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Kromholz G, Barak A. The Experience of Loneliness Among Gay Men in Israel: A Qualitative Study. JOURNAL OF HOMOSEXUALITY 2023; 70:2784-2805. [PMID: 35604306 DOI: 10.1080/00918369.2022.2076575] [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: 06/15/2023]
Abstract
The aim of this qualitative study is to explore the experience of loneliness among Israeli gay men in their early and mid-adulthood, ages 30-50 (N = 14). The findings demonstrate three main categories of loneliness that study participants experienced: childhood loneliness as an initial experience of gay identity; loneliness in the context of other gay men, via sexual encounters, friendships, and the use of dating apps; and loneliness in the context of heterosexual society. The findings point to the centrality of the experience of loneliness among Israeli gay men in their mid-adulthood years and emphasize how this loneliness is rooted in socio-cultural and political perceptions concerning hetero-normative as well as gay identities.
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Affiliation(s)
- Golan Kromholz
- The Louis & Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Adi Barak
- The Louis & Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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2
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Blankenau A, Wax A, Auerbach L, Schuman ZD, Hopmeyer A. Queer Peer Crowds on Campus: LGBT Crowd Affiliation as a Critical Correlate of College Students' Loneliness, Academic Well-Being, & Stress. JOURNAL OF HOMOSEXUALITY 2023; 70:1411-1439. [PMID: 35112989 DOI: 10.1080/00918369.2022.2030616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current study explored whether affiliating with an LGBT peer crowd on a college campus differentially predicts college adjustment (including loneliness, college belongingness, academic well-being, and stress), as opposed to affiliating with a non-LGBT peer crowd. Based on a sample of 692 students from a small liberal arts college in Southern California, factor and path analyses were carried out. Results indicated that, of all the crowd affiliations, affiliating with an LGBT peer crowd was the strongest predictor of loneliness, academic well-being, and stress. However, affiliating with an LGBT peer crowd was not the strongest predictor of college belongingness. Implications and applications of these results are discussed.
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Affiliation(s)
| | - Amy Wax
- California State University, Long Beach, California, USA
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3
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Shepp K, Drescher CF, Griffin JA, Stepleman LM. Loneliness in Sexual Minority Individuals in the Southeastern United States: The Role of Minority Stress and Resilience. JOURNAL OF HOMOSEXUALITY 2023; 70:963-988. [PMID: 34806943 DOI: 10.1080/00918369.2021.2006001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health disparities in the sexual minority population may be exacerbated by the loneliness experienced due to minority stress. Using a minority stress framework, this study examined minority stress, protective variables, and mental health as correlates of loneliness in sexual minority individuals in a small metropolitan area in the southeastern United States. Participants (n = 273) were a subsample of sexual minority individuals from a broader sample of LGBTQ adults in the Central Savannah River area who completed a health needs assessment. Bivariate correlations were calculated to assess for degree of significant relationships between loneliness and barriers to health care, minority stress, and mental health. Hierarchical linear regression was conducted to examine the relative importance of the study variables' associations with loneliness. A multiple regression model found household income, assault victimization, depressive symptoms, and sense of community to be significant correlates of loneliness. Interventions to decrease loneliness in this population will need to consider these interconnected, multi-level influences.
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Affiliation(s)
- Kasey Shepp
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Christopher F Drescher
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - James A Griffin
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- LGBT Health Resource Center, Chase Brexton Health Care, Baltimore, Maryland, USA
| | - Lara M Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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4
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Hughes M, Lyons A, Alba B, Waling A, Minichiello V, Fredriksen-Goldsen K, Barrett C, Savage T, Blanchard M, Edmonds S. Predictors of Loneliness Among Older Lesbian and Gay People. JOURNAL OF HOMOSEXUALITY 2023; 70:917-937. [PMID: 34806954 DOI: 10.1080/00918369.2021.2005999] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study sought to understand the social and individual factors that predict loneliness among older lesbian and gay people in Australia. A sample of 508 gay men and 241 lesbian women, aged 60 and over, completed a survey including measures of loneliness, internalized homonegativity, sexual orientation discrimination, and connectedness to lesbian and gay communities. A multivariable linear regression predicting loneliness was conducted. Not being in an intimate relationship and having less connection to lesbian and gay communities were significant predictors of loneliness for both older lesbian women and gay men. For the men, younger age, internalized homonegativity and more frequent lifetime experiences of sexual orientation discrimination also appeared to predict greater likelihood of loneliness. More frequent recent experiences of sexual orientation discrimination predicted loneliness for the women. The findings confirmed loneliness as an issue of concern among older lesbian and gay people and identified factors amenable to intervention to address loneliness.
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Affiliation(s)
- Mark Hughes
- Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Beatrice Alba
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- School of Psychology, Deakin University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Victor Minichiello
- School of Justice, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | | | | | - Teresa Savage
- Silver Rainbow, National LGBTI Health Alliance, Sydney, Australia
| | - Michelle Blanchard
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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5
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Goldbach JT, Parra LA, O’Brien RP, Rhoades H, Schrager SM. Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents. J Rural Health 2023; 39:262-271. [PMID: 35977886 PMCID: PMC9771913 DOI: 10.1111/jrh.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. METHODS A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. FINDINGS On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. CONCLUSIONS SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.
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Affiliation(s)
- Jeremy T. Goldbach
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Luis A. Parra
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Rory P. O’Brien
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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6
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Anderson-Carpenter KD. Do Spirituality, Rurality, and LGBTQ Support Increase Outness and Quality of Health in Gay and Bisexual Men? JOURNAL OF HOMOSEXUALITY 2022; 69:1081-1096. [PMID: 34292137 DOI: 10.1080/00918369.2021.1905382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although the existing research suggests that spirituality may positively affect health outcomes for gay and bisexual men, it is unclear to what extent it improves the quality of health over and above sociodemographic factors. Furthermore, there remains conflicting evidence regarding the role of residential location on levels of outness for gay and bisexual men. To that end, the present study used hierarchical linear regression analyses to examine the role of spirituality, rurality, and LGBTQ connectedness in outness and quality of health. The sample comprised 2,202 self-identified gay and bisexual men aged 18 and older who responded to the Social Justice Sexuality Project survey; participants represented all 50 states and Puerto Rico. The results indicate that whereas spirituality was positively associated with a greater quality of life, there was no significant difference in outness between rural versus nonrural participants. Moreover, bisexual men endorsed significantly lower levels of outness compared to their gay counterparts. Implications for future research regarding the role of spirituality and rurality in sexual minority health are discussed.
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Sextech Use as a Potential Mental Health Reprieve: The Role of Anxiety, Depression, and Loneliness in Seeking Sex Online. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178924. [PMID: 34501522 PMCID: PMC8430900 DOI: 10.3390/ijerph18178924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022]
Abstract
Depression, anxiety, and loneliness have long been recognized as global mental health concerns. To temporarily relieve psychological distress, self-soothing behavior is common, including engagement in sexual behaviors that are linked to positive mental well-being. Considering the COVID-19 pandemic further exacerbated many mental health ailments alongside physical distancing regulations, we specifically examined online sexual behavior via the use of emergent digital sexual technologies, or sextech. In a 2019 study of 8004 American adults, we assessed whether people experiencing higher anxiety, depression, and/or loneliness were more likely to engage in sextech use. Furthermore, we examined whether anxiety or depression mediated the association between loneliness and sextech use, as loneliness is one contributor to anxiety and depression. People with higher anxiety and depression were more likely to engage in sextech. However, those who were more lonely were less likely to engage with sextech, suggesting the aforementioned patterns were not due to lack of social connection. Our findings suggest people with mental health struggles may be drawn to interactive, digital forms of sexual behavior as a means of alleviating symptoms through distraction or self-soothing. This insight offers an important pathway for expanding the scope of mental health interventions, particularly as technology becomes increasingly prevalent and accessible in everyday life.
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Hubach RD, O'Neil A, Stowe M, Giano Z, Curtis B, Fisher CB. Perceived Confidentiality Risks of Mobile Technology-Based Ecologic Momentary Assessment to Assess High-Risk Behaviors Among Rural Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1641-1650. [PMID: 32078710 PMCID: PMC7438245 DOI: 10.1007/s10508-019-01612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.
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Affiliation(s)
- Randolph D Hubach
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA.
| | - Andrew O'Neil
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Mollie Stowe
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Zachary Giano
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Brenda Curtis
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, USA
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9
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Scott D. Stigma in place: Black gay men's experiences of the rural South. Health Place 2021; 68:102515. [PMID: 33515909 DOI: 10.1016/j.healthplace.2021.102515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability-sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.
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Affiliation(s)
- Darius Scott
- Department of Geography, Dartmouth College Hanover, New Hampshire, 03755, USA.
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10
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De Jesus M, Ware D, Brown AL, Egan JE, Haberlen SA, Palella FJ, Detels R, Friedman MR, Plankey MW. Social-environmental resiliencies protect against loneliness among HIV-Positive and HIV- negative older men who have sex with men: Results from the Multicenter AIDS Cohort Study (MACS). Soc Sci Med 2021; 272:113711. [PMID: 33550066 DOI: 10.1016/j.socscimed.2021.113711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Loneliness is associated with negative health outcomes, such as cardiovascular disease, cognitive impairment, dementia, physical functional decline, depression, and increased mortality risk, among HIV- positive and HIV-negative older men who have sex with men (MSM). Given these negative health outcomes, it is imperative to identify factors that minimize loneliness in these vulnerable groups. OBJECTIVE We sought to examine whether social-environmental resiliencies-defined as an individual's level of support, social bonding, and psychological sense of community among gay men-buffer against symptoms of loneliness. METHOD We analyzed longitudinal data from 1,255 older MSM with and without HIV infection, all of whom were enrolled in the Multicenter AIDS Cohort Study (MACS). Using longitudinal latent class analysis (LLCA), we identified three underlying classes (Social Connectors, Non-community Connectors, and Social Isolates) in the social environment of the sample. We assessed the prevalence of loneliness by these latent classes. By lagging social environmental factors over time, we were able to examine the temporal relationships between latent classes and subsequent loneliness. RESULTS Consistent with our hypothesis, multivariate associations revealed that compared to Social Connectors with high levels of social support and social bonding and a strong perceived sense of community among gay men, Social Isolates (Prevalence Ratio (PR): 1.42; 95% CI: 1.08-1.88; p = 0.0120) and Non-community Connectors (PR: 1.34; 95% CI: 1.03-1.75; p = 0.0322) were more likely to experience loneliness after adjustment for covariates and baseline loneliness. There were no differences by HIV status. CONCLUSIONS These longitudinal data allowed us to make causal inferences related to the social environmental resiliencies lowering the odds of loneliness among HIV-positive and HIV-negative older MSM. Developing individual- and community-level tailored interventions for these populations by leveraging social environmental resiliencies is key to reducing loneliness and promoting health.
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Affiliation(s)
- Maria De Jesus
- School of International Service, Center on Health, Risk, and Society, American University, Washington, DC, USA.
| | - Deanna Ware
- Georgetown University Department of Medicine, Washington, DC, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank Joseph Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roger Detels
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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11
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Giano Z, Kavanaugh KE, Durham AR, Currin JM, Wheeler DL, Croff JM, Hubach RD. Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma. JOURNAL OF HOMOSEXUALITY 2020; 67:1881-1901. [PMID: 31125299 DOI: 10.1080/00918369.2019.1616430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.
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Affiliation(s)
- Zachary Giano
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Katherine E Kavanaugh
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - André R Durham
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Joseph M Currin
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Julie M Croff
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Randolph D Hubach
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
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12
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Hubach RD, O'Neil AM, Stowe M, Hamrick J, Giano Z, Currin JM. Preferred Methods of HIV and Sexually Transmissible Infection Screening Delivery Among a Rural Sample of Men Who Have Sex with Men. AIDS Patient Care STDS 2020; 34:470-476. [PMID: 33147083 DOI: 10.1089/apc.2020.0170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations-particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM residing in Oklahoma and Arkansas to assess their (1) experiences with HIV and STI testing; (2) perceptions of at-home testing; and (3) preferences for receiving results and care. Barriers to accessing HIV/STI screening included lack of medical providers within rural communities, privacy and confidentiality concerns, and perceived stigma from providers and community members. To overcome these barriers, all participants recognized the importance of screening paradigms that facilitated at-home screening, medical consultation, and care. This included the ability to request a testing kit and receive results online, to access affirming and competent providers utilizing telemedicine technology, as well as prompt linkage to treatment. These narratives highlight the need for systems of care that facilitate HIV and STI screening within rural communities, which do not require participants to access services at traditional physical venues.
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Affiliation(s)
- Randolph D. Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Andrew M. O'Neil
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Mollie Stowe
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Justin Hamrick
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Zachary Giano
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Joseph M. Currin
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA
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13
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Owens C, Hubach RD, Williams D, Voorheis E, Lester J, Reece M, Dodge B. Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2179-2191. [PMID: 32219687 DOI: 10.1007/s10508-020-01654-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 05/24/2023]
Abstract
Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Room 116, 1025 E 7th St., Bloomington, IN, 47403, USA.
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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14
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Giano Z, Currin JM, Wheeler DL, Hubach RD. Outness amplifies the negative effect of gay related rejection in rural, but not urban sexual minority men. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1765411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
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15
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Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:51-66. [PMID: 32073310 DOI: 10.1521/aeap.2020.32.1.51] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non-primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio State University, Athens, Ohio
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
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16
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Giano Z, Hubach RD. Adverse childhood experiences and mental health: Comparing the link in rural and urban men who have sex with men. J Affect Disord 2019; 259:362-369. [PMID: 31470179 DOI: 10.1016/j.jad.2019.08.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/04/2019] [Accepted: 08/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research shows individuals experiencing adverse childhood experiences (ACEs) as well as identifying as a man who has sex with other men (MSM) are at an increased risk for mental health issues. Less has been studied, however, on ACEs in MSM; with even fewer studies investigating non-urban (e.g., rural/small town/suburban) MSM, as most research features urban samples. This is problematic due to studies showing that rurality can influence the behavior of MSM. The current study comparatively investigates the impact of ACEs on the mental health of rural/small town/suburban and urban MSM. METHODS Participants included 156 MSM residing in Oklahoma. Linear regression was used to test the association between ACEs' and mental health (anxiety, depressive symptoms, and loneliness). Split-sample regressions were conducted on rural/small town/suburban and urban MSM. RESULTS ACEs were associated with all three mental health outcomes in the full sample. However, ACEs were significantly linked to anxiety and depressive symptoms only in urban MSM. LIMITATIONS Limitations include a smaller sample size with limited racial/ethnic variations. CONCLUSIONS Results suggest that living in an urban environment may amplify the risks of ACEs, rural/small town/suburban MSM may acquire outside, unique support networks which work to limit the effect of ACEs, or that rural/small town/suburban MSM may manifest the effects of ACEs differently (or a combination of the three). Trauma-informed programming has been shown to effectively reduce mental health issues, yet consideration is generally not given with regards to rurality. Future programming and research should consider rurality/urbanity as influential factor.
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Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA.
| | - Randolph D Hubach
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA.
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17
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Hubach RD, Currin JM, Giano Z, Meyers HJ, DeBoy KR, Wheeler DL, Croff JM. Experiences of Stigma by Gay and Bisexual Men in Rural Oklahoma. Health Equity 2019; 3:231-237. [PMID: 31289783 PMCID: PMC6608693 DOI: 10.1089/heq.2018.0095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The unique experiences of men who have sex with men (MSM) residing in culturally conservative rural areas are not well represented in the scientific literature. The human immunodeficiency virus (HIV) epidemic in the United States has shifted toward rural areas where populations are dispersed and health care resources are limited. Methods: We recruited 40 sexual minority men, ages 22-66, residing in rural Oklahoma for in-depth, qualitative sexual health interviews that sought to understand how cultural and social environments impacted health behaviors. Findings: Participants described a stigmatizing social environment and less access to quality, sexual minority medical care within rural communities and perceived these as substantial barriers to enhancing health. Structural issues, including lack of sexual minority-affirming policies, institutional practices, and hostile cultural norms, were noted. Conclusions: Results indicate the need to develop greater awareness of stigma as an etiologic factor that contributes to the health of rural sexual minority populations, specifically when it relates to provision of culturally appropriate care.
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Affiliation(s)
- Randolph D. Hubach
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | | | - Zachary Giano
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Hunter J. Meyers
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Kyle R. DeBoy
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Julie M. Croff
- Center for Wellness and Recovery, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
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18
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Lauckner C, Truszczynski N, Lambert D, Kottamasu V, Meherally S, Schipani-McLaughlin AM, Taylor E, Hansen N. “Catfishing,” cyberbullying, and coercion: An exploration of the risks associated with dating app use among rural sexual minority males. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1587729] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Carolyn Lauckner
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | | | - Danielle Lambert
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Varsha Kottamasu
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Saher Meherally
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | | | - Erica Taylor
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
| | - Nathan Hansen
- Health Promotion and Behavior, University of Georgia, Athens, Georgia, USA
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19
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Giano Z, Hubach RD, Deboy K, Meyers H, Currin JM, Wheeler DL. A comparative analysis of rural and urban MSM depressive symptomology: the mediating effects of loneliness. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2019.1593885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Kyle Deboy
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Hunter Meyers
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
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20
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Currin JM, Hubach RD, Croff JM. Sex, drugs, & rurality: A brief qualitative analysis of rural gay and bisexual men’s substance use sex expectancies. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1581284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joseph M. Currin
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Julie M. Croff
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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21
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Algarin AB, Ward PJ, Christian WJ, Rudolph AE, Holloway IW, Young AM. Spatial Distribution of Partner-Seeking Men Who Have Sex With Men Using Geosocial Networking Apps: Epidemiologic Study. J Med Internet Res 2018; 20:e173. [PMID: 29853441 PMCID: PMC6002670 DOI: 10.2196/jmir.9919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Geosocial networking apps have made sexual partner-seeking easier for men who have sex with men, raising both challenges and opportunities for human immunodeficiency virus and sexually transmitted infection prevention and research. Most studies on men who have sex with men geosocial networking app use have been conducted in large urban areas, despite research indicating similar patterns of online- and app-based sex-seeking among men who have sex with men in rural and midsize cities. OBJECTIVE The goal of our research was to examine the spatial distribution of geosocial networking app usage and characterize areas with increasing numbers of partner-seeking men who have sex with men in a midsize city in the South. METHODS Data collection points (n=62) were spaced in 2-mile increments along 9 routes (112 miles) covering the county encompassing the city. At each point, staff logged into 3 different geosocial networking apps to record the number of geosocial networking app users within a 1-mile radius. Data were collected separately during weekday daytime (9:00 AM to 4:00 PM) and weekend nighttime (8:00 PM to 12:00 AM) hours. Empirical Bayesian kriging was used to create a raster estimating the number of app users throughout the county. Raster values were summarized for each of the county's 208 Census block groups and used as the outcome measure (ie, geosocial networking app usage). Negative binomial regression and Wilcoxon signed rank sum tests were used to examine Census block group variables (eg, median income, median age) associated with geosocial networking app usage and temporal differences in app usage, respectively. RESULTS The number of geosocial networking app users within a 1-mile radius of the data collection points ranged from 0 to 36 during weekday daytime hours and 0 to 39 during weekend nighttime hours. In adjusted analyses, Census block group median income and percent Hispanic ethnicity were negatively associated with geosocial networking app usage for all 3 geosocial networking apps during weekday daytime and weekend nighttime hours. Population density and the presence of businesses were positively associated with geosocial networking app usage for all 3 geosocial networking apps during both times. CONCLUSIONS In this midsize city, geosocial networking app usage was highest in areas that were more population-dense, were lower income, and had more businesses. This research is an example of how geosocial networking apps' geospatial capabilities can be used to better understand patterns of virtual partner-seeking among men who have sex with men.
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Affiliation(s)
- Angel B Algarin
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Patrick J Ward
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States
| | - W Jay Christian
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States
| | - Abby E Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, United States
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
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22
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Pollard A, Nadarzynski T, Llewellyn C. Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex. CULTURE, HEALTH & SEXUALITY 2018; 20:411-427. [PMID: 28741417 DOI: 10.1080/13691058.2017.1350751] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the 'gay scene' on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic 'risk-environments' and 'littoral spaces' in which chemsex and risk behaviours are played out.
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Affiliation(s)
- Alex Pollard
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Tom Nadarzynski
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Carrie Llewellyn
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
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