted significantly such that the odds of RSA increased for those with a lower income and a lower education; (b) sexual orientation and partnership status interacted, resulting in decreased odds among bisexual men in heterosexual partnerships; and (c) income and education interacted with geography; the effects of these variables were significant only among urban men. These findings suggest that GBM are at unequal risk of RSA according to intersecting sociodemographics.
Collapse
Affiliation(s)
- Olivier Ferlatte
- a Men's Health Research Program , University of British Columbia , Vancouver , British Columbia , Canada
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
| | - Travis Salway
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada
| | - Olena Hankivsky
- d School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Terry Trussler
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
| | - John L Oliffe
- a Men's Health Research Program , University of British Columbia , Vancouver , British Columbia , Canada
| | - Rick Marchand
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
| |
Collapse
|
11
|
Collins TW, Grineski SE, Morales DX. Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners. Soc Sci Med 2017; 191:38-47. [PMID: 28888127 DOI: 10.1016/j.socscimed.2017.08.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 11/17/2022]
Abstract
Air pollution is deleterious to human health, and numerous studies have documented racial and socioeconomic inequities in air pollution exposures. Despite the marginalized status of lesbian, gay, bisexual, and transgender (LGBT) populations, no national studies have examined if they experience inequitable exposures to air pollution. This cross-sectional study investigated inequities in the exposure of same-sex partner households to hazardous air pollutants (HAPs) in the US. We examined cancer and respiratory risks from HAPs across 71,207 census tracts using National Air Toxics Assessment and US Census data. We calculated population-weighted mean cancer and respiratory risks from HAPs for same-sex male, same-sex female and heterosexual partner households. We used generalized estimating equations (GEEs) to examine multivariate associations between sociodemographics and health risks from HAPs, while focusing on inequities based on the tract composition of same-sex, same-sex male and same-sex female partners. We found that mean cancer and respiratory risks from HAPs for same-sex partners are 12.3% and 23.8% greater, respectively, than for heterosexual partners. GEEs adjusting for racial/ethnic and socioeconomic status, population density, urban location, and geographic clustering show that living in census tracts with high (vs. low) proportions of same-sex partners is associated with significantly greater cancer and respiratory risks from HAPs, and that living in same-sex male partner enclaves is associated with greater risks than living in same-sex female partner enclaves. Results suggest that some health disparities experienced by LGBT populations (e.g. cancer, asthma) may be compounded by environmental exposures. Findings highlight the need to extend the conceptual framework for explaining LGBT health disparities beyond psycho-behavioral mechanisms translating social stress into illness to include environmental mechanisms. Because psycho-behavioral and environmental factors may together exacerbate health disparities, we call for a shift toward interdisciplinary research on LGBT health that takes into account cumulative risks, including the role of environmental exposures.
Collapse
Affiliation(s)
- Timothy W Collins
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Avenue, El Paso, TX, 79968, USA.
| | - Sara E Grineski
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Avenue, El Paso, TX, 79968, USA.
| | - Danielle X Morales
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Avenue, El Paso, TX, 79968, USA.
| |
Collapse
|
12
|
Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, Greene E, Phelan JC, Koblin BA, Taylor-Akutagawa V. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model. EVALUATION AND PROGRAM PLANNING 2017; 63:45-53. [PMID: 28371668 DOI: 10.1016/j.evalprogplan.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.
Collapse
Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States; Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Mark Q Paige
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Steven Gordon
- Gay Men of African Descent (GMAD), Brooklyn, NY, United States
| | - David Matthews
- Brooklyn Men Konnect/Bridging Access to Care (BMK), Brooklyn, NY, United States
| | | | | | - Emily Greene
- Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
| | - Jo C Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States
| | | |
Collapse
|
13
|
Cassels S, Jenness SM, Biney AAE, Dodoo FNA. Geographic mobility and potential bridging for sexually transmitted infections in Agbogbloshie, Ghana. Soc Sci Med 2017; 184:27-39. [PMID: 28501018 PMCID: PMC5525941 DOI: 10.1016/j.socscimed.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
Abstract
Short-term mobility can significantly influence the spread of infectious disease. In order for mobile individuals to geographically spread sexually transmitted infections (STIs), individuals must engage in sexual acts with different partners in two places within a short time. In this study, we considered the potential of mobile individuals as bridge populations - individuals who link otherwise disconnected sexual networks and contributed to ongoing STI transmission. Using monthly retrospective panel data, we examined associations between short-term mobility and sexual partner concurrency in Agbogbloshie, Ghana. We also examined bridging by the location of sex acts and the location of sexual partners in concurrent triads, and whether mobile individuals from our sample were more likely to be members of geographic bridging triads. Although reported rates of sexual partnership concurrency were much higher for men compared to women, mobility was only associated with increased concurrency for women. Additionally, this association held for middle-distance mobility and short-duration trips for women. Taking into account the location of sex acts and the location of sexual partners, about 22% of men (21.7% and 22.4% for mobile and non-mobile men, respectively) and only 3% of women (1.4% and 3.3% for mobile and non-mobile women, respectively) were potential bridges for STIs over the last year. Our results highlight the gendered nature of mobility and sexual risk behavior, reflecting the normative social context that encourages women to conceal certain types of sexual behavior.
Collapse
Affiliation(s)
- Susan Cassels
- Department of Geography, University of California, Santa Barbara, CA 93106-4060, United States.
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana
| | - F Nii-Amoo Dodoo
- The Pennsylvania State University & University of Ghana, 211 Oswald Tower, University Park, PA 16802, United States
| |
Collapse
|
14
|
Koblin BA, Egan JE, Nandi V, Sang JM, Cerdá M, Tieu HV, Ompad DC, Hoover DR, Frye V. Congruence of Home, Social and Sex Neighborhoods among Men Who Have Sex with Men, NYCM2M Study. J Urban Health 2017; 94:364-374. [PMID: 27646852 PMCID: PMC5481209 DOI: 10.1007/s11524-016-0074-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantial literature demonstrates the influence of the neighborhood environment on health behaviors and outcomes. But limited research examines on how gay and bisexual men experience and exist in various geographic and virtual spaces and how this relates to their sexual behavior. New York City Men 2 Men (NYCM2M) was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use, and depression among men who have sex with men (MSM) living in NYC. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. Whether key neighborhoods of human activity, where a participant resided (termed home), socialized (termed social), or had sex most often (termed sex), were the same or different was evaluated. "Congruence" (or the sameness) of home, social, and most often sex neighborhood was reported by 17 % of men, while 30 % reported that none of their neighborhoods were the same. The largest group of men (39 %) reported that their home and sex neighborhoods were the same but their social neighborhood was different while 10 % reported that their home neighborhood was different than their social and sex neighborhood; 5 % men reported same home and social neighborhoods with a different sex neighborhood. Complete neighborhood incongruence was highest among men who were Black and/or Latino, had lower education and personal income levels, and had greater financial insecurity. In adjusted analysis, serodiscordant condomless anal intercourse and condomless anal intercourse with partners from the Internet or mobile applications were significantly associated with having the same social and sex (but not home) neighborhoods. Understanding the complexity of how different spaces and places relate to the health and sexual behavior of MSM is essential for focusing interventions to best reach various populations of interest.
Collapse
Affiliation(s)
- Beryl A Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, 310 E.67th Street, New York, NY, 10065, USA.
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Nandi
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, 310 E.67th Street, New York, NY, 10065, USA
| | - Jordan M Sang
- College of Global Public Health, New York University, New York, NY, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, 310 E.67th Street, New York, NY, 10065, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Danielle C Ompad
- College of Global Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV Research, NYU Rory Meyers College of Nursing, New York, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Victoria Frye
- Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA.,Department of Community Health and Social Medicine, City College of New York, CUNY Medical School, City University of New York, New York, NY, USA
| |
Collapse
|
15
|
Cerdá M, Nandi V, Frye V, Egan JE, Rundle A, Quinn JW, Sheehan D, Hoover DR, Ompad DC, Van Tieu H, Greene E, Koblin B. Neighborhood determinants of mood and anxiety disorders among men who have sex with men in New York City. Soc Psychiatry Psychiatr Epidemiol 2017; 52:749-760. [PMID: 28382385 PMCID: PMC5479697 DOI: 10.1007/s00127-017-1379-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 03/27/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE We examined the relationship between economic, physical, and social characteristics of neighborhoods, where men who have sex with men (MSM) lived and socialized, and symptom scores of depression and generalized anxiety disorder (GAD). METHODS Participants came from a cross-sectional study of a population-based sample of New York City MSM recruited in 2010-2012 (n = 1126). Archival and survey-based data were obtained on neighborhoods, where the men lived and where they socialized most often. RESULTS MSM who socialized in neighborhoods with more economic deprivation and greater general neighborhood attachment experienced higher GAD symptoms. The relationship between general attachment to neighborhoods where MSM socialized and mental health depended on the level of gay community attachment: in neighborhoods characterized by greater gay community attachment, general neighborhood attachment was negatively associated with GAD symptoms, while in low gay community attachment neighborhoods, general neighborhood attachment had a positive association with GAD symptoms. CONCLUSIONS This study illustrates the downsides of having deep ties to social neighborhoods when they occur in the absence of broader access to ties with the community of one's sexual identity. Interventions that help MSM cross the spatial boundaries of their social neighborhoods and promote integration of MSM into the broader gay community may contribute to the reduction of elevated rates of depression and anxiety in this population.
Collapse
Affiliation(s)
- Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA, USA.
| | - Vijay Nandi
- New York Blood Center, Lindsley F. Kimball Research Institute, New York, NY, USA
| | - Victoria Frye
- New York Blood Center, Lindsley F. Kimball Research Institute, New York, NY, USA
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, City College of New York, City University of New York, New York, NY, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel Sheehan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Danielle C Ompad
- Center for Health, Identity, Behavior and Prevention Studies, New York University College of Global Public Health, New York University, New York, NY, USA
- Center for Drug Use and HIV Research, New York University Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Hong Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Emily Greene
- New York Blood Center, Lindsley F. Kimball Research Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| |
Collapse
|
16
|
Bauermeister JA, Connochie D, Eaton L, Demers M, Stephenson R. Geospatial Indicators of Space and Place: A Review of Multilevel Studies of HIV Prevention and Care Outcomes Among Young Men Who Have Sex With Men in the United States. JOURNAL OF SEX RESEARCH 2017; 54:446-464. [PMID: 28135857 PMCID: PMC5623108 DOI: 10.1080/00224499.2016.1271862] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Young men who have sex with men (YMSM), particularly YMSM who are racial/ethnic minorities, are disproportionately affected by the human immunodeficiency virus (HIV) epidemic in the United States. These HIV disparities have been linked to demographic, social, and physical geospatial characteristics. The objective of this scoping review was to summarize the existing evidence from multilevel studies examining how geospatial characteristics are associated with HIV prevention and care outcomes among YMSM populations. Our literature search uncovered 126 peer-reviewed articles, of which 17 were eligible for inclusion based on our review criteria. Nine studies examined geospatial characteristics as predictors of HIV prevention outcomes. Nine of the 17 studies reported HIV care outcomes. From the synthesis regarding the current state of research around geospatial correlates of behavioral and biological HIV risk, we propose strategies to move the field forward in order to inform the design of future multilevel research and intervention studies for this population.
Collapse
Affiliation(s)
| | | | - Lisa Eaton
- b Department of Psychology , University of Connecticut
| | | | | |
Collapse
|
17
|
Keene DE, Eldahan AI, White Hughto JM, Pachankis JE. 'The big ole gay express': sexual minority stigma, mobility and health in the small city. CULTURE, HEALTH & SEXUALITY 2017; 19:381-394. [PMID: 27604293 PMCID: PMC5300938 DOI: 10.1080/13691058.2016.1226386] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Recent research has examined how gay and bisexual men experience and navigate the variations in sexual minority stigma that exist across geographic contexts, with implications for their health. We extend this literature on stigma, mobility, and health by considering the unique and understudied setting of the small city. Drawing on semi-structured interviews (n = 29) conducted in two small US cities (New Haven and Hartford), we find that these small cities serve as both destinations and points of departure for gay and bisexual men in the context of stigma. New Haven and Hartford attracted gay and bisexual men from surrounding suburbs where sexual minority stigma was more prevalent and where there were fewer spaces and opportunities for gay life. Conversely, participants noted that these small cities did not contain the same identity affirming communities as urban gay enclaves, thus motivating movement from small cities to larger ones. Our data suggest these forms of mobility may mitigate stigma, but may also produce sexual health risks, thus drawing attention to small cities as uniquely important sites for HIV prevention. Furthermore, our analysis contributes to an understanding of how place, stigma and mobility can intersect to generate spatially distinct experiences of stigmatised identities and related health consequences.
Collapse
Affiliation(s)
- Danya E Keene
- a Division of Social Behavioral Sciences , Yale University School of Public Health , New Haven , USA
| | - Adam I Eldahan
- a Division of Social Behavioral Sciences , Yale University School of Public Health , New Haven , USA
| | - Jaclyn M White Hughto
- a Division of Social Behavioral Sciences , Yale University School of Public Health , New Haven , USA
| | - John E Pachankis
- a Division of Social Behavioral Sciences , Yale University School of Public Health , New Haven , USA
| |
Collapse
|
18
|
Wilton L, Koblin B, Nandi V, Xu G, Latkin C, Seal D, Flores SA, Spikes P. Correlates of Seroadaptation Strategies Among Black Men Who have Sex with Men (MSM) in 4 US Cities. AIDS Behav 2015; 19:2333-46. [PMID: 26363789 DOI: 10.1007/s10461-015-1190-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We assessed associations of demographic, psychosocial, and substance use factors with seroadaptation strategies among 835 BMSM in four US cities. Seroadaptation strategies were practiced by 59.8 % of men, with 10.5 % practicing 100 % condom use, 26.5 % serosorting, 7.2 % condom serosorting, and 15.6 % seropositioning. In multivariable analyses, compared to men who used no seroadaptation strategies, serosorters were older, were less likely to be HIV infected, had fewer male sex partners, and had higher levels of social support and sexual self-efficacy. Condom serosorters had less psychological distress, were more likely to use methamphetamine, and had higher levels of sexual self-efficacy. Seropositioners were older, were less likely to be HIV infected, to have a main partner, and report alcohol/drug use with sex, while having higher levels of sexual self-efficacy. Seroadaptation practices among BMSM need to be considered to address perceived safer sex strategies and strengthen access to a broader reach of culturally-relevant prevention efforts.
Collapse
|
19
|
Lewis NM. Rupture, resilience, and risk: Relationships between mental health and migration among gay-identified men in North America. Health Place 2014; 27:212-9. [DOI: 10.1016/j.healthplace.2014.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 11/27/2022]
|