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Ahonkhai AA, Rebeiro PF, Jenkins CA, Rickles M, Cook M, Conserve DF, Pierce LJ, Shepherd BE, Brantley M, Wester C. Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee. PLoS One 2022; 17:e0264508. [PMID: 35239705 PMCID: PMC8893655 DOI: 10.1371/journal.pone.0264508] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We assessed trends and identified individual- and county-level factors associated with individual linkage to HIV care in Tennessee (TN). METHODS TN residents diagnosed with HIV from 2012-2016 were included in the analysis (n = 3,751). Individuals were assigned county-level factors based on county of residence at the time of diagnosis. Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual-level and the contribution of individual and county-level factors to this outcome. RESULTS Both MSM (aRR 1.23, 95%CI 0.98-1.55) and women who reported heterosexual sex risk factors (aRR 1.39, 95%CI 1.18-1.65) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.71-0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.63, 95%CI: 0.40-0.99). CONCLUSIONS Racial disparities in linkage to care persist at both individual and county levels, even when adjusting for county-level social determinants of health. These findings suggest a need for structural interventions to address both structural racism and mental health needs to improve linkage to care and minimize racial disparities in HIV outcomes.
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Affiliation(s)
- Aima A. Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Peter F. Rebeiro
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Michael Rickles
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Mekeila Cook
- Division of Public Health Practice, Meharry Medical College, Nashville, TN, United States of America
| | - Donaldson F. Conserve
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States of America
| | - Leslie J. Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Meredith Brantley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Carolyn Wester
- Tennessee Department of Health, Nashville, TN, United States of America
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Canidate SS, Schrimshaw EW, Schaefer N, Gebru NM, Powers N, Maisto S, Parisi C, Leeman RF, Fields S, Cook RL. The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South? AIDS Behav 2021; 25:302-313. [PMID: 34741688 PMCID: PMC8610946 DOI: 10.1007/s10461-021-03479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.-particularly in the southern U.S.-despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population's unique risks and needs to inform the development of tailored interventions.
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Affiliation(s)
- Shantrel S Canidate
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA.
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Nancy Schaefer
- UF Health Science Center Libraries, University of Florida, Gainesville, FL, 32610, USA
| | - Nioud Mulugeta Gebru
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
| | - Noelani Powers
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Stephen Maisto
- Department of Psychiatry, College of Arts and Sciences, Syracuse University, Syracuse, NY, 13244, USA
| | - Christina Parisi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Sheldon Fields
- College of Nursing, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
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Sass D, Farkhad BF, Li B, Sally Chan MP, Albarracín D. Are spatial models advantageous for predicting county-level HIV epidemiology across the United States? Spat Spatiotemporal Epidemiol 2021; 38:100436. [PMID: 34353528 DOI: 10.1016/j.sste.2021.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
Predicting human immunodeficiency virus (HIV) epidemiology is vital for achieving public health milestones. Incorporating spatial dependence when data varies by region can often provide better prediction results, at the cost of computational efficiency. However, with the growing number of covariates available that capture the data variability, the benefit of a spatial model could be less crucial. We investigate this conjecture by considering both non-spatial and spatial models for county-level HIV prediction over the US. Due to many counties with zero HIV incidences, we utilize a two-part model, with one part estimating the probability of positive HIV rates and the other estimating HIV rates of counties not classified as zero. Based on our data, the compound of logistic regression and a generalized estimating equation outperforms the candidate models in making predictions. The results suggest that considering spatial correlation for our data is not necessarily advantageous when the purpose is making predictions.
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Affiliation(s)
| | | | - Bo Li
- University of Illinois at Urbana-Champaign, USA
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Olakunde BO, Pharr JR, Adeyinka DA, Conserve DF, Duncan DT. Spatial analysis of HIV infection and the associated correlates among transgender persons in the United States. AIDS Care 2021; 34:1000-1007. [PMID: 34029150 DOI: 10.1080/09540121.2021.1929817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Identifying the geographic hotspots of HIV infection among high-risk populations such as transgender people is critical to ending the HIV epidemic in the United States (U.S.). This study examined the spatial pattern of HIV positivity rate and the associated correlates among transgender persons in the 48 contiguous states and the District of Columbia in the U.S. The data source was the 2015 U.S. Transgender Survey (n = 27,715). We conducted spatial analyses, with state as the unit of analysis. We fitted a spatial lag regression model to assess demographic, social, and behavioral risk variables associated with HIV. The HIV positivity rate ranged by state from 0.5% to 17.1%, with a mean of 2.9%. There was a significant positive global spatial autocorrelation (global Moran's I = 0.42, p = 0.001). The identified spatial clusters of high values (hot spots i.e., states with high HIV positivity rates surrounded by states with similarly high rates) included five neighboring states (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee) in the Southern region. HIV positivity rate was positively associated with the percentage of transgender persons who were non-Hispanic Black, had no high school education, living in poverty, and engaged in sex work. Structural interventions are needed to address education, poverty, racial discrimination, and sex work that predispose transgender persons to HIV.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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5
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Hussen SA, Camp DM, Jones MD, Patel SA, Crawford ND, Holland DP, Cooper HLF. Exploring influences on methamphetamine use among Black gay, bisexual and other men who have sex with men in Atlanta: A focus group study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103094. [PMID: 33429161 DOI: 10.1016/j.drugpo.2020.103094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Methamphetamine use is a contributor to HIV risk and poor health outcomes among gay, bisexual and other men who have sex with men (GBMSM). There is a paucity of research examining methamphetamine use and its social context specifically among Black GBMSM. We therefore sought to: (1) describe trends in methamphetamine use among Black GBMSM in Atlanta, Georgia, and (2) examine the risk environment (micro-, meso‑ and macro-level factors operating in the political, social, physical, economic, and healthcare environments) that might elevate risk for methamphetamine use in this population. METHODS We conducted a qualitative study consisting of eight focus groups with 54 key informants between December 2019 and March 2020. Participants represented community-based and healthcare organizations that work closely with Black GBMSM. Our thematic analysis included an iterative, team coding approach combining deductive and inductive elements. RESULTS Participants unanimously agreed that methamphetamine use was increasingly prevalent among Black GBMSM in Atlanta, with many describing a historical arc in which methamphetamine use - previously associated with predominantly white, affluent GBMSM - was now common among younger, lower socioeconomic status Black GBMSM. At the micro-level, participants described contributors to increasing methamphetamine use including use as a sex drug, and the interrelated burdens of stress and mental illness, housing instability, geographic mobility and poverty. At the meso‑level, participants described virtual and physical sex scenes including use of geosocial networking apps that facilitated the spread of methamphetamine use in the Black GBMSM community. At the macro-level, participants described how policies prioritizing other concerns (e.g., HIV, opioids) seemed to limit resources available for methamphetamine prevention and treatment programming. CONCLUSION Multi-level environmental influences are working together to elevate risk for methamphetamine use among Black GBMSM in Atlanta, with potential to adversely impact health and well-being and undermine HIV prevention and treatment efforts.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, Georgia, USA; Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia, USA.
| | - Daniel M Camp
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, Georgia, USA
| | - Marxavian D Jones
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, Georgia, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, Georgia, USA
| | - Natalie D Crawford
- Department of Behavioral, Social and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, Georgia, USA
| | - David P Holland
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia, USA; Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, Georgia, USA; Division of Medical and Preventive Services, Fulton County Board of Health, 10 Park Place South, SE, Atlanta, Georgia, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, Georgia, USA; Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, Georgia, USA
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Moore S, Jones M, Smith JC, Hood J, Harper GW, Camacho-Gonzalez A, Del Rio C, Hussen SA. Homonegativity Experienced over the Life Course by Young Black Gay, Bisexual and Other Men Who Have Sex with Men (YB-GBMSM) Living with HIV in Atlanta, Georgia. AIDS Behav 2019; 23:266-275. [PMID: 31463712 PMCID: PMC8380492 DOI: 10.1007/s10461-019-02658-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Minority stress theory posits that homonegativity-whether experienced, anticipated, or internalized-adversely impacts health. We conducted qualitative interviews with 28 YB-GBMSM living with HIV to explore manifestations of homonegativity over the life course. Thematic analysis identified patterns in the ways that homonegativity was discussed at different points in participants' lives. Stifling, and sometimes traumatic, familial and religious environments led to experienced homonegativity early in life. These experiences led to anticipated and internalized homonegativity, which in turn shaped sexual identity formation processes in adolescence and into young adulthood. Ultimately, many participants distanced themselves from home environments, seeking and often finding extrafamilial support. Most participants eventually reached self-acceptance of both their sexuality and HIV status. In conclusion, experienced, anticipated and internalized homonegativity were pervasive as YB-GBMSM navigated family and religious environments over the life course. Future interventions should work with youth, families, and churches to prevent these harmful experiences.
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Affiliation(s)
- Shamia Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Marxavian Jones
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Justin C Smith
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jasper Hood
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andres Camacho-Gonzalez
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Carlos Del Rio
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia.
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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7
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Characteristics of and Trends in HIV Diagnoses in the Deep South Region of the United States, 2012-2017. AIDS Behav 2019; 23:224-232. [PMID: 31473847 DOI: 10.1007/s10461-019-02659-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV prevention goals in the United States include reducing new HIV infections among people in the South Census region (commonly referred as the South). Using data reported to the National HIV Surveillance System, we examined trends in HIV diagnoses in the South, including the Deep South and Other South, during 2012-2017. Although diagnosis rates declined in all regions during the time period, declines were greater in all other regions compared to the Deep South, with the exception of the West region. Moreover, the South continues to have a diagnosis rate 50% higher (65% higher in the Deep South) than that of any other region. Diagnoses in the Deep South increased among some groups, including men who have sex with men, persons aged 25-34 years and Hispanics/Latinos. These findings highlight the need to further strengthen interventions in the South, particularly among communities of color and young adults.
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8
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Blake BJ, Taylor GAJ, Sowell RL. Exploring Experiences and Perceptions of Older African American Males Aging With HIV in the Rural Southern United States. Am J Mens Health 2016; 11:221-232. [PMID: 27550774 DOI: 10.1177/1557988316662875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The HIV (human immunodeficiency virus) epidemic in the United States remains a serious public health concern. Despite treatment and prevention efforts, approximately 50,000 new HIV cases are transmitted each year. Estimates indicate that 44% of all people diagnosed with HIV are living in the southern region of the United States. African Americans represent 13.2% of the United States population; however, 44% (19,540) of reported new HIV cases in 2014 were diagnosed within this ethnic group. The majority of cases were diagnosed in men (73%, 14,305). In the United States, it is estimated that 21% of adults living with HIV are 50 years or older. There exists limited data regarding how well African American men are aging with HIV disease. The purpose of this study was to explore the perceptions and experiences of older African American men living with HIV in rural Georgia. Data were collected from 35 older African American men living with HIV using focus groups and face-to-face personal interviews. Qualitative content analysis revealed six overlapping themes: (1) Stigma; (2) Doing Fine, Most of the Time; (3) Coping With Age-Related Diseases and HIV; (4) Self-Care; (5) Family Support; and (6) Access to Resources. The findings from this study provide new insights into the lives of rural HIV-infected African American men, expands our understanding of how they manage the disease, and why many return to or remain in rural communities.
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9
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Koenig LJ, Hoyer D, Purcell DW, Zaza S, Mermin J. Young People and HIV: A Call to Action. Am J Public Health 2016; 106:402-5. [PMID: 26794156 PMCID: PMC4815747 DOI: 10.2105/ajph.2015.302979] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/04/2022]
Abstract
HIV is having a significant impact on young people, among whom the rate of new diagnoses is high and health disparities are more pronounced. Incidence is increasing among young gay and bisexual men, and, among Black males, the largest percentage of new infections occur among those aged between 13 and 24 years. Youths are least likely to experience the health and prevention benefits of treatment. Nearly half of young people with HIV are not diagnosed; among those diagnosed, nearly a quarter are not linked to care, and three quarters are not virally suppressed. Addressing this burden will require renewed efforts to implement effective prevention strategies across multiple sectors, including educational, social, policy, and health care systems that influence prevention knowledge, service use, and treatment options for youths.
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Affiliation(s)
- Linda J Koenig
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Deborah Hoyer
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - David W Purcell
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Stephanie Zaza
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Jonathan Mermin
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
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