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Lu W, Vu TT, Wilton L, Paige M, Nandi V, Greene E, Frye V. Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City. Am J Mens Health 2024; 18:15579883231218580. [PMID: 38700239 PMCID: PMC11069334 DOI: 10.1177/15579883231218580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 05/05/2024] Open
Abstract
Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Mark Paige
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Vijay Nandi
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Emily Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Victoria Frye
- School of Social Work, Columbia University, New York, NY, USA
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Robles G, Bosco SC, Cardenas I, Hostetter J, Starks TJ. Psychosocial and Culturally-Specific Factors Related to Intimate Partner Violence Victimization among a Sample of Latino Sexual Minority Cis Men in the U.S. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22501-NP22527. [PMID: 35166599 PMCID: PMC9376202 DOI: 10.1177/08862605211072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A growing body of research illustrates that sexual minority men (SMM) experience elevated rates of intimate partner violence (IPV) compared to heterosexual individuals. Researchers have examined the relationship between minority stress and IPV victimization among sexual minority men. A majority of the IPV research identifying risk factors associated with IPV victimization among SMM have sampled predominately non-Hispanic White SMM, while Latino SMM are consistently under-represented in IPV research. This study examines the associations between (1) co-occurring psychosocial factors (e.g., depression, anxiety, childhood sexual abuse, drug use, and problematic drinking) and (2) Latino-specific minority stress factors (e.g., U.S.-born, language, race/ethnic identities, and discrimination) on IPV victimization in a nationwide sample of Latino SMM. Data were collected from Latino SMM aged 18 or older, identified as cis-male, and in a romantic relationship with a cis-male partner (N = 530). The participants were recruited through social media and geo-location-based dating mobile applications. A majority (72%) of the sample reported IPV victimization in their lifetime. Specific to forms of IPV, more than half (51.9%) of the sample reported monitoring behaviors, while 49.6% reported emotional IPV, 45.1% reported physical IPV, 31.5% reported controlling behaviors, and 22.3% reported HIV-related IPV. In multivariable models, psychosocial and Latino-specific factors were associated with the increased likelihood of IPV victimization. Regarding Latino-specific factors, being born in the U.S. and race-based discrimination predicted IPV victimization. These findings highlight the extent to which minority stress elevates the risk of IPV for Latino SMM and point to the need to address social factors in IPV prevention services. Further, work on SMM IPV victimization tends to focus on the potential role of sexual orientation-related discrimination, whereas the current study points to the importance of race-based discrimination.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ
| | - Stephen C. Bosco
- Doctoral Program in Health Psychology and Clinical Science, the Graduate Center of the City University of New York, New York, NY
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Iris Cardenas
- School of Social Work, Rutgers University, New Brunswick, NJ
| | | | - Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY
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Daly FP, O'Donnell K, Davoren MP, Noone C, Weatherburn P, Quinlan M, Foley B, Igoe D, Barrett PM. Potential alcohol use disorder among MSM in Ireland - Findings from the European MSM internet survey (EMIS 2017). Drug Alcohol Depend 2021; 223:108698. [PMID: 33878574 DOI: 10.1016/j.drugalcdep.2021.108698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) disproportionately affects men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this. METHODS The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD. RESULTS In total, 1793 MSM met inclusion criteria. 31 % screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95 %CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95 %CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95 %CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95 %CI 1.14-2.63) (other illicit drugs, aOR 2.28 95 %CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95 %CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95 %CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95 %CI 0.46-0.93). CONCLUSIONS The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.
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Affiliation(s)
- Fionn P Daly
- School of Medicine and Health, University College Cork, Cork, T12V821, Ireland; School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Kate O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, D01A4A3, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland; Sexual Health Centre, Cork, T12DX73, Ireland
| | - Chris Noone
- School of Psychology, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene and Tropical Medicine, London, WC1E7HT, United Kingdom
| | | | - Bill Foley
- Gay Health Network, Dublin, D01R290, Ireland
| | - Derval Igoe
- HSE Health Protection Surveillance Centre, Dublin, D01A4A3, Ireland
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland; Department of Public Health HSE-South, St. Finbarr's Hospital, Cork, T12XH60, Ireland.
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Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: The P18 Cohort Study. Addict Behav 2021; 117:106831. [PMID: 33588290 DOI: 10.1016/j.addbeh.2021.106831] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Knowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood. METHODS A prospective cohort study was conducted in two waves: 2009-2014 (Wave I) and 2014-2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18-19 years were recruited for Wave I. A total of 665 SMM ages 22-23 years were recruited for Wave II, of which 41.2% (n = 274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit. RESULTS A total of 5.4% of participants of between the ages of 18-27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F = 4.34, p = 0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I. CONCLUSION We have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM.
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Passaro RC, Chávez-Gomez S, Castañeda-Huaripata A, Gonzales-Saavedra W, Beymer MR, Segura ER, Nanclares F, Dilley J, Cabello R, Clark JL. Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial. AIDS Behav 2020; 24:3205-3214. [PMID: 32418164 PMCID: PMC8112108 DOI: 10.1007/s10461-020-02882-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of Infectious Diseases, Department of Medicine, UCLA SAPHIR Program C/O UCLA, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | | | | | | | - Matthew R Beymer
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Francisco Nanclares
- Alliance Health Project, University of California San Francisco, San Francisco, CA, USA
| | - James Dilley
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Covariates of hazardous alcohol use among sexual and gender minorities in Texas: Identifying the most vulnerable. Addict Behav 2020; 105:106327. [PMID: 32044679 DOI: 10.1016/j.addbeh.2020.106327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Information is limited on the prevalence of hazardous drinking and associated covariates among sexual and gender minority (SGM) persons. These analyses estimated the prevalence of hazardous drinking and identified associated covariates. METHODS A total of 1273 SGM adolescents and adults living in Texas completed an online survey between March 2016 and January 2017. Variables associated with hazardous drinking at the bivariate-level (p < 0.10) were entered into multiple logistic regression models to estimate the strength of their association. RESULTS More than a third (39.1%) of participants meet criteria for hazardous drinking. Compared to non-hazardous drinkers, hazardous drinkers were younger (x- = 20.7 [SD = 8.9] vs. x- = 26.5 [SD = 13.8]) and more likely to be Hispanic (41.5% vs. 26.2%). Hazardous drinkers were more likely to report using substances in past 12 months, including opioids (15.3% vs. 6.7%), stimulants (26.3% vs. 12.7%), and marijuana (37.6% vs. 21.2%). More hazardous drinkers reported injecting drugs (12.3% vs. 5.8%) and having a history of incarceration (14.1% vs. 7.3%). They were less likely to be diagnosed with depression (50.2% vs. 56.5%). When entered into a multivariate logistic regression model, hazardous drinkers were more likely to be younger (aOR = 0.97 [0.95, 0.98]), Hispanic (aOR = 1.5 [1.2, 2.0]), have a history of incarceration (aOR = 2.4 [1.5, 3.6]), and use a substance, not including marijuana (aOR = 1.7 [1.3, 2.3]). They were less likely to be diagnosed with depression (aOR = 0.73 [0.6, 0.9]). CONCLUSIONS Our findings highlight the intersection of race and ethnicity, mental health, criminal justice involvement, and substance use and the need for tailored interventions that address underlying determinants.
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Hsiang E, Offer C, Prescott M, Rodriguez A, Behar E, Matheson T, Santa Maria D, Santos GM. Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e15282. [PMID: 32347807 PMCID: PMC7221651 DOI: 10.2196/15282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. OBJECTIVE This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. METHODS Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. RESULTS Overall, 93.9% (295/314) of all delivered surveys were initiated, and of those, 98.0% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message-based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. CONCLUSIONS EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance.
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Affiliation(s)
- Elaine Hsiang
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Claudine Offer
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Maximo Prescott
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Amy Rodriguez
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Emily Behar
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Tim Matheson
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Glenn-Milo Santos
- Substance Use Research Unit, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
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Anderson-Carpenter KD, Fletcher JB, Swendeman D, Reback CJ. Associations between sociodemographic characteristics and substance use disorder severity among methamphetamine-using men who have sex with men. Subst Use Misuse 2019; 54:1763-1773. [PMID: 31075997 PMCID: PMC6644069 DOI: 10.1080/10826084.2019.1610445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Men who have sex with men (MSM) have elevated rates of substance use disorders (SUDs) and differences across sociodemographic sub-groups of MSM are associated with a greater risk of deleterious outcomes. Although studies have shown that MSM report greater rates of polysubstance use relative to other adult populations, the associations between sociodemographic characteristics and both acute substance use and substance use severity among methamphetamine-using MSM are unknown. Objectives: The present study examines associations between sociodemographic characteristics and (a) recent substance use and (b) SUD severity. Method: From March 2014 to January 2016, 286 methamphetamine-using MSM were recruited to complete a baseline Audio Computer-Assisted Self-Interview (ACASI) assessment and the SCID MINI. Multivariable analyses employed generalized structural equation modeling given the non-continuous nature of the endogenous variables. Results: All measured sociodemographic characteristics except gay self-identification were significantly associated with recent substance use (all ps ≤ .05), and all characteristics except current homelessness were significantly associated with diagnostic SUD severity (all ps ≤ .05). However, nuanced risks were observed in participants' use of specific substances regarding recent substance use and substance use severity. Conclusion: These results suggest that multiple factors contribute to the risks of SUD severity among methamphetamine-using MSM. As such, these results are useful in the tailoring of clinical and psychosocial intervention strategies that serve this and other high-risk populations.
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Affiliation(s)
- Kaston D Anderson-Carpenter
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,b Department of Psychology , Michigan State University , East Lansing , MI , USA
| | | | - Dallas Swendeman
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,d Development Core, Center for HIV Identification, Prevention, and Treatment Services, University of California , Los Angeles , CA , USA
| | - Cathy J Reback
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,c Friends Research Institute, Inc ., Los Angeles , CA , USA.,e Center for HIV Identification, Prevention and Treatment Services, University of California , Los Angeles , CA , USA
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Reback CJ, Fletcher JB, Swendeman D. Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men. Subst Use Misuse 2018; 53:1826-1833. [PMID: 29432057 PMCID: PMC6179439 DOI: 10.1080/10826084.2018.1436566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors. OBJECTIVES This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners. METHODS From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors. RESULTS Participants' racial/ethnic identity (χ2(6) = 43.5; p < 0.0001), HIV status (χ2(6) = 22.0; p = 0.0012), educational attainment level (χ2(6) = 13.8; p = 0.0322), and years of age (χ2(6) = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ2(2) = 7.0; p = 0.0309) and marijuana (χ2(2) = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners. CONCLUSION Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.
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Affiliation(s)
- Cathy J Reback
- a Friends Research Institute, Inc. , Los Angeles , California , USA.,b David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior , University of California , Los Angeles , California , USA.,c Center for HIV Identification, Prevention and Treatment Services , University of California , Los Angeles , California , USA
| | - Jesse B Fletcher
- a Friends Research Institute, Inc. , Los Angeles , California , USA
| | - Dallas Swendeman
- c Center for HIV Identification, Prevention and Treatment Services , University of California , Los Angeles , California , USA
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Santos GM, Rowe C, Hern J, Walker JE, Ali A, Ornelaz M, Prescott M, Coffin P, McFarland W, Raymond HF. Prevalence and correlates of hazardous alcohol consumption and binge drinking among men who have sex with men (MSM) in San Francisco. PLoS One 2018; 13:e0202170. [PMID: 30118495 PMCID: PMC6097698 DOI: 10.1371/journal.pone.0202170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 07/30/2018] [Indexed: 01/19/2023] Open
Abstract
Objectives To describe heavy alcohol use patterns and correlates in a diverse sample of MSM. Methods We used respondent-driven sampling (RDS) to enroll 252 alcohol-using MSM in San Francisco from March 2015-July 2017. We examined heavy alcohol use patterns and conducted RDS-adjusted multivariable analyses to characterize correlates of hazardous alcohol consumption and binge drinking. Results RDS-adjusted prevalence of weekly and at least weekly binge drinking was 24.9% and 19.3%, respectively. Hazardous consumption was common; prevalence of mid- and high-levels of hazardous drinking was 11.4% and 29.9%, respectively. In multivariable analyses, identifying as Hispanic/Latino or mixed/other race; being moderately or extremely interested in reducing alcohol use; ever receiving alcohol treatment; using ecstasy; reporting syphilis diagnosis; and having more than 5 male partners were independently associated with hazardous alcohol consumption. Less hazardous consumption was associated with having a bachelor's degree or completing post-graduate studies; and not being in a relationship. Reporting chlamydia infection; being somewhat, moderately or extremely interested in reducing alcohol use; and having multiple male sex partners were associated with higher odds of at least weekly binge drinking. Lower odds of binge drinking were associated with completing post-graduate studies. Moreover, for the outcomes of hazardous alcohol consumption and binge-drinking, we observed significant interaction effects between race/ethnicity and interest in reducing alcohol, past receipt of alcohol treatment, use of ecstasy, syphilis diagnosis, and number of male partners. Conclusion Among alcohol-using MSM in San Francisco, heavy drinking patterns were common and independently associated with greater number of male sexual partners and sexually transmitted infections (STI). Moreover, significant racial/ethnic and socioeconomic disparities related to heavy alcohol use were observed and race/ethnicity modified the effect of the risk factors associated with these outcomes. These findings underscore the need to develop more MSM-specific interventions that jointly address heavy alcohol use and HIV/STI risk, as well as culturally-tailored and targeted strategies to alleviate health disparities.
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Affiliation(s)
- Glenn-Milo Santos
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Christopher Rowe
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Jaclyn Hern
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - John E. Walker
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Arsheen Ali
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Marcial Ornelaz
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Maximo Prescott
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Phillip Coffin
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, United States of America
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - H. Fisher Raymond
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, United States of America
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Allen VC, Ray LA, Myers HF. Examining the Sexual Health Consequences of Alcohol Consumption Among Black Gay and Bisexual Men. Alcohol Clin Exp Res 2018; 42:1548-1555. [PMID: 29924387 DOI: 10.1111/acer.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Black men who have sex with men (MSM) are disproportionately affected by HIV infection. Efforts are needed to understand correlates of HIV risk among this group. Alcohol consumption may have a role in HIV transmission given its association with condomless sex. This study aimed to examine the association between alcohol consumption (i.e., drinking before/during sex and levels of alcohol use problems) and condom use during lifetime, past 6 months, and the event (i.e., a specific sexual episode) level. METHODS Black MSM (N = 102) reported sexual behavior and condom use for lifetime, past 6 months, and the most recent condom and condomless sex events. The Alcohol Use Disorders Identification Test (AUDIT) determined alcohol use problems. RESULTS Ordinal and binary regression analyses analyzed associations between AUDIT scores and condomless sex (receptive and insertive). AUDIT scores were associated with a greater likelihood of condomless sex (lifetime receptive sex: OR = 1.06, p < 0.05; past 6 months insertive sex: odds ratio [OR] = 1.09, p < 0.01). At the event level, there was no greater likelihood of drinking during last condomless sex as compared to last condom sex, χ2 (1) = 0.18, p = 0.39. CONCLUSIONS There was evidence that an increase in alcohol use problems was associated with a greater likelihood of risky sexual behavior. Drinking before/during sex was not related to condom use. These findings contribute to understanding the nuanced relationship between alcohol use and sexual risk.
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Affiliation(s)
- Vincent C Allen
- Counseling and Testing Center, Georgia State University, Atlanta, Georgia
| | - Lara A Ray
- Psychology Department, University of California Los Angeles, Los Angeles, California
| | - Hector F Myers
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
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Goyette M, Flores-Aranda J, Bertrand K, Pronovost F, Aubut V, Ortiz R, Saint-Jacques M. Links SU-Sex: development of a screening tool for health-risk sexual behaviours related to substance use among men who have sex with men. Sex Health 2018; 15:160-166. [DOI: 10.1071/sh17134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022]
Abstract
Background
Men who have sex with men (MSM) have distinctive substance use (SU), which is more often linked to a sexual context than it is for their heterosexual peers. Screening of MSM’s SU, its sexual contexts and the associated risks, is of clinical and public health concern. This paper aims to describe the preliminary development of a screening tool for health-risk sexual behaviours related to SU and to make recommendations for its potential use. Methods: Community-based participatory research and transdisciplinary approaches guided the development process. The Links SU-Sex screening tool is the result of the integration of findings from a scoping review and from four meetings among SU and sexual health experts (n = 19), consisting of researchers, community stakeholders, as well as substance-using MSM. Results: The Links SU-Sex questionnaire consists of 64 items divided into 13 components that focus on the links between SU and sexual health. It addresses the contexts in which SU occurs, its frequency, its perceived influence, as well as MSM’s concerns about these various links. In accordance with current knowledge, the interpretation of the instrument offers feedback that is based on the respondents’ answers to the various components assessed. Conclusions: The Links SU-Sex represents a potential screening tool that rests on a robust development process supporting its content validity that aims to identify MSM at risk or with concerns surrounding the influence of their SU on their sexual health. The psychometric qualities and the interpretation validity both remain to be established.
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14
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Zaller N, Yang C, Operario D, Latkin C, McKirnan D, O'Donnell L, Fernandez M, Seal D, Koblin B, Flores S, Spikes P. Alcohol and cocaine use among Latino and African American MSM in 6 US cities. J Subst Abuse Treat 2017; 80:26-32. [PMID: 28755769 PMCID: PMC5839147 DOI: 10.1016/j.jsat.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Nick Zaller
- Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David McKirnan
- Psychology Department, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - David Seal
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
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15
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Martinez O, Wu E, Levine EC, Muñoz-Laboy M, Spadafino J, Dodge B, Rhodes SD, Rios JL, Ovejero H, Moya EM, Baray SC, Carballo-Diéguez A, Fernandez MI. Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City. ADDICTION RESEARCH & THEORY 2016; 24:466-476. [PMID: 28077938 PMCID: PMC5222534 DOI: 10.3109/16066359.2016.1167191] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors - clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination - reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.
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Affiliation(s)
- Omar Martinez
- Temple University School of Social Work, Philadelphia, PA, USA
| | - Elwin Wu
- School of Social Work at Columbia University, New York, NY, USA
| | - Ethan C. Levine
- Department College of Liberal Arts at Temple University, Philadelphia, PA, USA
| | | | | | - Brian Dodge
- School of Public Health at Indiana University - Bloomington, Bloomington, IN, USA
| | | | - Javier López Rios
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Hugo Ovejero
- Lutheran Family Health Center, Brooklyn, NY, USA
| | - Eva M. Moya
- School of Social Work at the University of Texas at El Paso, El Paso, TX, USA
| | - Silvia Chavez Baray
- School of Social Work at the University of Texas at El Paso, El Paso, TX, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - M. Isabel Fernandez
- Department of Public Health at Nova Southeastern University, Fort Lauderdale, FL, USA
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16
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Washington TA, Patel SN, Meyer-Adams N. Drinking Patterns and HIV Risk Behaviors Among Black and Latino Men Who Have Sex Within Los Angeles County. Am J Mens Health 2015; 11:834-844. [PMID: 26400715 PMCID: PMC5325819 DOI: 10.1177/1557988315605894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men’s groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. Fisher’s exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse (p = .001), race (p < .001), age (p = .02), and perception of alcohol-related HIV risk (p = .007). The Fisher’s exact tests findings for age held true in the multiple regression model (p = .014). Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.
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17
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Allen VC, Myers HF, Ray L. The Association Between Alcohol Consumption and Condom Use: Considering Correlates of HIV Risk Among Black Men Who Have Sex with Men. AIDS Behav 2015; 19:1689-700. [PMID: 25935215 PMCID: PMC4553138 DOI: 10.1007/s10461-015-1075-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Epidemiological data indicate Black men who have sex with men (MSM) are the most at-risk group for HIV infection. However, the factors driving this disparity are not fully understood. Condom use remains a significant point of intervention in mitigating sexually transmitted infections. Alcohol consumption is highly prevalent among Black MSM, has a significant role in the culture of sex, and may significantly interfere with condom use. This review will examine the relationship between alcohol consumption and condom use among Black MSM. In this review we, (a) discuss the prevalence of alcohol use among MSM and its association with condom use; (b) consider the role of alcohol in the culture of MSM; (c) review the literature on the relationship between alcohol and condom use; and (d) discuss the role of several empirically-supported moderating variables in strengthening the relationship between alcohol use and noncondom use. This review places the finding and implications for HIV risk among Black MSM in the context of the broader literature on MSM.
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Affiliation(s)
- Vincent C Allen
- Psychology Department, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA,
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18
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Yang C, Linas B, Kirk G, Bollinger R, Chang L, Chander G, Siconolfi D, Braxton S, Rudolph A, Latkin C. Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore. JMIR Mhealth Uhealth 2015; 3:e67. [PMID: 26085078 PMCID: PMC4526945 DOI: 10.2196/mhealth.4344] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/15/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. OBJECTIVE We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. METHODS Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants' location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants' self-reported episodes of drinking. RESULTS A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. CONCLUSIONS This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.
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Affiliation(s)
- Cui Yang
- Johns Hopkins School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, United States.
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Halkitis PN, Siconolfi DE, Stults CB, Barton S, Bub K, Kapadia F. Modeling substance use in emerging adult gay, bisexual, and other YMSM across time: the P18 cohort study. Drug Alcohol Depend 2014; 145:209-16. [PMID: 25456332 PMCID: PMC4254590 DOI: 10.1016/j.drugalcdep.2014.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/17/2014] [Accepted: 10/18/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine patterns of substance use over time in a new generation of emerging adult gay, bisexual, and other young men who have sex with men (YMSM). METHODS Data were drawn from the first four waves of on ongoing prospective cohort study of YMSM who were ages 18 to 19 at baseline and were assessed each 6 months for substance use via calendar based methods. Latent growth curve modeling was utilized to assess changes over time for four drug use categories: alcohol, marijuana, inhalant nitrates, and other drugs (e.g., cocaine, ecstasy) and between groups (race/ethnicity, perceived familial socioeconomic status; SES). RESULTS Use of all substances increased steadily across the follow-up period. White YMSM demonstrated higher levels of alcohol use at the 18-mo follow-up visit compared to other racial/ethnic groups, while rates of change across groups were similar. Marijuana use at 18 months was highest for Hispanics who also indicated the highest rate of change. Finally, YMSM who reported higher perceived SES reported the lowest use and lowest rates of change for other drug use. Controlling for perceived SES, differences in patterns of drug use by race/ethnicity were evident but differences were not as large. CONCLUSIONS Increases in substance use in the emerging adulthood of YMSM indicate the need for structural and behavioral interventions tailored to address substance use in these young men before chronic patterns of use develop. Differences in patterns of drug use across racial/ethnic and SES groups suggest that interventions need to consider person-level differences.
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Affiliation(s)
- Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 726 Broadway Suite 525, New York, NY 10003, United States; Global Institute of Public Heath, New York University, New York, NY 10003, United States; Department of Population Health, Langone School of Medicine, New York University, New York, NY 10003, United States.
| | - Daniel E Siconolfi
- Department of Health Behavior & Society, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Christopher B Stults
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 726 Broadway Suite 525, New York, NY 10003, United States
| | - Staci Barton
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 726 Broadway Suite 525, New York, NY 10003, United States
| | - Kristen Bub
- College of Education, University of Illinois at Urban-Champaign, Champaign, IL, United States
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 726 Broadway Suite 525, New York, NY 10003, United States; Global Institute of Public Heath, New York University, New York, NY 10003, United States; Department of Population Health, Langone School of Medicine, New York University, New York, NY 10003, United States
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20
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Coffin PO, Santos GM, Colfax G, Das M, Matheson T, DeMicco E, Dilley J, Vittinghoff E, Raiford JL, Carry M, Herbst JH. Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: a randomized controlled trial. AIDS Behav 2014; 18:1390-400. [PMID: 24510401 DOI: 10.1007/s10461-014-0712-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34-0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence.
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21
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White D, Rosenberg ES, Cooper HL, del Rio C, Sanchez TH, Salazar LF, Sullivan PS. Racial differences in the validity of self-reported drug use among men who have sex with men in Atlanta, GA. Drug Alcohol Depend 2014; 138:146-53. [PMID: 24629628 PMCID: PMC4104302 DOI: 10.1016/j.drugalcdep.2014.02.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/29/2014] [Accepted: 02/14/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Men who have sex with men (MSM), particularly young black MSM, are disproportionately affected in the United States' HIV epidemic. Drug use may contribute to these disparities, yet previous studies have failed to provide evidence of elevated use among black MSM, relying exclusively on self-reported usage. This study uses biological assays to validate self-reports of drug use and explore the potential for misclassification to distort findings on racial patterns of use in this population. METHODS From an Atlanta-based cohort study of 454 black and 349 white MSM from 2010 to 2012, participants' self-reported drug use was compared to urine drug screening findings. The sensitivity of self-report was calculated as the proportion reporting recent usage among those who screened positive. Multivariable regression models were constructed to examine racial patterns in self-report, urine-detection, and self-report sensitivity of marijuana and cocaine usage, adjusted for socio-demographic factors. RESULTS In analyses that adjusted for age, education, income, sexual orientation, and history of arrest, black MSM were less likely to report recent use of marijuana (P<0.001) and cocaine (P=0.02), but equally likely to screen positive for either drug. This discrepancy between self-reported and urine-detected drug use was explained by significantly lower sensitivity of self-report for black participants (P<0.001 for marijuana, P<0.05 for cocaine). CONCLUSIONS The contribution of individual drug-related risk behaviors to the HIV disparities between black and white MSM should be revisited with methods that validate self-reports of illegal drug use.
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Affiliation(s)
- Darcy White
- Public Health Program Associate, Department of Epidemiology and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Eli S. Rosenberg
- Assistant Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Hannah L.F. Cooper
- Associate Professor, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Carlos del Rio
- Chair and Professor, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Travis H. Sanchez
- Associate Research Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Laura F. Salazar
- Associate Professor, Institute of Public Health, Georgia State University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322
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Uhlmann S, Debeck K, Simo A, Kerr T, Montaner JSG, Wood E. Crystal methamphetamine initiation among street-involved youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 40:31-6. [PMID: 24191637 DOI: 10.3109/00952990.2013.836531] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although many settings have recently documented a substantial increase in the use of methamphetamine-type stimulants, recent reviews have underscored the dearth of prospective studies that have examined risk factors associated with the initiation of crystal methamphetamine use. OBJECTIVES Our objectives were to examine rates and risk factors for the initiation of crystal methamphetamine use in a cohort of street-involved youth. METHODS Street-involved youth in Vancouver, Canada, were enrolled in a prospective cohort known as the At-Risk Youth Study (ARYS). A total of 205 crystal methamphetamine-naïve participants were assessed semi-annually and Cox regression analyses were used to identify factors independently associated with the initiation of crystal methamphetamine use. RESULTS Among 205 youth prospectively followed from 2005 to 2012, the incidence density of crystal methamphetamine initiation was 12.2 per 100 person years. In Cox regression analyses, initiation of crystal methamphetamine use was independently associated with previous crack cocaine use (adjusted relative hazard [ARH] = 2.24 [95% CI: 1.20-4.20]) and recent drug dealing (ARH = 1.98 [95% CI: 1.05-3.71]). Those initiating methamphetamine were also more likely to report a recent nonfatal overdose (ARH = 3.63 [95% CI: 1.65-7.98]) and to be male (ARH = 2.12 [95% CI: 1.06-4.25]). CONCLUSIONS We identified high rates of crystal methamphetamine initiation among this population. Males those involved in the drug trade, and those who used crack cocaine were more likely to initiate crystal methamphetamine use. Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.
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Affiliation(s)
- Sasha Uhlmann
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, BC , Canada
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23
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Young SD, Shoptaw S. Stimulant use among African American and Latino MSM social networking users. J Addict Dis 2013; 32:39-45. [PMID: 23480246 DOI: 10.1080/10550887.2012.759859] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High stimulant-using and at-risk HIV populations, such as African American and Latino men who have sex with men (MSM), are increasingly using social networking technologies. However, no known research has explored associations between stimulant use, sexual risk behaviors, and social networking among these populations. Participants were recruited using the Facebook Connect software application, which narrowed the sample to 118 (primarily African American and Latino MSM) active Facebook users. Participants completed demographic, Internet and social media use, and drug use survey items. Participants reported high rates of cocaine and methamphetamine use (both more than 15% within the past 12 months). More than 70% of participants reported using social networking technologies to meet people, and more than 30% used them to find sexual partners. A multivariate logistic regression showed that (1) participants using social networks to find sexual partners were more likely to have used methamphetamines within the past 12 months and (2) those who were more comfortable talking online compared to face-to-face had over 4 times the odds of methamphetamine use and over 6 times the odds of cocaine use within the past 12 months. Minority MSM who used social networks to meet men and find sexual partners had high risk for stimulant use. Understanding drug use among minority social networking users will provide insights to incorporate these technologies into drug prevention interventions.
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Affiliation(s)
- Sean D Young
- Department of Family Medicine, Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California 90024, USA.
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Senreich E. Lesbian, Gay, and Bisexual Clients in a Substance Abuse Treatment Program Serving a Mostly Black and Hispanic Population. JOURNAL OF LGBT ISSUES IN COUNSELING 2012. [DOI: 10.1080/15538605.2012.730474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mayer KH, Bekker LG, Stall R, Grulich AE, Colfax G, Lama JR. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet 2012; 380:378-87. [PMID: 22819653 PMCID: PMC5603076 DOI: 10.1016/s0140-6736(12)60835-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information.
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Affiliation(s)
- Kenneth H Mayer
- Fenway Health, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. khmayer@gmail
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Reisner SL, Mimiaga MJ, Bland S, Skeer M, Cranston K, Isenberg D, Driscoll M, Mayer KH. Problematic alcohol use and HIV risk among Black men who have sex with men in Massachusetts. AIDS Care 2011; 22:577-87. [PMID: 20336557 DOI: 10.1080/09540120903311482] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This analysis was designed to explore the frequency of problem drinking and its role in potentiating HIV risk among a community-recruited sample of Black men who have sex with men (MSM) in Massachusetts. Black MSM (n=197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered survey, including HIV sexual behavior, the Center for Epidemiologic Studies Depression Scale (CES-D), and the CAGE alcohol screener. Bivariate and multivariable logistic regression procedures examined the association of behavioral HIV-risk factors and other psychosocial variables with problematic alcohol use (CAGE score 3 or 4). Overall, 29% of the sample was found to abuse alcohol. In a multivariable model adjusting for demographic and behavioral variables, factors associated with increased odds of problem drinking were: (1) depressive symptoms (CES-D 16); (2) one or more episodes of serodiscordant unprotected anal sex during last sexual encounter with a casual male partner; and (3) one or more episodes of unprotected anal or vaginal sex with a female partner in the past 12 months. Black MSM who engaged in HIV risk behaviors may be more likely to have concurrent problematic alcohol use. HIV prevention interventions with Black MSM may benefit from incorporating screening and/or treatment for alcohol problems, as well as screening for co-morbid depressive symptoms.
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Affiliation(s)
- Sari L Reisner
- Fenway Health, The Fenway Institute, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA.
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Mutchler MG, McKay T, Candelario N, Liu H, Stackhouse B, Bingham T, Ayala G. Sex drugs, peer connections, and HIV: Use and risk among African American, Latino, and Multiracial young men who have sex with men (YMSM) in Los Angeles and New York. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2011; 23:271-295. [PMID: 21731406 PMCID: PMC3126154 DOI: 10.1080/10538720.2011.560100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
African American and Latino young men who have sex with men are at high risk for HIV infection. We administered brief intercept surveys (N=416) at 18 Black and Latino gay pride events in Los Angeles and New York in 2006 and 2007. Ordinal logistic regressions were used to model the effects of substance use during sex, peer connectedness, relationship status, and homelessness on condom use. Alcohol use, crystal use, homelessness, and having a primary relationship partner were negatively associated with condom use, while peer connectedness and marijuana use during sex were positively associated with condom use. Implications for service providers and future research are discussed.
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Affiliation(s)
- Matt G. Mutchler
- Corresponding author. Department of Sociology, California State University - Dominguez Hills, Carson, CA; Community Based Research, AIDS Project Los Angeles, 3550 Wilshire Blvd Ste 300, Los Angeles, CA
| | - Tara McKay
- Department of Sociology, University of California – Los Angeles, CA
| | | | - Honghu Liu
- Department of Biostatistics, University of California – Los Angeles, CA
| | | | - Trista Bingham
- Los Angeles County HIV Epidemiology Program—Los Angeles, CA
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Hurt CB, Torrone E, Green K, Foust E, Leone P, Hightow-Weidman L. Methamphetamine use among newly diagnosed HIV-positive young men in North Carolina, United States, from 2000 to 2005. PLoS One 2010; 5:e11314. [PMID: 20593025 PMCID: PMC2892509 DOI: 10.1371/journal.pone.0011314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/24/2010] [Indexed: 11/30/2022] Open
Abstract
Background Methamphetamine (MA) is a new arrival to the Southeastern United States (US). Incidence of HIV is also increasing regionally, but data are limited regarding any association between this trend and MA use. We examined behavioral data from North Carolina (NC) residents newly diagnosed with HIV, collected by the Department of Health between 2000-2005. Principal Findings Among 1,460 newly diagnosed HIV-positive young men, an increasing trend was seen from 2000-2005 in MA use (p = 0.01, total n = 20). In bivariate analyses, users of MA had significantly greater odds of reporting other substance use, including alcohol, powder or crack cocaine, marijuana, and methylenedioxymethamphetamine (MDMA, “ecstasy”). They were also more likely to have reported sexual activity while traveling outside NC; sex with anonymous partners; and previous HIV testing. In a predictive model, MA use had a negative association with nonwhite race, and strong positive associations with powder cocaine, “ecstasy,” or intravenous drug use and being a university student. Conclusions Similar to trends seen in more urban parts of the US, MA use among newly diagnosed, HIV-positive young men is increasing in NC. These data are among the first to demonstrate this relationship in a region with a burgeoning epidemic of MA use. Opportunities exist for MA-related HIV risk-reduction interventions whenever young men intersect the healthcare system.
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Affiliation(s)
- Christopher B Hurt
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
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Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men. Sex Transm Dis 2010; 36:693-5. [PMID: 19704399 DOI: 10.1097/olq.0b013e3181ad54a3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared associations between methamphetamine use, drug use other than methamphetamine, and HIV transmission factors among men who have sex with men, attending an sexually transmitted disease clinic. Of 6435 participants, newly recognized HIV status (OR: 3.02 95% CI: 2.30, 3.99) was associated with methamphetamine use compared with nondrug users, an association not found among other club drug users.
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Reisner SL, Mimiaga MJ, Skeer M, Bright D, Cranston K, Isenberg D, Bland S, Barker TA, Mayer KH. Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav 2009; 13:798-810. [PMID: 19462228 PMCID: PMC3947411 DOI: 10.1007/s10461-009-9571-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 05/04/2009] [Indexed: 11/28/2022]
Abstract
High rates of depression have been observed among men who have sex with men (MSM) relative to the general adult male population; however, a dearth of research has explored depression among Black MSM. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered quantitative assessment and voluntary HIV counseling and testing. Bivariate and multivariable logistic regression procedures examined the associations of demographics, behavioral HIV risk factors, and psychosocial variables with depressive symptoms by severity, using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Adjusting for demographic and behavioral variables, significant factors associated with (1) clinically significant depressive symptoms (33%; CES-D score > or = 16): being publicly insured by Medicaid, having serodiscordant anal sex with a casual male partner, and being diagnosed with an STD in the prior 12 months; (2) moderate depressive symptoms (19%; CES-D score 16-26): having serodiscordant unprotected anal sex with a casual male partner and being diagnosed with an STD in the prior 12 months; (3) severe depressive symptoms (14%; CES-D score 27+): being publicly insured by Medicaid and reporting difficulty accessing healthcare in the past 12 months. Moderately depressed Black MSM may be more likely to engage in behaviors that place them at increased risk for HIV and other STDs. HIV prevention interventions for Black MSM may benefit from incorporating screening and/or treatment for depression, allowing MSM who are depressed to respond more effectively to behavioral change approaches.
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Affiliation(s)
- Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA. Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Margie Skeer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA. School of Public Health, Harvard University, Boston, MA, USA
| | | | - Kevin Cranston
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Sean Bland
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
| | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA. Brown Medical School/Miriam Hospital, Providence, RI, USA
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Semple SJ, Amaro H, Strathdee SA, Zians J, Patterson TL. Ethnic differences in substance use, sexual risk behaviors, and psychosocial factors in a sample of heterosexual methamphetamine users. Subst Use Misuse 2009; 44:1101-20. [PMID: 19544148 PMCID: PMC2905044 DOI: 10.1080/10826080802490055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ethnic differences in measures of substance use, sexual risk behaviors, and psychosocial factors (depression, stigma, self-esteem) were examined in a sample of 402 heterosexual methamphetamine users (55.0% Caucasian, 29.9% African American, 15.1% Latino) who participated in a sexual risk reduction intervention between June 2001 and March 2005 in San Diego, California. Participants were primarily male (67%) and noncollege graduates (72%) and belonged to the low-income group (66%). African Americans were older when they first used methamphetamine and had used fewer grams in the past 30 days; Caucasians were more likely to inject. A larger percentage of African Americans reported anonymous sex partners in the past 2 months. African Americans reported lower levels of social stigma, and Caucasians reported lower self-esteem. Limitations and potential applications of these findings to prevention and treatment programs for ethnic minority populations are discussed.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M. Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:748-62. [PMID: 18546069 PMCID: PMC2574823 DOI: 10.1007/s10508-008-9361-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We examined the role of drug use and addiction in same-sex sexuality among non-gay-identifying African American men who have sex with men or with both men and women (MSM/MSMW). Between July 2005 and February 2006, we conducted seven focus groups with 46 predominately low socioeconomic status African American MSM/MSMW. A total of 29 men self-identified as HIV-infected and 17 self-identified as uninfected. Focus group transcripts were analyzed using consensual qualitative research techniques. Alcohol, crack cocaine, and crystal methamphetamine were the primary drugs mentioned by participants. Drug use was identified as playing a central role in same-sex sexuality for many African American MSM/MSMW. Participants described alcohol use and drug transactions, use, and addiction as motivating sex with men, allowing and rationalizing same-sex activity and unprotected sex, and facilitating access to male sex partners. Some of those in treatment for substance abuse indicated that a readiness to admit their same-sex activity and come to terms with their homosexuality/bisexuality was necessary for recovery. Because successful engagement of non-gay-identifying African American MSM/MSMW is essential to the reduction of HIV transmission and substance abuse in Black communities, findings call for drug treatment approaches that acknowledge and accept diverse sexuality in clients. Service providers and policy-makers may be guided by these findings toward building cultural competency among direct service staff. Future research should examine interrelated dynamics of sexual activity, identity, and drug use as they evolve within individual African American MSM/MSMW and compare the frequency with which sex, condom use, and substance use co-occur with male versus female partners.
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Affiliation(s)
- Nina T Harawa
- Department of Research, Charles R. Drew University, 1731 E. 120th St., Third Floor, Hawkins Bldg., Room 3090, Los Angeles, CA 90059, USA.
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Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 2007; 21:2083-91. [PMID: 17885299 DOI: 10.1097/qad.0b013e3282e9a64b] [Citation(s) in RCA: 440] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. RESULTS Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history. CONCLUSIONS Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.
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Affiliation(s)
- Gregorio A Millett
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health 2006; 96:1007-19. [PMID: 16670223 PMCID: PMC1470628 DOI: 10.2105/ajph.2005.066720] [Citation(s) in RCA: 386] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2005] [Indexed: 12/11/2022]
Abstract
HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses.Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM.
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Affiliation(s)
- Gregorio A Millett
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop E-45, Atlanta, GA 30333, USA.
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Bryant KJ. Expanding research on the role of alcohol consumption and related risks in the prevention and treatment of HIV/AIDS. Subst Use Misuse 2006; 41:1465-507. [PMID: 17002990 DOI: 10.1080/10826080600846250] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article is a review of some of the major epidemiological, behavioral, biological, and integrative prevention research issues and priorities in the area of HIV/AIDS and alcohol consumption. Drinking alcohol increases both the risk for infection with HIV and related illnesses and the morbidity and mortality of patients who progress to AIDS. New and improved measurement procedures have helped in assessment of the complex patterns of alcohol use, identification of intervening explanatory mechanisms for risk behaviors and contexts, and determination of intervention outcomes. Both the direct and indirect effects of alcohol misuse appear to be major contributors to both the risk for infection with HIV and the transmission of HIV/AIDS at the individual and population levels. There is increasing evidence that perhaps no level of alcohol consumption is "safe" for those who are HIV infected and receiving antiretroviral treatment. Interdisciplinary basic behavioral and biomedical research is needed to develop comprehensive culturally appropriate strategies for programs that can be effectively delivered in community contexts in the United States and abroad and that focus on the integration of our understanding of individual behaviors, high-risk group membership, biological mechanisms, and the social and physical environments that place individuals at risk for HIV infection. High-priority topics include improving adherence to antiretroviral medications, prevention of infection in young minority women in the United States, and treatment of HIV+ pregnant women who are alcohol abusers to prevent adverse fetal outcomes, which is an international focus in under-resourced settings in Africa.
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