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Lin H, Zhou W, Tian X, Wang F. Detection Rates of Mental Health Problems Among Sexual Minorities in Mainland China: A Meta-Analysis. JOURNAL OF HOMOSEXUALITY 2024; 71:1991-2009. [PMID: 37256336 DOI: 10.1080/00918369.2023.2217678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Previous studies that have addressed the growing mental health problems among sexual minorities in mainland China, but failed to inform mental health programs and public health policies with consistent detection results. To obtain robust results on aggregate detection rates and moderators of these problems, we performed a meta-analysis of the related Chinese and English literature published before 2022. Ultimately, 305 eligible studies (ndepression = 127, nanxiety = 71, nsuicide ideation = 55, nsuicide plan = 13, nsuicide attempt = 39) were pooled in the analysis. The results revealed "Money boys" and people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) had higher detection rates than general men who have sex with men. Depression was more prevalent in gays than lesbians, and the latter had a higher detection rate of suicide. Detection rates of anxiety and depression among sexual minorities in China were moderated by detection time, measurement tools, and their detection thresholds. Suggested future priorities include developing more targeted measurement tools that consider the living conditions and psychological characteristics of local sexual minorities, enhancing mental health programs for sexual minorities, and devising more practical and effective interventions to prevent and reduce their mental health problems.
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Affiliation(s)
- Hongyi Lin
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Wenqin Zhou
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Xuan Tian
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Fengyan Wang
- School of Psychology, Nanjing Normal University, Nanjing, China
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Lodge W, Kelly PJA, Napoleon S, Plezia S, Mimiaga MJ, Biello KB. Prevalence of methamphetamine use among gay, bisexual and other men who have sex with men: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104271. [PMID: 38061224 DOI: 10.1016/j.drugpo.2023.104271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND International efforts have reduced the availability of methamphetamine precursors, but its distribution and use continue to rise. Methamphetamine use can lead to short- and long-term adverse effects, including addiction, physical and psychosocial health problems, socioeconomic troubles, incarceration, overdose, and death. Gay, bisexual, and other men who have sex with men (MSM) have been shown to have an elevated prevalence of methamphetamine use. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of methamphetamine use among MSM. We searched electronic databases, such as PubMed, for peer-reviewed literature published between 2011 and 2022. Data on methamphetamine use were extracted, including study features, location, study design, sampling method, recruitment period, specific MSM subgroups, prevalence period, and demographics. Employing a random-effects model, we computed the pooled prevalence of methamphetamine use among MSM across two prevalence periods: recent use (i.e., one month, three months, six months, one year) and lifetime use. RESULTS The systematic review included 56 studies with a total of 25,953 MSM who use methamphetamine. Most studies were conducted in Europe, with the highest prevalence reported in the United Kingdom. The studies primarily used cross-sectional or cohort study designs with convenience sampling. The pooled prevalence rates across recent use (i.e., past month, past three months, past six months, and past year) was 15% (95% CI [11-19%]). Additionally, we pooled lifetime use, which was 23% (95% CI [9-38%]). High heterogeneity (I2 > 99%) was observed, indicating significant variation. CONCLUSION This systematic review and meta-analysis provide a pooled prevalence of methamphetamine use among MSM. The analysis accounts for study design, prevalence period, specific MSM subgroups, and geographical areas to estimate methamphetamine use in diverse settings and populations. The review highlights the need for targeted interventions and harm reduction strategies focused on prevention, education, healthcare access, and stakeholder collaboration to address the multifaceted challenges of methamphetamine use among MSM.
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Affiliation(s)
- William Lodge
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA.
| | - Patrick J A Kelly
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Siena Napoleon
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Samantha Plezia
- Brown University School of Public Health, Providence, RI, USA
| | - Matthew J Mimiaga
- Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Katie B Biello
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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Nguyen MX, Zimmer C, Latkin CA, Lancaster KE, Dowdy DW, Hutton H, Chander G, Frangakis C, Gaynes BN, Sripaipan T, Tran HV, Go VF. Validation of the combined Patient Health Questionnaire Anxiety and Depression Scale among people with HIV in Vietnam. Int J STD AIDS 2023; 34:832-840. [PMID: 37287254 DOI: 10.1177/09564624231180782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam. METHODS Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n = 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined. RESULTS The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life. CONCLUSIONS Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.
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Affiliation(s)
- Minh X Nguyen
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Catherine Zimmer
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teerada Sripaipan
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ha V Tran
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Vivian F Go
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
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Nouri E, Moradi Y, Moradi G. The global prevalence of suicidal ideation and suicide attempts among men who have sex with men: a systematic review and meta-analysis. Eur J Med Res 2023; 28:361. [PMID: 37735701 PMCID: PMC10514985 DOI: 10.1186/s40001-023-01338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/02/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND This study aimed to determine the global prevalence of suicidal ideation and attempts among men who have sex with men (MSM) as a systematic review, and meta-analysis. METHODS For this meta-analysis, a search in four international databases (PubMed, Scopus, Web of Science, and EMBASE) was designed, and performed. In the next step, the information extraction checklist was prepared based on the study authors' opinions, and the quality of the articles was evaluated using the Newcastle-Ottawa scale (NOS) checklist. Data meta-analysis was performed using STATA16 software with a significance level below 0.05. RESULTS The results showed the prevalence of suicidal ideation, and suicide attempts among MSM was 21% (95% CI 17%-26%), and 12% (95% CI 8%-17%), respectively. The results of the subgroup analysis showed that the prevalence of suicidal ideation in the population of MSM living with Human immunodeficiency virus (HIV) was 40% (95% CI 35%-45%), and the prevalence of suicide attempts among MSM with HIV was 10% (95% CI 1%-27%). The prevalence of suicidal ideation in European MSM, and the prevalence of suicide attempts among American MSM were higher than other MSM in other geographical areas. CONCLUSION Considering that the prevalence of suicidal ideation and attempts among these people is many times higher than that among men in the general population, developing programs for the prevention of mental disorders with special attention to suicide is necessary for these people. Screening programs are also recommended for early diagnosis and prevention of suicide among these people.
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Affiliation(s)
- Elham Nouri
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Wang H, Jonas KJ, Guadamuz TE. Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis. Drug Alcohol Depend 2023; 243:109741. [PMID: 36630807 PMCID: PMC10435892 DOI: 10.1016/j.drugalcdep.2022.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom, Thailand; John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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Liu S, Xia D, Wang Y, Xu H, Xu L, Yuan D, Liang A, Chang R, Wang R, Liu Y, Chen H, Hu F, Cai Y, Wang Y. Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable selection methods. Front Public Health 2022; 10:1015699. [PMID: 36388367 PMCID: PMC9641070 DOI: 10.3389/fpubh.2022.1015699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission. Methods HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram. Results In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705. Conclusions The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.
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Affiliation(s)
- Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Xia
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxuan Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ajuan Liang
- Renji Hospital, Affiliated With the School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Fan Hu
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Yong Cai
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Ying Wang
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Nguyen MX, Reyes HL, Pence BW, Muessig KE, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Tran HV, Go VF. Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam. AIDS Behav 2022; 26:1829-1840. [PMID: 34807321 PMCID: PMC10144180 DOI: 10.1007/s10461-021-03532-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.
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Affiliation(s)
- M X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA.
| | - H L Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - B W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Chander
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - K E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H V Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
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Magno L, Guimarães MDC, Leal AF, Dourado I, Knauth DR, Bermúdez XPD, Rocha GM, Veras MADSM, Kendall C, Brito AMD, Kerr LRS. Perception of discrimination due to sexual orientation and associated factors among men who have sex with men in 12 Brazilian cities. CAD SAUDE PUBLICA 2022; 38:EN199121. [DOI: 10.1590/0102-311xen199121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
Discrimination due to sexual orientation (DDSO) has an important association with health outcomes among men who have sex with men (MSM). This study aimed to analyze factors associated with DDSO among MSM in 12 Brazilian cities. This is a cross-sectional study with 4,176 MSM participants recruited in 2016 which used a respondent-driven sampling method in 12 Brazilian cities. DDSO levels were previously identified by a latent class analysis based on 13 variables from the discrimination section. An ordinal logistic regression was used to assess associations with these DDSO levels, and weighted ordinal odds ratios (OR) and their respective 95% confidence intervals (95%CI) were estimated using Gile’s estimator. Most participants were young (< 25 years old) black or of mixed-race (pardo), single individuals who had a religious affiliation, primary or incomplete secondary education, and a high and average socioeconomic status. More than half (65%) reported DDSO in the 12 months prior to this study. We observed an independent association among the four latent DDSO classes and the following variables: age < 25 years old (OR = 1.66; 95%CI: 1.21-2.27), white skin color (OR = 1.43; 95%CI: 1.02-2.01), history of sexual (OR = 2.33; 95%CI: 1.58-3.43) and physical violence (OR = 3.08; 95%CI: 2.11-4.49), disclosure of their sexual orientation as MSM to their fathers (OR = 2.00; 95%CI: 1.47-2.72), experienced suicidal ideation in the two weeks prior to this study (OR = 2.09; 95%CI: 1.46-2.98), and use of any illicit drugs in the last six months (OR = 1.61; 95%CI: 1.19-2.18). Our results indicate that contextual factors may contribute to high DDSO levels among MSM in Brazil. Public health policies toward human rights surveillance and protection among MSM must be urgently addressed.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | | | | | | | | | | | | | | | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, U.S.A
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Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region. AIDS Behav 2022; 26:3862-3877. [PMID: 35668223 PMCID: PMC9170121 DOI: 10.1007/s10461-022-03714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.
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Storm S, Deuba K, Shrestha R, Pandey LR, Dahal D, Shrestha MK, Pokhrel TN, Marrone G. Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal. BMC Psychiatry 2021; 21:476. [PMID: 34587934 PMCID: PMC8479926 DOI: 10.1186/s12888-021-03477-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The prevalence of depression and suicidality is high among men who have sex with men (MSM) and transgender women (TGW) worldwide. Stigma and discrimination are likely contributing factors. More research is needed in low-income, non-English speaking countries to assess the effects of social and structural factors on depression and suicidality among MSM and TGW. METHODS Nepalese MSM and TGW (n = 340) were recruited using a respondent-driven sampling design and filled out a survey questionnaire. The outcomes were depression and suicidality. Data was analyzed using bivariate and multivariable logistic regression. RESULTS More than half of the participants (59%) suffered from depression. Severe depression was more common among TGW compared to MSM (41 and 20%, respectively). When it comes to suicidality, TGW had higher lifetime prevalence of suicidal thoughts compared to MSM (32 and 5%, respectively). Depression was positively associated with sex work both for MSM (AOR: 7.9; 95% CI 3.4-18.2) and TGW (AOR: 6.5; 95% CI: 2.3-18.2). MSM who were evicted by family had high odds of suicidal thoughts (AOR: 6.2; 95% CI: 1.3-28.8). For TGW, suicidality was associated with being cheated and threatened (AOR: 3.9; 95% CI: 1.2-12.5) and having forced to marry a female (AOR: 2.2; 95% CI 1.1-5.1). CONCLUSIONS Nepalese MSM and TGW suffer from a high degree of mental and psychosocial health issues. Future studies should focus on intervention research and on collecting data from a larger variety of gender and sexual minorities.
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Affiliation(s)
- Sanna Storm
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- National Centre for AIDS and STD Control/Global Fund Programs, Kathmandu, Nepal.
| | | | - Lok Raj Pandey
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Deepak Dahal
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Shrestha
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Tara Nath Pokhrel
- grid.500537.4Family Welfare Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Gaetano Marrone
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Nguyen MX, McNaughton Reyes HL, Pence BW, Muessig K, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Ha Tran V, Go VF. The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam. J Int AIDS Soc 2021; 24 Suppl 2:e25746. [PMID: 34165258 PMCID: PMC8222856 DOI: 10.1002/jia2.25746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association. METHODS This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time-lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation. RESULTS The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. CONCLUSIONS Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.
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Affiliation(s)
- Minh X Nguyen
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - H. Luz McNaughton Reyes
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Brian W Pence
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kate Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Carl A Latkin
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Kathryn E Lancaster
- Department of EpidemiologyCollege of Public HealthOhio State UniversityColumbusOHUSA
| | - Constantine Frangakis
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Teerada Sripaipan
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Viet Ha Tran
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Vivian F Go
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Tan RKJ, O'Hara CA, Koh WL, Le D, Tan A, Tyler A, Tan C, Kwok C, Banerjee S, Wong ML. Social capital and chemsex initiation in young gay, bisexual, and other men who have sex with men: the pink carpet Y cohort study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:18. [PMID: 33608005 PMCID: PMC7893730 DOI: 10.1186/s13011-021-00353-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
Background Young gay, bisexual, and other men who have sex with men (YMSM) are especially vulnerable to the risks associated with sexualized substance use, or ‘chemsex’. Engaging in chemsex established as a major risk factor for Human Immunodeficiency Virus (HIV) acquisition, and is thus a public health issue of increasing urgency. This paper attempts to explore the association between measures of social capital and patterns of sexualized substance use among a sample of YMSM in Singapore. Methods Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study in Singapore, comprising a sample of 570 HIV-negative YMSM aged 18 to 25 years old. Latent class analysis was employed to identify classes with similar patterns of sexualized substance use, and multinomial logistic regression was employed to examine associations between class membership and proxy measures of social capital, including age of sexual debut, bonding and bridging social capital, connectedness to the lesbian, gay, bisexual and transgender community, and outness. Results Latent class analysis revealed three classes of YMSM based on their histories of sexualized substance use, which we labelled as ‘alcohol’, ‘poppers’, and ‘chemsex’. Multivariable analyses revealed that participants who were older (aOR = 1.19, p = 0.002) and who identified as gay (aOR = 2.43, p = 0.002) were more likely to be in the poppers class compared to the alcohol class. Participants with a later age of sexual debut were increasingly less likely to be in the poppers (aOR = 0.93, p = 0.039) and chemsex classes (aOR = 0.85, p = 0.018), compared to the alcohol class. Conclusions Varying measures of social capital such as an earlier age of exposure to sexual networks may predispose YMSM to greater opportunities for sexualized substance use. Future interventions should target YMSM who become sexually active at an earlier age to reduce the risks associated with sexualized substance use.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore.
| | - Caitlin Alsandria O'Hara
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Wee Ling Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
| | - Daniel Le
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Avin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Adrian Tyler
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Calvin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Chronos Kwok
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Sumita Banerjee
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
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Schreck B, Victorri-Vigneau C, Guerlais M, Laforgue E, Grall-Bronnec M. Slam Practice: A Review of the Literature. Eur Addict Res 2021; 27:161-178. [PMID: 33279895 DOI: 10.1159/000511897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Slamming has been developing since 2011 as a new international phenomenon, mostly among men who have sex with men (MSM). It consists of intravenous drug injection before or during planned sexual activity to sustain, enhance, disinhibit, or facilitate the experience. We aimed to synthesize the available published evidence through a systematic literature review in order to precisely describe this phenomenon and to better characterize the population engaging in this practice and its specific motives. METHODS A systematic review of the available literature was conducted to identify all relevant publications using PubMed, Psyc-INFO, the Cochrane Library, and ScienceDirect. To complete the review, we followed the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" method. We limited the search to studies published between January 2008 and May 2020. RESULTS Our search identified 530 publications, of which 27 were included in the final data synthesis. One study focused on heterosexual and homosexual subpopulations, and all other studies focused on MSM-specific samples. Among MSM, slam prevalence was extremely variable, ranging from 2 to 91%; regarding other sexually active subjects, prevalence ranged from 7 to 14%. The prevalence of HIV-positive subjects varied widely across studies, ranging from 0.6 to 100%. We found less data about hepatitis C virus serostatus, ranging from 3 to 100%. Methamphetamine and mephedrone were the 2 most used drugs. DISCUSSION/CONCLUSION The data we found in international literature were very heterogeneous and from poorly reproducible studies. The definition of slamming in the international literature is not always clear, which limits the completeness of the collected data. This topic has been open to studies only recently; however, health professionals must be trained in the management of this practice, considering its risks in the short and medium terms and its addictive potential. We provided and discussed recommendations and potential future directions.
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Affiliation(s)
- Benoit Schreck
- Department of Addictology and Psychiatry, CHU Nantes, Nantes, France, .,Universités de Nantes et de Tours, French Institute of Health and Medical Research, INSERM UMR 1246 SPHERE, Nantes, France,
| | - Caroline Victorri-Vigneau
- Universités de Nantes et de Tours, French Institute of Health and Medical Research, INSERM UMR 1246 SPHERE, Nantes, France.,Department of Clinical Pharmacology, CHU Nantes, Nantes, France
| | | | - Edouard Laforgue
- Department of Addictology and Psychiatry, CHU Nantes, Nantes, France.,Universités de Nantes et de Tours, French Institute of Health and Medical Research, INSERM UMR 1246 SPHERE, Nantes, France
| | - Marie Grall-Bronnec
- Department of Addictology and Psychiatry, CHU Nantes, Nantes, France.,Universités de Nantes et de Tours, French Institute of Health and Medical Research, INSERM UMR 1246 SPHERE, Nantes, France
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14
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Xiao L, Qi H, Wang YY, Wang D, Wilkinson M, Hall BJ, Ungvari GS, Wang G, Xiang YT. The prevalence of depression in men who have sex with men (MSM) living with HIV: A meta-analysis of comparative and epidemiological studies. Gen Hosp Psychiatry 2020; 66:112-119. [PMID: 32818791 DOI: 10.1016/j.genhosppsych.2020.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) living with Human Immunodeficiency Virus (HIV) are more likely to suffer from depressive symptoms (depression hereafter). This is a comprehensive meta-analysis of the prevalence of depression in HIV-infected MSM. METHODS Relevant publications were systematically searched in PubMed, PsycINFO, EMBASE, Cochrane Library and Web of Science. Comparative and epidemiological studies with prevalence of depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) were included. The prevalence of depression was pooled using the random-effects model. RESULTS A total of 18 studies with 7653 MSM with HIV and 3395 MSM without HIV were included in the meta-analysis. The pooled prevalence of depression in MSM living with HIV was 43% (95%CI: 32%-53%). Compared to MSM without HIV, MSM living with HIV were more likely to be depressed (OR = 1.46, 1.05-2.03). Subgroup and meta-regression analyses revealed that different CES-D cut-off values and survey year had significant moderating effects on the prevalence of depression. CONCLUSIONS Depression was common in MSM living with HIV. Considering the negative effects of depression on health outcomes and wellbeing, regular screening for depression and effective treatment and interventions should be developed for this vulnerable population.
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Affiliation(s)
- Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Han Qi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan-Yuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montford University, Leicester, UK
| | - Di Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meredith Wilkinson
- Division of Psychology, Faculty of Health and Life Sciences, De Montford University, Leicester, UK
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao SAR, China; Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia; The University of Notre Dame Australia, Fremantle, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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15
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Li Y, Cai M, Qin S, Lu X. Depressive Emotion Detection and Behavior Analysis of Men Who Have Sex With Men via Social Media. Front Psychiatry 2020; 11:830. [PMID: 32922323 PMCID: PMC7456911 DOI: 10.3389/fpsyt.2020.00830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/30/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A large amount of evidence has indicated an association between depression and HIV risk among men who have sex with men (MSM), but traditional questionnaire-based methods are limited in timely monitoring depressive emotions with large sample sizes. With the development of social media and machine learning techniques, MSM depression can be well monitored in an online and easy-to-use manner. Thereby, we adopt a machine learning algorithm for MSM depressive emotion detection and behavior analysis with online social networking data. METHODS A large-scale MSM data set including 664,335 users and over 12 million posts was collected from the most popular MSM-oriented geosocial networking mobile application named Blued. Also, a non-MSM Benchmark data set from Twitter was used. After data preprocessing and feature extraction of these two data sets, a machine learning algorithm named XGBoost was adopted for detecting depressive emotions. RESULTS The algorithm shows good performance in the Blued and Twitter data sets. And three extracted features significantly affecting the depressive emotion detection were found, including depressive words, LDA topic words, and post-time distribution. On the one hand, the MSM with depressive emotions published posts with more depressive words, negative words and positive words than the MSM without depressive emotions. On the other hand, in comparison with the non-MSM with depressive emotions, the MSM with depressive emotions showed more significant depressive symptoms, such as insomnia, depressive mood, and suicidal thoughts. CONCLUSIONS The online MSM depressive emotion detection using machine learning can provide a proper and easy-to-use way in real-world applications, which help identify high-risk individuals at the early stage of depression for further diagnosis.
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Affiliation(s)
- Yong Li
- College of Economy and Management, Changsha University, Changsha, China
| | - Mengsi Cai
- College of Systems Engineering, National University of Defense Technology, Changsha, China
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Shuo Qin
- National Key Laboratory of Science and Technology on Blind Signal Processing, Chengdu, China
| | - Xin Lu
- College of Systems Engineering, National University of Defense Technology, Changsha, China
- School of Business, Central South University, Changsha, China
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16
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Bórquez A, Rich K, Farrell M, Degenhardt L, McKetin R, Tran LT, Cepeda J, Silva‐Santisteban A, Konda K, Cáceres CF, Kelly S, Altice FL, Martin NK. Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study. J Int AIDS Soc 2020; 23 Suppl 1:e25495. [PMID: 32562365 PMCID: PMC7305413 DOI: 10.1002/jia2.25495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre-exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants. METHODS We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01-2020/01-2021). We also investigated the 10-year impact (01-2020/01-2030) of: (1) PrEP prioritization for stimulant-using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant-associated risk. RESULTS MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant-associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade. CONCLUSIONS MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed.
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Affiliation(s)
- Annick Bórquez
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | | | - Michael Farrell
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Lucy T. Tran
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
| | - Javier Cepeda
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Alfonso Silva‐Santisteban
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Kelika Konda
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Carlos F. Cáceres
- Centro de Investigación Interdisciplinaria en SexualidadSIDA y SociedadUniversidad Peruana Cayetano HerediaLimaPeru
| | - Sherrie Kelly
- Modelling and BiostatisticsBurnet InstituteMelbourneVICAustralia
| | - Frederick L. Altice
- National Drug and Alcohol Research CenterUniversity of New South WalesSydneyNSWAustralia
- Yale University Center for Interdisciplinary Research on AIDSNew HavenCTUSA
- Centre of Excellence in Research on AIDSFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Natasha K. Martin
- Department of MedicineUniversity of California San DiegoLa JollaCAUSA
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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17
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Sexual Minority Stigma, Sexual Orientation Concealment, Social Support and Depressive Symptoms Among Men Who have Sex with Men in China: A Moderated Mediation Modeling Analysis. AIDS Behav 2020; 24:8-17. [PMID: 31664571 DOI: 10.1007/s10461-019-02713-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Men who have sex with men (MSM) often experience depressive symptoms. However, the potential mechanisms resulting in depressive symptoms are not fully understood. Here, we explore possible mechanisms behind the associations between sexual minority stigma (SMS), sexual orientation concealment (SOC), and social support (SS) with depressive symptoms among MSM. Data (N = 715) used in the study were from the baseline survey of a 3-year cohort study in China. Computer-assisted self-interview was used to collect data. Mediation and moderated mediation modeling analysis were employed to address the question. It was found that SOC partially mediated the association between SMS and depressive symptoms (indirect effect = 0.11, 95% CI 0.05-0.17). SS moderated the mediation model by buffering the path from SMS to SOC (β = 0.17, t = 3.18, P = 0.002). These findings suggested that SS might strengthen the association between SMS and depressive symptoms by moderating the pathway between SMS and SOC.
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18
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Mburu G, Tuot S, Mun P, Chhoun P, Chann N, Yi S. Prevalence and correlates of amphetamine-type stimulant use among transgender women in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:136-143. [DOI: 10.1016/j.drugpo.2019.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/06/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
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19
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Miedema SS, Haardörfer R, Keyes CLM, Yount KM. Does Socio-structural Context Matter? A Multilevel Test of Sexual Minority Stigma and Depressive Symptoms in Four Asia-Pacific Countries. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:416-433. [PMID: 31771346 DOI: 10.1177/0022146519877003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the Asia-Pacific region, individual sexual stigma contributes to elevated rates of depression among sexual minority men. Less well understood is the role of socio-structural sexual stigma despite evidence that social context influences the experience of stigma. We use data from the United Nations Multi-country Study on Men and Violence to conduct a multilevel test of associations between individual- and cluster unit-level indicators of sexual stigma and depressive symptoms among sexual minority men (n = 562). In the full model, individual-level sexual stigma is not associated with depressive symptoms, although there is significant variation in the association between individual stigma and depressive symptoms across clusters. Contrary to expectation, at the community level, homophobic injunctive norms are negatively associated with depressive symptoms. We discuss the implications for policies, programs, and future research to improve mental health among sexual minority men in the region.
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Affiliation(s)
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kathryn M Yount
- Department of Sociology, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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20
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Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, Ali R, Tran LT, Rehm J, Torrens M, Shoptaw S, McKetin R. Responding to global stimulant use: challenges and opportunities. Lancet 2019; 394:1652-1667. [PMID: 31668409 PMCID: PMC6924572 DOI: 10.1016/s0140-6736(19)32230-5] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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Affiliation(s)
- Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jürgen Rehm
- Institute Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marta Torrens
- Addiction Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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Levintow SN, Pence BW, Ha TV, Minh NL, Sripaipan T, Latkin CA, Vu PT, Quan VM, Frangakis C, Go VF. Prevalence and predictors of depressive symptoms among HIV-positive men who inject drugs in Vietnam. PLoS One 2018; 13:e0191548. [PMID: 29364928 PMCID: PMC5783407 DOI: 10.1371/journal.pone.0191548] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023] Open
Abstract
Background HIV infection is common among people who inject drugs (PWID), and HIV-positive PWID may be particularly vulnerable to depression. This study measured the prevalence of depressive symptoms and the factors associated with severe symptoms among 455 HIV-positive PWID in Thai Nguyen, Vietnam. Methods We used cross-sectional data from PWID in a randomized controlled trial of an intervention to reduce high-risk injecting and sexual behaviors in Thai Nguyen from 2009–2013. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). We used logistic regression to assess demographic, clinical, and psychosocial predictors of severe depressive symptoms (CES-D≥23) with prevalence odds ratios (POR) and 95% confidence intervals (CI). Results The prevalence of severe depressive symptoms (CES-D≥23) was 44%. 25% of participants had mild to moderate depressive symptoms (16≤CES-D<23), and 31% experienced no depressive symptoms (CES-D<16). Not being married, self-rated poor health, greater frequency of injection drug use, history of overdose, no alcohol use, and daily cigarette smoking were positively associated with severe depressive symptoms in unadjusted models and remained predictive in a multivariable model. The strongest predictors of depressive symptoms were self-reported poor health (POR = 2.94, 95% CI: 1.82, 4.76), no current alcohol use (POR = 2.35, 95% CI: 1.47, 3.77), and not currently married or cohabitating (POR = 2.21, 95% CI = 1.40, 3.47). Conclusion Severe depressive symptoms were common among HIV-positive PWID in Thai Nguyen and were strongly associated with demographic, clinical, and psychosocial factors. Interventions that promote social support from family and reduce drug dependence may particularly benefit PWID experiencing severe depressive symptoms. Greater recognition and treatment of depressive symptoms has the potential to enhance quality of life and improve HIV clinical outcomes for PWID.
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Affiliation(s)
- Sara N. Levintow
- University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
- * E-mail:
| | - Brian W. Pence
- University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Tran Viet Ha
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
| | - Nguyen Le Minh
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Teerada Sripaipan
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, United States of America
| | - Pham The Vu
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Vu Minh Quan
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America
| | - Constantine Frangakis
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, United States of America
| | - Vivian F. Go
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
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