Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men

Drug Use, Family Support, and Depressive Symptoms Among Latinx Sexual Minority Men: A Longitudinal Analysis

Family rejection has negative health consequences for Latinx sexual minority men (LSMM). However, LSMM often reconcile with their families, a phenomenon cross-sectional studies miss. We analyzed longitudinal data from the Healthy Young Men's Study in Los Angeles. We used individual fixed-effects Poisson regression to model changes over time in the associations among family support, drug use, and depressive symptoms. We found that (1) the initiation of drug use was associated with a 7.2% (Ratio=1.072, 95% CI 1.006 - 1.142, p = 0.03) increase in family support among LSMM who reported high depressive symptoms (depression subscale T-score ≥ 63) in at least one data wave; (2) a 1-unit increase in family support was associated with a 4.7% (RR = ;0.953, 95% CI 0.931 - 0.976, p < 0.001) decrease in the probability of high depressive symptoms; and (3) no significant association between a change in drug use and a change in high depressive symptoms. Over time, LSMM appear to benefit from the health effects of family support associated with Latinx family structures.

Impulsivity, Sexual Compulsivity, and Sexual Risk Behaviors among Hispanic Men Who Have Sex with Men in a US-Mexico Border City

Hispanic men who have sex with men (HMSM) experience HIV risk-related and mental health disparities. The relationship of mental health (i.e., depressive symptoms and anxiety) on sexual risk behaviors of HMSM has been reported. However, little is known about the influence of impulsivity and compulsivity on sexual risk behaviors. A cross-sectional study explored these factors among 150 HMSM in the El Paso, Texas area utilizing standardized measures, in a cross-sectional study. Regression analysis determined the influence of sexual impulsivity and compulsivity, and demographic variables on sexual risk behaviors, indicating interventions should target these behaviors to mitigate sexual risk among HMSM.

HIV-related drivers of sexual compulsivity and sexuality in sexual minority men who use methamphetamine

Although co-occurring methamphetamine (meth) use and HIV amplify the risk for neuropsychiatric comorbidities, the underlying neuroimmune mechanisms are not well characterized. We examined whether a detectable viral load and dysregulated metabolism of amino acid precursors for neurotransmitters predicted subsequent levels of sexual compulsivity and sexual sensation seeking. This 15-month longitudinal study enrolled 110 sexual minority men (SMM) living with HIV who had biologically confirmed meth use (i.e., reactive urine or hair toxicology results). Peripheral venous blood samples collected at baseline, 6 months, 12 months, and 15 months were used to measure a detectable viral load (> 40 copies/mL), the kynurenine/tryptophan (K/T) ratio, and the phenylalanine/tyrosine (P/T) ratio. The K/T and P/T ratios index dysregulated serotonin and catecholamine (e.g., dopamine) synthesis, respectively. In a cross-lagged panel model, a detectable viral load at 6 months predicted greater sexual compulsivity at 12 months after adjusting for prior levels of sexual compulsivity and recent stimulant use (β = 0.26, p = 0.046). A greater P/T ratio at baseline predicted decreased sexual sensation seeking at 6 months (β = - 0.25, p = 0.004) after adjusting for baseline sexual sensation seeking and recent stimulant use. Taken together, HIV replication and dysregulated catecholamine synthesis could potentiate sexual compulsivity while decreasing sexual pleasure in SMM who use meth.

PrEP Use and PrEP Use Disclosure are Associated with Condom Use During Sex: A Multilevel Analysis of Latino MSM Egocentric Sexual Networks

Pre-exposure prophylaxis (PrEP) is integral to HIV prevention; however, the influence of PrEP use and PrEP use disclosure on condom use is unclear among Latinx men who have sex with men (LMSM). This study explored associations of LMSM PrEP use and use disclosure on consistent dyadic condom use in the past 6 months. Participants were 130 HIV-negative PrEP and non-PrEP using LMSM ages 20-39 years. Two-level logistic regression models assessing individual- and dyadic-level predictors on condom use were fitted using R. Participants reported a mean of four sexual partners (n = 507 dyads). Participants who reported using PrEP or having more sexual partners were more likely to use condoms; however, participants who reported disclosing PrEP use were less likely to use condoms. Future longitudinal studies should characterize approaches to increase informed personal health choices and conversations about PrEP, condom use, and other HIV risk-reduction strategies using network methodologies.

Tobacco, Alcohol, Drug Use, and Intimate Partner Violence Among MSM Living With HIV

Men who have sex with men (MSM) and are living with HIV have reported high rates of intimate partner violence (IPV) and substance use. We examined relationships between accumulative IPV, incidents of IPV, and numbers of substances used. One hundred twenty Taiwanese MSM living with HIV completed a cross-sectional survey. Accumulative IPV was assessed by summing the number of 15 types of IPV experienced in the previous year; substance use was measured by any use of alcohol, tobacco, or other drugs during the previous week. In multivariate analysis, IPV was not associated with tobacco use but was positively associated with alcohol and other drug use and significantly associated with the probability of using multiple substances. MSM living with HIV who experienced greater IPV were more likely to use alcohol and other drugs and were more likely to use more than one substance. Health care providers screening for IPV should also screen for substance use.

Heterosexual Self-Presentation and Other Individual- and Community-Based Correlates of HIV testing among Latino Men Who Have Sex With Men

From 2010 to 2014, HIV diagnoses among Latino men who have sex with other men (LMSM) have increased by 14%, while diagnoses declined by 11% among white, non-Latino MSM. This health disparity is in part due to exposure to other LMSM with undiagnosed HIV infections. To effectively engage LMSM who are unaware of their serostatus, profiles of men differing in theorized determinants of HIV testing must be considered. In this retrospective study, we examined data from 546 LMSM to investigate whether hypothesized individual- (traditional masculine gender role conformity; sexual identity development status; alcohol and illicit drug use; sexual risk behaviors; perceived HIV susceptibility; and HIV stigma) and community-based (HIV prevention programming, access to health care, social support, neighborhood collective efficacy) factors were associated with differences in HIV testing. Latent profile analysis was used to identify profiles of men, and subsequent analyses examined whether profiles exhibited differential proportions of HIV testing. Four latent profiles were observed. One profile (50.3% tested) differed markedly from all other profiles (5.1 to 11% tested) in HIV testing. Characteristics of participants in this unique profile included reporting lower levels of heterosexual self-presentation, sexual identity uncertainty (and high levels of sexual identity commitment), condom use, HIV stigma, education, and perceived HIV susceptibility than all other profiles. Findings could improve HIV testing rates among LMSM by specifying ways in which public health advertisements/campaigns and community-based testing outreach efforts could be tailored to men most at-risk for transmitting HIV due to unknown serostatus.

Influences of Economic, Social and Cultural Marginalization on the Association Between Alcohol Use and Sexual Risk Among Formerly Incarcerated Latino Men

Formerly incarcerated Latino men (FILM) have been significantly impacted by the HIV/AIDS and alcohol abuse epidemics in the United States. In this analysis, we examine the role of social, economic and cultural marginalization in the likelihood of alcohol-related sexual risk taking behavior among FILM. We recruited a non-random sample of FILM, ages 18-49 (n = 259). We performed logistic regression modeling to test four hypotheses examining the direct and moderating effects of socio-cultural factors. Drinking before sex was strongly associated with high likelihood of condomless intercourse (adjusted odds ratio, AOR = 2.93; 95% CI 1.74, 4.94). Low acculturation and social marginalization factors were significant moderators of the association between high-risk alcohol use and sexual risk behavior among FILM. Our data suggest that risk reduction initiatives geared towards reducing alcohol-related sexual risk taking among FILM should target FILM with low levels of acculturation, and those with high levels loneliness, anxiety, and/or depression.

The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men

Self-medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self-blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals' self-perceptions and appraisals of the world as dangerous may play a role in self-medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV-infection risk.

High Substance Use and HIV Risk Behavior Among Young Argentine Men Who Have Sex with Men

In the United States young men who have sex with men have higher rates of substance use, higher HIV incidence, and less frequent HIV testing than their heterosexual counterparts and older MSM. Less is known about comparable populations in Latin America. As part of an epidemiological study, MSM were recruited through Respondent Driven Sampling in the metropolitan area of Buenos Aires, Argentina and answered a computerized behavioral survey. From the total of 500 MSM enrolled, a sub-sample of 233 aged 18-25 was analyzed. The sample was concentrated among lower socioeconomic strata, and only 16% identified as gay. Nearly half reported male, female, and transvestite sexual partners. Reported substance use was widespread ranging from 61% for marijuana to 20% for pasta base (cocaine sulfate). Seventy percent of the sample had never been tested for HIV infection; 3% tested positive for HIV and 8% for syphilis during the study.

"We hide…": Perceptions of HIV Risk Among Black and Latino MSM in New York City

Black and Latino men who have sex with men (BLMSM) are disproportionately infected with HIV; they comprised 66% of HIV diagnoses among men who have sex with men (MSM) in the United States in 2015. Risk factors for HIV infection among BLMSM include a high community prevalence of diagnosed and undiagnosed HIV/STDs, and dense sex partner networks. Perceptions of HIV risk among BLMSM were explored to inform HIV prevention efforts. During 2011-2012, semistructured interviews were conducted with BLMSM in New York City. Using computer-assisted thematic analyses (NVivo), transcribed interview responses to questions regarding HIV risk for main themes were examined. Interview data were available for 108 BLMSM: 86% Black, 13% Latino, 26% aged 18-24 years, 59% self-identified as "gay," and 33% self-identified as "bisexual." The main emergent theme was stigma. Subthemes related to stigma included: (a) homophobia in the Black and Latino community, (b) fear of losing support from family and friends, and (c) lack of support leading to low self-esteem. Addressing the stigma felt by BLMSM may be an important strategy to facilitate improved HIV prevention efforts, HIV care and treatment, and to decrease HIV-related disparities.

Disparities Within the Disparity-Determining HIV Risk Factors Among Latino Gay and Bisexual Men Attending a Community-Based Clinic in Los Angeles, CA

BACKGROUND

Latino gay, bisexual, and other men who have sex with men (MSM) in the United States have a 50% greater incidence of HIV when compared with White MSM. Previous studies have analyzed factors contributing to condomless anal intercourse among Latino MSM, but few studies have followed cohorts of HIV-negative Latino MSM to determine circumstances for HIV infection. Informed by Syndemics theory, we examine behavioral, biological, and contextual factors associated with HIV infection for Latino MSM.

METHODS

Risk assessment and HIV testing data were analyzed for all initially HIV negative, Latino MSM (n = 3111) visiting a community-based clinic in Los Angeles, CA from January 2009 to June 2014. Survival analyses were used to determine characteristics of Latino MSM who became HIV positive during the study time frame.

RESULTS

Similar to previous studies of MSM, self-reported history of chlamydia, gonorrhea, and/or syphilis (adjusted hazard ratio (aHR): 1.97; CI: 1.28 to 3.04), receptive condomless anal intercourse (aHR: 1.7; CI: 1.16 to 2.49), and methamphetamine use (aHR: 1.99; CI: 1.15 to 3.43) predicted HIV infection. In addition, originating from Central America (aHR: 2.31; CI: 1.41 to 3.79), Latino ethnicity of the last sex partner (aHR: 1.67; CI: 1.16 to 2.39) and experiencing intimate partner violence (IPV) (aHR: 1.73; CI: 1.13 to 2.64) were also associated with HIV infection among Latino MSM.

CONCLUSIONS

This is the first study to show independent associations between IPV and HIV infection among Latino MSM. This study shows that psychosocial conditions such as IPV fuel HIV incidence among Latino MSM, and psychosocial interventions should be considered to reduce HIV disparities among Latino MSM.

Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos study

Little research has been conducted to examine whether correlates of sexual risk vary by nativity among Latino men who have sex with men (MSM). We used cross sectional data collected from 870 Latino MSM recruited with respondent-driven sampling techniques. For each sub-sample (US-born and foreign-born), we assessed the association between each of the potential correlates (substance use, acculturation, social support, and social discrimination) and sexual risk behavior. Illicit drug use was associated with increased odds of sexual risk behavior in both US-born (OR = 2.17, 95% CI 1.17-4.03) and foreign-born (OR = 1.86, 1.14-3.05) subgroups. Multivariate correlates specific to foreign-born men included binge drinking (OR = 1.91, 1.17-3.14), 15 years or longer spent in the US (OR = 1.79, 1.06-3.03) and exposure to social discrimination (OR = 2.02, 1.03-3.99). Given the diversity of Latino MSM, information from research that identifies both common and different HIV risk factors across subgroups of Latino MSM may help better tailor HIV prevention programs.

Drug Treatment Needs of Hispanic Drug Users in Long Beach, California

The objective of this study is to investigate differences between Hispanic and non-Hispanic drug users in Long Beach, CA, with respect to drug use, HIV risk behaviors, and drug treatment experience and to explore the dissimilarities between Hispanic drug users who identify their family origin as Mexican American compared to those who identify their family origin as Mexican. We recruited 1,728 drug users into an HIV risk reduction intervention; of these, 404 were Hispanic. The Risk Behavior Assessment (RBA) was used to collect information on demographics, drug and sex risk behaviors, and drug treatment experience. Hispanic drug users are significantly more likely to inject drugs than non-Hispanic drug users and were found to have a higher mean number of injections in the last 30 days. Hispanic drug users were more likely to have taken part in drug treatment programs, specifically methadone detoxification and maintenance programs. Self-identified Mexican drug users were less likely to have ever attended a drug treatment program than were Mexican-American drug users. Greater availability of drug treatment programs for monolingual and bilingual Hispanic injectors is needed.

A Comparison of HIV-Related Factors Among Seropositive Brazilian, South American, and Puerto Rican Gay Men in the United States

Latino men who have sex with men are a group at high risk for HIV infection. Much of the research addressing attitudes and behaviors related to HIV among Latinos in the United States has overlooked differences based on nationality. Brazilian immigrants, in particular, are an understudied subgroup of Latinos. This study compared HIV-positive Brazilian gay men ( n = 75) with their Spanish-speaking counterparts from South America ( n = 103) and Puerto Rico ( n = 61) on a variety of HIV-related factors. Results failed to reveal any significant group differences in disclosure of serostatus or in behaviors relevant to sexual risk. Some differences in demographic characteristics, reasons for immigration, and acculturation, however, did emerge among the three groups. Implications for aggregation of Latino subgroups in HIV-related programs are discussed.

Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study

Background

The prevalence of unprotected anal intercourse (UAI) is high among Chinese men who have sex with men (MSM). As important aspects of quality of life (QOL), psychological health and social relationships have been found to be associated with UAI among MSM, which was of great concern for intervening on UAI.

Methods

We conducted a cross-sectional study in Zhengzhou, Henan province, and in Huludao, Liaoning province, China, to measure quality of life (QOL) using the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Cronbach's α coefficient was used to test the internal consistency of the questionnaire items, and construction validity was assessed by exploratory factor analysis. T-test, chi-square test and multivariate logistic analysis were carried out to test the relationship between quality of life and unprotected anal intercourse.

Results

The questionnaires of 320 of the 373 men who have sex with men that were surveyed met our validity criteria (response rate: 85.8 %). A total of 161 subjects (50.3 %) reported having unprotected anal sex in the last 6 months. The results of univariate analysis indicated that having unprotected anal sex was significantly associated with psychological health (PSYCH), social relationships (SOCIL), age, and marital status (P-value <0.05). The 3 items (“Negative feelings”, “Hopeness on your life”, and “Be able to concentrate”) in the PSYCH subscale were associated with UAI significantly (P-value <0.05). Multivariate analysis showed that psychological health (adjusted odd ratio (AOR) 0.979, 95 % confidence interval (CI) 0.961-0.998) was independent factor affecting the likelihood of having UAI in the population of Chinese MSM, and participants who aged 45 or more had higher odds of UAI (AOR 3.986, 95 % CI 1.199-13.255).

Conclusions

WHOQOL-BREF was acceptable for evaluating the quality of life of MSM. Psychological health, as one important aspect of quality of life, was negatively associated with unprotected anal intercourse. The finding underscored the needs to incorporate the strategies on improving psychological health into the UAI intervention to reduce the HIV transmission among MSM.

Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors - clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination - reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.

Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications

High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one's sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling. Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one-two types of people, p < 0.01; aRRR = 4.0 for disclosure to three-nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01). These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified.

Hispanic Men in the United States: Acculturation and Recent Sexual Behaviors With Female Partners, 2006-2010

OBJECTIVES

We examined Hispanic men's recent risky and protective sexual behaviors with female partners by acculturation.

METHODS

Using the 2006-2010 National Survey of Family Growth, we performed bivariate analyses to compare acculturation groups (Hispanic Spanish-speaking immigrants, Hispanic English-speaking immigrants, Hispanic US natives, and non-Hispanic White men) by demographics and recent sexual behaviors with women. Multivariable logistic regression models for sexual behaviors by acculturation group were adjusted for demographics.

RESULTS

Compared with Hispanic Spanish-speaking immigrants, non-Hispanic White men were less likely to report exchange of money or drugs for sex (adjusted odds ratio [AOR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9), but were also less likely to report condom use at last vaginal (AOR = 0.6; 95% CI = 0.4, 0.8) and anal sex (AOR = 0.4; 95% CI = 0.3, 0.7). Hispanic US natives were less likely to report condom use at last vaginal sex than were Spanish-speaking immigrants (AOR = 0.6; 95% CI = 0.4, 0.8). English- and Spanish-speaking immigrants did not differ in risky or protective sexual behaviors.

CONCLUSIONS

Our findings suggest that targeted interventions focusing on unique sexual risks and sociodemographic differences by acculturation level, particularly nativity, may be helpful for preventing sexually transmitted infections.

Associations between cognitive, sociocontextual, and affective variables and unprotected anal intercourse among men who have sex with men--a comparative study conducted in two Chinese cities

Few studies compared HIV-related risk behaviors between cities with different sociocultural environments among men who have sex with men (MSM). This study investigated the prevalence of unprotected anal intercourse (UAI) and associated individual and socio-cultural factors among Chinese MSM in Hong Kong and Shenzhen in Mainland China, which were proximal to each other but experienced different socioeconomic developments. Amongst all the 535 participants, 40.2% had had UAI. Significant factors of UAI among Shenzhen MSM included being able to find someone to share one's sexual orientation, disclosure of sexual orientation to family members, HIV risk perception, and use of alcohol or substances (adjusted OR ranged from 2.37 to 4.91), whilst disclosure of sexual orientation to family members was the only significant factor among Hong Kong MSM (adjusted OR = 1.64). Geographic variations in factors associated with UAI were observed. Future research and interventions need to take this into account.

HIV-related sexual risk behaviors among male-to-female transgender people in Nepal

BACKGROUND

Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons.

METHODS

Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews.

RESULTS

The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education.

CONCLUSIONS

Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population.

[A couple-based approach: An innovative effort to tackle HIV infection among Latino gay men.]

The HIV epidemic is a serious and pervasive health issue in the Latino community. While prevention efforts have helped maintain stability in the overall number of infections among Latinos for more than a decade, this population continues to be affected by HIV at high levels. In particular, Predominantly Spanish-speaking Latino men who have sex with men (MSM) are disproportionately impacted by HIV. Several factors contribute to the HIV epidemic among Predominantly Spanish-speaking Latino MSM including substance use; intimate partner violence; the presence of certain STIs; same-sex relationship dynamics; avoidance of seeking testing counseling and treatment out of fear of discrimination and immigration status; and poverty, migration patterns, and language barriers. In particular, epidemiological behavioral research has identified how relationship dynamics in male couples are associated with sexual risk behavior. Consequently, further research is needed to identify and deliver interventions geared toward couple-based risk reduction among men in same-sex relationships. This paper describes the potential significance that innovative couple-based approaches can have on reducing HIV and AIDS cases among Predominantly Spanish-speaking Latino MSM and their same-sex partners.

Substance use and experienced stigmatization among ethnic minority men who have sex with men in the United States

Research has documented deleterious effects of racism among ethnic minorities and of homophobia among men who have sex with men (MSM). Less is known about the impact of multiple forms of stigmatization on ethnic minority MSM. This study examined substance use by African American, Asian/Pacific Islander and Latino MSM, and the associations of experienced racism and homophobia from various sources with polydrug use and stimulant drug use. Experienced racism within the general community was associated with higher levels of use; other forms of discrimination were either not associated with polydrug or stimulant use or had more complex relationships with use. Implications for further research and interventions are discussed.

Acculturation and HIV-related sexual behaviours among international migrants: a systematic review and meta-analysis

This review examines the global literature regarding the relationship between acculturation and HIV-related sexual behaviours among international migrants. Seventy-nine articles published in English-language journals prior to July 2012 met the criteria for inclusion. We conducted a systematic review and subset meta-analysis of correlations between acculturation and five types of sexual behaviours including condom use, multiple partnerships, early sexual initiation, sexually transmitted diseases (STDs) and other unsafe sexual practices. Immigrants high in mainstream acculturation were more likely to have multiple partnerships, early sexual initiation, STDs and unsafe sex (rs ranged from 0.10 to 0.16), but acculturation was not associated with condom use (r = 0.02). Gender moderated the relationships between acculturation and multiple partnerships, STDs and unsafe sex. The relationship between acculturation and unsafe sex also varied across ethnicity. These findings suggest that acculturation may serve as a risk factor towards immigrants' HIV-related sexual health. We offered a theoretical framework and suggested applying cross-cultural and longitudinal designs in future research on acculturation and health behaviours.

Correlates of bisexual behaviors among men who have sex with men in El Salvador

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30-5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01-9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26-0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22-0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.

High prevalence of substance use among men who have sex with men in Buenos Aires, Argentina: implications for HIV risk behavior

Five hundred gay and other men who have sex with men (G&MSM) from Buenos Aires, Argentina completed an assessment regarding substance use and sexual behavior. During the past 2 months, 78 % of participants consumed alcohol and 61 % drugs. Over 20 % of participants reporting alcohol, marijuana, cocaine sulfate, or tranquilizer use, did so daily. Heavy alcohol use was more likely among participants with greater mood reactivity (AOR = 1.64) and less likely among those who identified as gay (AOR = 0.38). Weekly drug use was less likely among older (AOR = 0.98), and gay-identified participants (AOR = 0.50), but more likely among participants with greater mood reactivity (AOR = 1.49). Drug use was correlated with unprotected anal and vaginal intercourse with men, women, and transvestites among non-gay identified participants (r = 0.22). Findings highlight the need to reduce substance use and sexual risk behavior in this population.

Conflict and expectancies interact to predict sexual behavior under the influence among gay and bisexual men

As the mechanisms of the associations between substance use and risky sex remain unclear, this study investigates the interactive roles of conflicts about casual sex and condom use and expectancies of the sexual effects of substances in those associations among gay men. Conflict interacted with expectancies to predict sexual behavior under the influence; low casual sex conflict coupled with high expectancies predicted the highest number of casual partners, and high condom use conflict and high expectancies predicted the highest number of unprotected sex acts. Results have implications for intervention efforts that aim to improve sexual decision-making and reduce sexual expectancies.

Depressive symptoms among MSM who engage in bareback sex: does mood matter?

Much research has examined the relationship between depressive symptoms and unprotected sex among men who have sex with men (MSM), but little is known about how depression is related to the sexual behavior of men who intentionally engage in unprotected anal intercourse, or bareback sex. In this study, we explored the extent to which depressive symptoms were associated with rates of unprotected sex among barebackers, and whether this relationship was dependent upon HIV serostatus. Using a sample of 120 MSM who engage in intentional condomless sex, we found that for HIV-negative participants, depressive symptoms were associated with the overall frequency of unprotected anal intercourse as well as unprotected anal intercourse with a serodiscordant partner. For HIV-positive participants, depressive symptoms were not associated unprotected intercourse. Additional research is needed to better understand depression among men who bareback and how interventions could be designed to address depression and reduce sexual risk behaviors.

Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men

Drug assertiveness skills have been demonstrated to be effective in reducing substance use behaviors among patients with alcohol or heroin use disorders. This study examined the association between drug assertiveness and methamphetamine use, psychological factors, and sexual risk behaviors in a sample of 250 HIV-positive men who have sex with men enrolled in a safer sex intervention in San Diego, CA. Less assertiveness in turning down drugs was associated with greater frequency and larger amounts of methamphetamine use, lower self-esteem, higher scores on a measure of sexual sensation seeking, and greater attendance at risky sexual venues. These data suggest that drug assertiveness training should be incorporated into drug abuse treatment programs and other risk reduction interventions for methamphetamine users.

How do the sexual behaviors of foreign-born Hispanic men who have sex with men differ by relationship status?

High-risk sexual behaviors may result in acquisition of sexually transmitted infections including HIV. Hispanic men who have sex with men (MSM) experience a disproportionate incidence of these infections. Various risk factors, cultural aspects, and relationship factors may influence the sexual behaviors of this subgroup of MSM. The purpose of this study was to describe the sexual behaviors of a sample of foreign-born Hispanic MSM and to compare these sexual behaviors in terms of condom usage, risky sexual behaviors, avoidance of body fluids, and sexual negotiation when stratified by relationship status. Using a cross-sectional, descriptive research design, a convenience sample of 135 foreign-born Hispanic MSM, the majority of whom were Cubans, was recruited and surveyed from the South Florida area. The majority of participants reported engaging in the high-risk sexual behaviors of sex without condoms, substance abuse before or during sex, anal sex, contact with body fluids, and did not negotiate safer sex behaviors. Differences in sexual behaviors when compared by relationship status were found only in terms of certain risky sexual behaviors but not in terms of condom usage, contact with body fluids, or sexual negotiation. Despite participation in a number of high-risk activities and finding few differences among those men in relationships and those not in primary relationships, factors that promote or inhibit participation in high-risk sexual behaviors among Hispanic MSM in various types of relationships need further exploration.

A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics

Hispanics are disproportionately affected by substance abuse, HIV infection, intimate partner violence, and mental health conditions. To address health disparities among Hispanics and other vulnerable groups, it is necessary to understand the complex interactions between health conditions clustering together (e.g., substance abuse, intimate partner violence, and HIV) and the social ecology in which these conditions exist. A syndemic orientation, a consideration of clustering epidemics and common individual, relationship, cultural, and socioenvironmental factors linking these conditions, may be helpful in developing comprehensive models that expand our ability to understand and address health disparities. The purpose of this paper is to introduce a Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics, and provide evidence from the research literature to support the central relationships and risk and protective factors (i.e., potential links between conditions) depicted by the model. The development and evaluation of interventions aimed at the prevention of substance abuse, intimate partner violence, HIV/AIDS, and mental health problems as a syndemic affecting Hispanics is urgently needed. Public health nurses can initiate this endeavor with the guidance of a Syndemic Model.

Acculturation, depression, self-esteem, and substance abuse among Hispanic men

The demographics of the United States are rapidly changing as a result of immigration from Latin America. Predictions indicate that by the year 2050, one of every four persons in the United States will be of Hispanic ethnicity. If health disparities relating to substance abuse and related mental health conditions among Hispanics are not fully understood and addressed, these will continue to grow along with this population. The purpose of this pilot study was to describe the relationships among acculturation, depression, self-esteem, and substance abuse among a community sample of Hispanic men in South Florida (N = 164, 82 heterosexual men and 82 men who have sex with men). Standardized instruments measuring acculturation, depression, self-esteem, and substance abuse were administered in English or Spanish in a face-to-face interview format. Descriptive statistics and multiple logistic regression were used to illustrate participant characteristics and test relationships among the variables. Despite the fact that the majority of participants were more acculturated to the Hispanic culture than US culture, reported low levels of education and income, were depressed, and used substances, this group of men reported high levels of self-esteem. However, age and depression were the only predictors of substance abuse. Acculturation and self-esteem were not predictors of substance abuse. Clinicians need to be aware of the high rates of depression and substance abuse in this population and screen frequently for signs and symptoms of depression and substance abuse during health care encounters.

A randomized controlled trial to test an HIV-prevention intervention for Latino gay and bisexual men: lessons learned

At the time of this writing, no randomized controlled trial (RCT) of an intervention to reduce unsafe sex among Latino gay and bisexual men (LGBM) had been published. We report the results of an RCT conducted in New York City in which 180 LGBM were assigned either to an intervention developed specifically for this population or to a wait-list control group. The intervention was based on empowerment theory and used factors identified in prior research as determinants of unsafe sex. By eligibility criteria, all men had engaged in unprotected anal intercourse (UAI) within two months of the baseline assessment. At first (two months) and second (six months later) follow-up assessments, approximately half of the men in the experimental group reported no UAI. Yet, a similar proportion of the control group also reported no UAI. Baseline data indicate that although the men had been the subject of social oppression and sexual prejudice (homophobia), they did not feel disempowered, externally controlled or fatalistic, and they reported self-efficacy and intentionality to enact safer sex. Lessons learned are discussed, as well as notes of caution for future research employing a similar conceptual framework.

Hepatitis vaccination of men who have sex with men at gay pride events

Prevention researchers have advocated primary prevention such as vaccination in alternative venues. However, there have been major questions about both the attendance of, and the ability to, vaccinate high-risk individuals in such settings. The current study seeks to assess the feasibility of vaccinating high-risk men who have sex with men (MSM) at Gay Pride events. The research questions are: Do gay men who are sampled at Gay Pride events engage in more or less risky behavior than gay men sampled at other venues? Do the gay men who receive hepatitis vaccinations at Gay Pride engage in more or less risky behavior than gay men at Gay Pride who do not receive hepatitis vaccination? Of the 3689 MSM that completed the Field Risk Assessment (FRA), 1095/3689 = 29.68% were recruited at either the 2006 or 2007 Long Beach, California Gay Pride events. The remaining, 2594/3689 = 70.32% were recruited at Long Beach gay bars, gay community organizations and institutions, and through street recruitment in various gay enclaves in the Long Beach area. Logistic regression analysis yielded eight factors that were associated with non-attendance of Gay Pride: Age, had sex while high in the last 12 months, had unprotected anal intercourse (UAI) in the last 12 months, had sex for drugs/money in the last 12 months, been diagnosed with a sexually transmitted infection (STI) in the last 12 months, used nitrites (poppers) in the last 12 months, and used methamphetamine in the last 12 months. Identifying as White, Asian, or African American compared to Hispanic was also associated with non-attendance. Bivariate analysis indicated that, of the MSM sampled at Gay Pride, 280/1095 = 25.57% received a hepatitis vaccination there. The MSM sampled at Gay Pride who reported engaging in UAI or having used any stimulant (cocaine, crack-cocaine, or methamphetamine) in the last 12 months were more likely to receive hepatitis vaccination on-site. The results provide evidence for the viability of successfully vaccinating high-risk MSM at Gay Pride events. However, it is vital that no-cost vaccinations are also funded in other community settings such as STI clinics, drug treatment programs, prisons, universities, and other community resource centers in order to reach those additional high-risk MSM who do not attend Gay Pride.

The effects of husband's alcohol consumption on married women in three low-income areas of Greater Mumbai

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women's lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored.

Condom use in men who have sex with men: a literature review

The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process. The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identified: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.

Latino gay men's drug functionality: the role of social networks and social support

This study describes the consequences of drug use and abuse across Latino gay men's (LGM) lives. We also explore the role social networks play in LGM's access to drug use, as well as identifying the role of social support in regulating drug intake. Using a thematic content analysis, we analyzed a subsample (n = 16) of the interviews. Results suggest LGM's drug functionality varies according to their involvement in non-drug and drug-present social networks, with functional drug users reporting less convergence of their social networks than their drug-abusing counterparts. Furthermore, participants voiced being able to regulate their drug intake better when social support was available in their networks. These findings suggest the importance of developing preventative and harm reduction programs with strong social networks and social support components.

Accounts of HIV seroconversion among substance-using gay and bisexual men

Statistical associations between substance use and seroconversion among gay and bisexual men abound. However, these associations often ignore men's own interpretations of their seroconversion. Using in-depth interviews with gay and bisexual men who reported using drugs or alcohol at the time of their seroconversion, we identify how these men explain the events that led to HIV transmission. Whereas a small minority of respondents reported substance use to explain their seroconversion, the majority reported three competing explanations. These participants claimed that they lacked sufficient knowledge about the behavioral risks that led to their seroconversion; that their decision to engage in unsafe sex was because of negative personal affect; and that they "trusted the wrong person." We link these findings to prevention and suggest that gay and bisexual men who use substances for recreational purposes will benefit from prevention efforts designed to address issues of gay and bisexual men rather than substance-using men.

Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts

High rates of depression have been observed among men who have sex with men (MSM) relative to the general adult male population; however, a dearth of research has explored depression among Black MSM. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered quantitative assessment and voluntary HIV counseling and testing. Bivariate and multivariable logistic regression procedures examined the associations of demographics, behavioral HIV risk factors, and psychosocial variables with depressive symptoms by severity, using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Adjusting for demographic and behavioral variables, significant factors associated with (1) clinically significant depressive symptoms (33%; CES-D score > or = 16): being publicly insured by Medicaid, having serodiscordant anal sex with a casual male partner, and being diagnosed with an STD in the prior 12 months; (2) moderate depressive symptoms (19%; CES-D score 16-26): having serodiscordant unprotected anal sex with a casual male partner and being diagnosed with an STD in the prior 12 months; (3) severe depressive symptoms (14%; CES-D score 27+): being publicly insured by Medicaid and reporting difficulty accessing healthcare in the past 12 months. Moderately depressed Black MSM may be more likely to engage in behaviors that place them at increased risk for HIV and other STDs. HIV prevention interventions for Black MSM may benefit from incorporating screening and/or treatment for depression, allowing MSM who are depressed to respond more effectively to behavioral change approaches.

Drug use, interpersonal attraction, and communication: situational factors as predictors of episodes of unprotected anal intercourse among Latino gay men

It is important to understand situational factors linked to episodes of unprotected sexual intercourse among Latino gay men (LGM), who are disproportionately affected by HIV/AIDS in the U.S. Past research has suggested that participation in difficult sexual situations mediates the relationship between socio-cultural factors and sexual risk behaviors among LGM. This study examined drug use by self and sex partners, interpersonal factors, and other key variables, each examined at the situation-level of analysis, as predictors of episodes of unprotected anal intercourse (UAI) among LGM. Study participants included 270 LGM living in New York City, Miami, and Los Angeles who reported inconsistent condom use during anal intercourse in the last year. Men participated in structured interviews in which they were asked sets of detailed questions about their most recent episode of anal intercourse in which they used condoms, and their most recent anal intercourse episode in which they did not use condoms. Conditional logistic regression was used to compare the relevance of specific situational factors to participants' episodes of UAI and protected anal intercourse. We found that drug use by a sex partner and lacks of discussions about condom use with partners, among other situational factors, were significantly related to episodes of UAI. The findings highlight the importance of considering the impact of sexual situations and interactions with sex partners when studying HIV risk among LGM and when designing interventions.

Behaviorally bisexual men and their risk behaviors with men and women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.

Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research

Latinos maintain an AIDS case rate more than 3 times higher than whites, a greater rate of progression to AIDS, and a higher rate of HIV/AIDS-related deaths. Three broad areas are reviewed related to these disparities: (1) relevant demographic, socioeconomic, and socio-cultural factors among Latinos; (2) drug abuse and mental health problems in Latinos relevant to HIV/AIDS outcomes; and (3) opportunities for psychosocial intervention. Latinos living with HIV are a rapidly growing group, are more severely impacted by HIV than whites, and confront unique challenges in coping with HIV/AIDS. A body of research suggests that depression, substance abuse, treatment adherence, health literacy, and access to healthcare may be fruitful targets for intervention research in this population. Though limited, the current literature suggests that psychosocial interventions that target these factors could help reduce HIV/AIDS disparities between Latinos and whites and could have important public health value.

Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda

Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15-24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06-1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25-2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.

The interaction of sexual identity with sexual behavior and its influence on HIV risk among latino men: results of a community survey in northern San Diego County, California

OBJECTIVES

We examined the sexual behavior, sexual identities, and HIV risk factors of a community sample of Latino men to inform efforts to reduce Latinos' HIV risk.

METHODS

In 2005 and 2006, 680 Latino men in San Diego County, California, in randomly selected, targeted community venues, completed an anonymous, self-administered survey.

RESULTS

Most (92.3%) respondents self-identified as heterosexual, with 2.2%, 4.9%, and 0.6% self-identifying as bisexual, gay, or other orientation, respectively. Overall, 4.8% of heterosexually identified men had a lifetime history of anal intercourse with other men. Compared with behaviorally heterosexual men, heterosexually identified men who had sex with both men and women were more likely to have had a sexually transmitted infection, to have unprotected sexual intercourse with female partners, and to report having sex while under the influence of alcohol or other drugs. Bisexually identified men who had sex with men and women did not differ from behaviorally heterosexual men in these risk factors.

CONCLUSIONS

Latino men who have a heterosexual identity and bisexual practices are at greater risk of HIV infection, and efforts to reduce HIV risk among Latinos should target this group.

It's All About “Connecting”

Research on Latino gay men drug use is limited. This study explores the narratives of 16 Latino drug-using gay men living in the San Francisco Bay Area by exploring the role social settings play in their drug use, as well as by identifying the reasons and motivations for drug-use. Using a thematic content analysis, 16 interviews with LGM living in the San Francisco Bay Area were analyzed. Results suggest LGMhave different reasons for drug use across multiple settings. Participants use drugs to cope with their sexual identity, to feel like part of the mainstream gay community, and to reduce sexual inhibitions. Understanding how Latino gay men (LGM) perceive their drug use within their social, political, and economic environment would aid in the development of culturally adequate interventions.

HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons

OBJECTIVES

We examined HIV prevalence and the socioeconomic correlates of HIV infection, sexual risk behaviors, and substance use among Latino gay and bisexual men and transgender persons in Chicago and San Francisco.

METHODS

Data were collected from a sample of 643 individuals (Chicago: n=320; San Francisco: n=323) through respondent-driven sampling and computer-assisted self-administered interviews.

RESULTS

HIV prevalence in San Francisco (0.325; 95% confidence interval [CI]=0.260, 0.393) was higher than in Chicago (0.112; 95% CI=0.079, 0.163). In San Francisco, HIV prevalence was higher among US-born residents than among those born outside the country; in Chicago, the opposite was true. Heavy use of alcohol was prevalent, especially in Chicago (0.368; 95% CI=0.309, 0.432; San Francisco: 0.154; 95% CI=0.116, 0.192). Drug use and more education were positively correlated and greater age was negatively correlated with unprotected anal intercourse.

CONCLUSIONS

Heavy alcohol drinking and use of drugs remain a significant public health problem in this population. Drug use was more closely linked to HIV sexual risk behaviors than was heavy drinking.

Acculturation and alcohol among Latino adults in the United States: a comprehensive review

BACKGROUND

In light of the inconsistent evidence associating acculturation with drinking outcomes among Latinos in the United States, the current paper comprehensively reviews the literature on this topic.

METHODS

Studies were eligible for review if they (1) were published in a refereed journal, (2) were published in English, (3) sampled Latino/Hispanic adults aged 18+, (4) examined self-reported drinking behavior, alcohol-related problems, and/or alcohol abuse/dependence, and (5) reported original results or unique analyses from a larger dataset. The review includes only studies using composite scales of acculturation. Studies were identified via electronic databases (i.e., PSYCHINFO, ETOH, and PUBMED) using search terms, and combinations thereof, including "acculturat*," "alcohol*," "Latino," and "Hispanic." This search was supplemented by recursive checking and author searches. Thirty-two articles were identified and coded on methodological characteristics; results from 24 disaggregating genders and using appropriate outcomes were summarized.

RESULTS

Higher acculturation was very consistently associated with higher odds of drinking among women, even controlling for demographic covariates. The evidence for women also suggested associations between higher acculturation and heavier drinking on other outcomes, including total volume, drinking frequency, typical quantity, heavy/problem drinking, drinking problems, and abuse/dependence, despite some null results. Relationships were weaker and ambiguous among men. Some evidence suggested that highly acculturated men are (compared with peers low on acculturation) more prone to drink, and perhaps as a result, can show higher consumption and problems. However, results also implied that, among male drinkers, higher acculturation may be associated with a lighter drinking pattern. Important study limitations were identified, including low power, aggregation of nondrinkers with drinkers, restrictive sampling, measurement issues, and analytical issues.

CONCLUSIONS

The pattern of results suggests important associations between acculturation and drinking outcomes-particularly for women-but conclusions are tempered by serious methodological limitations. The review urges further research, particularly large-scale, longitudinal studies, addressing these limitations.

The Relationship of Depressive Symptoms, Self-Esteem, and Sexual Behaviors in a Predominantly Hispanic Sample of Men Who Have Sex With Men

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM ( M = 37 years of age, SD = ±8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.