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Shi G, Lin B, Pan H, He W, Zhong X. Using an extended information-motivation-behavioral skills model to explain HPV vaccination intention among men who have sex with men only and men who have sex with men and women. Hum Vaccin Immunother 2024; 20:2327150. [PMID: 38465886 PMCID: PMC10936628 DOI: 10.1080/21645515.2024.2327150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
Men who have sex with men and women (MSMW) have been reported to differ in psychosocial and sexual behavior patterns from men who have sex with men only (MSMO). However, results regarding the differences in HPV vaccination intention/behavior were inconclusive. We compared HPV vaccination intention between MSMO and MSMW and analyzed the differences in potentially associated factors in China. MSM participants were recruited online using a snowball sampling method. Cross-sectional data were collected via a questionnaire based on the extended information-motivation-behavioral skills model. Structural equation modeling was conducted to examine the relationship between the variables, followed by multi-group analysis to test differences between groups. Of 914 MSM, 77.68% were MSMO and 22.32% were MSMW. MSMW had a higher rate of reluctance to vaccinate than MSMO (23.53% vs. 16.20%, p = .016). Differences between the two groups were statistically significant in risky sexual behavior, behavioral skills, and promotional attitude. In both groups, promotional attitude was the most significant predictor of vaccination intention. Vaccination intention was directly influenced by motivation and indirectly by risky sexual behavior in MSMO, but not significantly in MSMW. Additionally, the direct effect of information on behavioral skills in MSMW was significantly greater than that in MSMO, but we did not find any effect of behavioral skills on vaccination intention. MSMW had lower vaccination intention than MSMO. MSMO may be influenced by risky sexual behavior and motivation, positively impacting their vaccination intention, unlike MSMW. Targeted strategies could help promote HPV vaccination, especially in MSMW.
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Affiliation(s)
- Guiqian Shi
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Haiying Pan
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Wei He
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
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Jordan H, Jeremiah R, Watson K, Corte C, Steffen A, Matthews AK. Exploring Preventive Health Care Utilization Among Black/African American Men. Am J Mens Health 2024; 18:15579883231225548. [PMID: 38243644 PMCID: PMC10799604 DOI: 10.1177/15579883231225548] [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: 05/19/2023] [Revised: 09/21/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.
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Affiliation(s)
- Harrell Jordan
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Rohan Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Karriem Watson
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Colleen Corte
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Vitsupakorn S, Pierce N, Ritchwood TD. Cultural interventions addressing disparities in the HIV prevention and treatment cascade among Black/African Americans: a scoping review. BMC Public Health 2023; 23:1748. [PMID: 37679765 PMCID: PMC10485990 DOI: 10.1186/s12889-023-16658-9] [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: 10/17/2022] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
Culture is an important determinant of HIV risk and protective behaviors; yet, we know little about how it is integrated in HIV interventions. This scoping review characterizes the integration of culture in HIV prevention and treatment interventions focused on Black/African Americans. We searched MEDLINE, PsycINFO, CINAHL, and Google Scholar for peer-reviewed manuscripts published between July 1, 2011, and June 28, 2021. Twenty-five interventions were identified, with 96% focused on prevention. Most (40%) targeted men who have sex with men or transgender women. Only three were grounded in cultural theory. Although all interventions were labeled "culturally based," only two explicitly defined culture. Moreover, there was much diversity regarding the ways in which interventions integrated cultural elements, with some conflating race/ethnicity with culture. To improve uptake and HIV-related outcomes, interventions integrating culture are greatly needed. Additionally, HIV interventions purporting to be "culturally based" must include basic information to support rigor and reproducibility.
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Affiliation(s)
| | - Nia Pierce
- College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Tiarney D Ritchwood
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Adeyeba MO, Montazeri Q, Bivens-Davis T, Schrode KM, Harawa NT. Reducing Human Immunodeficiency Virus and Sexually Transmitted Infections Risk in African American Women with At-Risk Male Partners: A Randomized Trial. J Womens Health (Larchmt) 2023; 32:311-322. [PMID: 36520613 PMCID: PMC9993165 DOI: 10.1089/jwh.2022.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: We examined the efficacy of the Females of African American Legacy Empowering Self (FemAALES) intervention in a cohort of 203 publicly insured Black women in Los Angeles. Materials and Methods: Women who reported recent sex with a male partner who was at increased risk for infection by human immunodeficiency virus (HIV) and sexually transmitted infections (STI) were randomized to the six-session FemAALES intervention or to a single client-centered family planning and STI/HIV counseling session. Participants were followed at 3 and 9 months post-intervention. To investigate between-group behavioral changes in condomless sex in the prior 90 days and other HIV/STI risks, we used generalized estimating equations that accounted for repeated observations in individuals. Results: Most participants (mean age 34 ± 11 standard deviation) were low-income and unemployed, despite three-quarters having completed high school or the equivalent. The most common HIV/STI risk factors among recent male partners were incarceration (58.8%) and concurrent sex with other women (72.2%). At 3 months, the FemAALEs group showed a larger increase in the odds of asking their partner to test (adjusted odds ratio = 2.14; 95% confidence interval [CI], 1.02-4.47; p = 0.0431) and in sexual health self-efficacy scores (adjβ = 1.82; 95% CI, 0.02-3.62; p = 0.0471) compared to the control group, although these changes did not hold at 9 months. Both groups showed statistically significant declines in the frequency of several sexual risk factors between baseline and 9 months. Conclusion: Although we did not find evidence that the FemAALES intervention was more efficacious than the less-intensive control condition in reducing sexual risk behaviors, the overall declines in risk behaviors we observed warrant further research. ClinicalTrials.gov (Identifier: NCT02189876).
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Affiliation(s)
- Mariam O. Adeyeba
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Qiana Montazeri
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Traci Bivens-Davis
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Katrina M. Schrode
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Nina T. Harawa
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angels, California, USA
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Effectiveness of interventions aimed at reducing HIV acquisition and transmission among gay and bisexual men who have sex with men (GBMSM) in high income settings: A systematic review. PLoS One 2022; 17:e0276209. [PMID: 36260550 PMCID: PMC9581368 DOI: 10.1371/journal.pone.0276209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV transmission continues among gay and bisexual men who have sex with men (GBMSM), with those who are younger, or recent migrants, or of minority ethnicity or who are gender diverse remaining at increased risk. We aimed to identify and describe recent studies evaluating the effectiveness of HIV prevention interventions for GBMSM in high income countries. METHODS We searched ten electronic databases for randomized controlled trials (RCTs), conducted in high income settings, and published since 2013 to update a previous systematic review (Stromdahl et al, 2015). We predefined four outcome measures of interest: 1) HIV incidence 2) STI incidence 3) condomless anal intercourse (CLAI) (or measure of CLAI) and 4) number of sexual partners. We used the National Institute for Health and Care Excellence (UK) Quality Appraisal of Intervention Studies tool to assess the quality of papers included in the review. As the trials contained a range of effect measures (e.g. odds ratio, risk difference) comparing the arms in the RCTs, we converted them into standardized effect sizes (SES) with 95% confidence intervals (CI). RESULTS We identified 39 original papers reporting 37 studies. Five intervention types were identified: one-to-one counselling (15 papers), group interventions (7 papers), online interventions (9 papers), Contingency Management for substance use (2 papers) and Pre-exposure Prophylaxis (PrEP) (6 papers). The quality of the studies was mixed with over a third of studies rated as high quality and 11% rated as poor quality. There was some evidence that one-to-one counselling, group interventions (4-10 participants per group) and online (individual) interventions could be effective for reducing HIV transmission risk behaviours such as condomless anal intercourse. PrEP was the only intervention that was consistently effective at reducing HIV incidence. CONCLUSIONS Our systematic review of the recent evidence that we were able to analyse indicates that PrEP is the most effective intervention for reducing HIV acquisition among GBMSM. Targeted and culturally tailored behavioural interventions for sub-populations of GBMSM vulnerable to HIV infection and other STIs should also be considered, particularly for GBMSM who cannot access or decline to use PrEP.
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Zhang T, Yu Z, Song D, Chen Y, Yao T, Peixoto E, Huang H, Zhang H, Yang J, Gong H, Chen J, Liu Y, Li C, Yu M, Cui Z, Ma J. Sexual Behavior Transition and Acute and Early HIV Infection Among Men Who Have Sex With Men: Evidence from an Open Cohort in China, 2011-2019. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3557-3568. [PMID: 35904694 DOI: 10.1007/s10508-022-02320-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 12/14/2021] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
The present study examined how sexual behaviors transit over time among men who have sex with men (MSM) and whether these transitions were associated with acute and early HIV (AEH) infection. An open cohort study was conducted using snowball sampling to recruit MSM via physical venues and Internet venues from 2011 to 2019, in China. Cox models were used to estimate the correlates of risk factors and AEH infection. We used Latent Transition Analysis (LTA) to describe behavioral profile and explore latent behavioral "trans-phenotypes," then examined the effect between different "trans-phenotypes" and AEH infection risk and explored the effect of characteristics as possible predictors of sexual behavior transition. Of 6502 MSM, a total of 1974 individuals with negative human immunodeficiency virus (HIV) tests at baseline and at least 2 visit records were included in the final analysis from 2011 to 2019. During an average 1.84 years of follow-up, 64 AEH infections were documented. In the multivariable Cox model, the association between condom use in last anal sex (HR: 0.095, 0.038-0.205), fewer sexual partners (HR: 0.375, 0.205-0.712), low frequency of condom use (HR: 3.592, 1.186-11.272), and AEH acquisition were found. The percentage of MSM with "maintain/develop safety-profile," "consistent risky-profile," and "safety-profile to risky-profile" were 52.48, 40.17, and 7.35%, respectively. Compared with "maintain\develop safety-profile," "consistent or develop risky-profile" had an increasing likelihood of AEH infection. Meanwhile, male sex workers (MSWs) or older MSM were more likely to consist or transit in "risky-profile." Having middle education is a risk factor to transit in "risky-profile" for MSM with "safety-profile" at baseline. In addition, MSM who accept health services in the past year engaged in higher proportion of developing safety-profile. Approximately half of MSM maintain or develop risky behavior with the increasing likelihood of AEH acquisition in China, which suggested that targeted and intensive interventions should be prioritized to maintain safety-profile. Clinical Trial Number: ChiCTR2000039500.
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Affiliation(s)
- Tiantian Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Zeyang Yu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Desheng Song
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yang Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Tingting Yao
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Elissa Peixoto
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Huijie Huang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Honglu Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, Tianjin, China
| | - Hui Gong
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jiageng Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuanyuan Liu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Changping Li
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Zhuang Cui
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| | - Jun Ma
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
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Jemal A, Caliste S. Work-in-progress: Focus groups evaluate and inform revisions of a socio-behavioral health intervention. EVALUATION AND PROGRAM PLANNING 2022; 93:102079. [PMID: 35751913 PMCID: PMC10148963 DOI: 10.1016/j.evalprogplan.2022.102079] [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] [Received: 06/08/2021] [Revised: 11/24/2021] [Accepted: 03/13/2022] [Indexed: 05/03/2023]
Abstract
African American men and women are disproportionately impacted by HIV/STI risk. Particularly, African American women are more likely to be infected with HIV from heterosexual sex. Yet, much of the intervention research has focused on men who have sex with men. This article describes the development and feasibility study of a six-session socio-behavioral health intervention that utilized sociodrama to reduce substance use and HIV/STI risk among heterosexual, African American men and women who have multiple sex partners. The intervention was developed based on theories and models of critical consciousness, social scripts, and group work practice. Content and delivery were informed by qualitative data collection with a range of stakeholders including service providers and members of the target population. The resulting intervention was six group sessions, delivered by two licensed social workers, with one of the facilitators trained in sociodrama. The results of the qualitative study explored the feasibility of conducting this six-week intervention and evaluated a trial run of the intervention. The data was obtained through focus group interviews and observations. Findings revealed that the intervention could be delivered with fidelity and was acceptable to participants and indicated that the intervention's innovative components of sociodrama and critical consciousness resonated with the participants and has potential to reduce HIV/STI risk and substance use. Reported barriers and suggested revisions need to be examined further and addressed to develop and implement a sustainable program that can be delivered in community-based settings. A future randomized control trial of the revised intervention will evaluate the intervention's efficacy.
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Brewer R, Ramani SL, Khanna A, Fujimoto K, Schneider JA, Hotton A, Wilton L, Escobedo T, Harawa NT. A Systematic Review up to 2018 of HIV and Associated Factors Among Criminal Justice-Involved (CJI) Black Sexual and Gender Minority Populations in the United States (US). J Racial Ethn Health Disparities 2022; 9:1357-1402. [PMID: 34296420 PMCID: PMC8297427 DOI: 10.1007/s40615-021-01076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIV-related characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice-involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and more pronounced among BTW. The current evidence favors no association between incarceration and HIV acquisition among BMSM with limited information about BTW. Criminal justice involvement was associated with a greater likelihood of STIs among BMSM with mixed results for sexual risk behaviors. Criminal justice settings served as an important venue for HIV testing/diagnosis for both BMSM and BTW. However, these settings were not conducive for subsequent stages of the HIV care continuum. Studies pointed to an independent association between criminal justice involvement, substance use, housing instability, and greater odds of incarceration among BMSM who were unemployed and had limited education. Future incarceration was associated with high levels of perceived racism among BMSM. Among young BMSM, high network criminal justice prevalence was also associated with sexual risk behaviors, poorer mental health outcomes, drug use, and housing instability. CJI BMSM and BTW represent a critical subpopulation to end the HIV epidemic in the US.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA.
| | - Santhoshini L Ramani
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Aditya Khanna
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Kayo Fujimoto
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Anna Hotton
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Leo Wilton
- State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Tania Escobedo
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Nina T Harawa
- David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Del Pino HE, Steers WN, Lee M, McCuller J, Hays RD, Harawa NT. Measuring Gender Role Conflict, Internalized Stigma, and Racial and Sexual Identity in Behaviorally Bisexual Black Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1019-1030. [PMID: 34136991 PMCID: PMC8674384 DOI: 10.1007/s10508-021-01925-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Black men who have sex with men and women (BMSMW) experience pressure to fill hypermasculine ideals and may not identify with "gay" cultural norms. Existing measures of gender role expectations and internalized homophobia are not culturally appropriate for BMSMW. Researchers generally measure categorical identification with race, gender, and sexual orientation groups separately, whereas BMSMW may identify with multiple categories. We modified the Gender Role Conflict Scale to create the M-GRCS and the Internalized Homophobia Scale to include biphobia (Internalized Bi/Homophobia Scale, IBHS). To examine identification at the intersection of race, gender, and sexual orientation, we created 11 Integrated Race and Sexuality Scale (IRSS) items. With data from 429 BMSMW, we conducted exploratory factor analysis of the 59 items using categorical principal axis factoring with unweighted least squares extraction and Promax factor rotation. We created simple-summated multi-item scales and evaluated their construct validity. The rotated solution yielded four factors with 47 items and a simple factor structure: M-GRCS defined two factors (α = .93 for restricted emotionality/affection; .87 for success/power/competition); the IBHS (α = .89) and IRSS (α = .74) each defined a single factor. The IRSS factor was positively correlated with the Lukwago Racial Pride Scale, r(417) = .40. The IBHS factor was negatively correlated with the IRSS factor, r(414) = - .22. The two M-GRCS factors suggest that the construct of hypermasculinity impacts BMSMW. The high IBHS reliability indicates that homophobia and biphobia were positively correlated in this sample. These three scales have potential for future studies with BMSMW.
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Affiliation(s)
- Homero E Del Pino
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - W Neil Steers
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Martin Lee
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jason McCuller
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Ron D Hays
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Nina T Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA.
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Gunn JKL, Rooks-Peck C, Wichser ME, Denard C, McCree DH, Jeffries WL, DeLuca JB, Ross LW, Herron A, Barham T, Flores SA, Higa DH. Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses. AIDS Behav 2022; 26:51-89. [PMID: 34263349 DOI: 10.1007/s10461-021-03358-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
Stigma may contribute to HIV disparities for men who have sex with men (MSM). This systematic review quantified the effects of HIV stigma interventions for MSM on stigma and sex risk. We conducted a systematic search to identify US-based studies published between 2000 and June 2019 focused on HIV and MSM, and either measured stigma pre-post or included a stigma intervention component. Twenty-nine articles, representing 26 unique studies met inclusion criteria. Random effect models showed no intervention effect for reducing stigma and a non-significant increase in HIV testing. Significant decreases in condomless sex with males, condomless sex with females, and substance-influenced sex were found. Few intervention studies measured stigma pre-post. Findings suggest that including a stigma reduction component in interventions can improve HIV testing and reduce sex risk for MSM. Developing interventions to address stigma may be important in decreasing HIV infection among MSM and ending the HIV epidemic.
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Nwaosu U, Raymond-Williams R, Meyrick J. Are psychosocial interventions effective at increasing condom use among Black men? A systematic review. Int J STD AIDS 2021; 32:1088-1105. [PMID: 34144658 PMCID: PMC8593286 DOI: 10.1177/09564624211024785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Black men experience a disproportionate burden of sexually transmitted infections (STIs) in the United Kingdom (UK). STIs can seriously affect the health and well-being of affected individuals. With condoms effective at preventing STI transmission, this review aims to explore the evidence of effectiveness of psychosocial interventions at increasing condom use among Black men to inform UK-based interventions for this at-risk but unheard population. Nine databases were searched for qualifying studies. Two reviewers independently assessed the quality of studies. A narrative synthesis read across the heterogeneous studies for evidence of effectiveness. A total of 17 studies met the inclusion criteria. This review identified scientifically weak evidence of effectiveness in multifaceted psychosocial interventions to increase condom use among Black men, particularly men who have sex with women and men who have sex with men mainly from United States settings. The multifaceted nature of interventions provides obscure evidence on successful elements of interventions with positive effects. Despite the disproportionate STI burden among this group, no UK-based studies were identified. Future research should aim to better understand condom use behavioural experiences and motivators of condom use among UK Black men to inform ethnically culturally relevant and tailored interventions.
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Affiliation(s)
- Uzochi Nwaosu
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Jane Meyrick
- Health and Applied Sciences, University of the West of England, Bristol, UK
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Henderson JT, Senger CA, Henninger M, Bean SI, Redmond N, O'Connor EA. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:682-699. [PMID: 32809007 DOI: 10.1001/jama.2020.10371] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Increasing rates of preventable sexually transmitted infections (STIs) in the US pose substantial burdens to health and well-being. OBJECTIVE To update evidence for the US Preventive Services Task Force (USPSTF) on effectiveness of behavioral counseling interventions for preventing STIs. DATA SOURCES Studies from the previous USPSTF review (2014); literature published January 2013 through May 31, 2019, in MEDLINE, PubMed (for publisher-supplied records only), PsycINFO, and Cochrane Central Register of Controlled Trials. Ongoing surveillance through May 22, 2020. STUDY SELECTION Good- and fair-quality randomized and nonrandomized controlled intervention studies of behavioral counseling interventions for adolescents and adults conducted in primary care settings were included. Studies with active comparators only or limited to individuals requiring specialist care for STI risk-related comorbidities were excluded. DATA EXTRACTION AND SYNTHESIS Dual risk of bias assessment, with inconsistent ratings adjudicated by a third team member. Study data were abstracted into prespecified forms. Pooled odds ratios (ORs) were estimated using the DerSimonian and Laird method or the restricted maximum likelihood method with Knapp-Hartung adjustment. MAIN OUTCOMES AND MEASURES Differences in STI diagnoses, self-reported condom use, and self-reported unprotected sex at 3 months or more after baseline. RESULTS The review included 37 randomized trials and 2 nonrandomized controlled intervention studies (N = 65 888; 13 good-quality, 26 fair-quality) recruited from primary care settings in the US. Study populations were composed predominantly of heterosexual adolescents and young adults (12 to 25 years), females, and racial and ethnic minorities at increased risk for STIs. Nineteen trials (n = 52 072) reported STI diagnoses as outcomes (3 to 17 months' follow-up); intervention was associated with reduced STI incidence (OR, 0.66 [95% CI, 0.54-0.81; I2 = 74%]). Absolute differences in STI acquisition between groups varied widely depending on baseline population STI risk and intervention effectiveness, ranging from 19% fewer to 4% more people acquiring STI. Thirty-four trials (n = 21 417) reported behavioral change outcomes. Interventions were associated with self-reported behavioral change (eg, increased condom use) that reduce STI risk (OR, 1.31 [95% CI, 1.10-1.56; I2 = 40%, n = 5253). There was limited evidence on persistence of intervention effects beyond 1 year. No harms were identified in 7 studies (n = 3458) reporting adverse outcomes. CONCLUSIONS AND RELEVANCE Behavioral counseling interventions for individuals seeking primary health care were associated with reduced incidence of STIs. Group or individual counseling sessions lasting more than 2 hours were associated with larger reductions in STI incidence, and interventions of shorter duration also were associated with STI prevention, although evidence was limited on whether the STI reductions associated with these interventions persisted beyond 1 year.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Jemal A, Urmey LS, Caliste S. From Sculpting an Intervention to Healing in Action. SOCIAL WORK WITH GROUPS 2020; 44:226-243. [PMID: 34483402 PMCID: PMC8411875 DOI: 10.1080/01609513.2020.1757923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Blacks/African Americans have the most severe and disproportionate burden of HIV of all racial/ethnic groups in the United States. Oppression (i.e., socio-structural (macro), institutional (exo), community (meso), and interpersonal (micro)), operates as four interrelated prongs that perpetuate the HIV epidemic in Black/ African American communities. Oppressive (i.e., racist and sexist) cultural scripts transferred to individuals through community, family and interpersonal relationships may play a role in HIV/STI risk. However, socio-behavioral health interventions or behavioral risk reduction interventions have traditionally focused solely on individual-level health risk behaviors allowing invisible, inequitable socio-structural factors to continue unchallenged. A new intervention, Black Men and Women: Empowering Self, Relationships and Community, was sculpted from two existing interventions Community Wise and Men of African American Legacy Empowering Self (MAALES) to develop awareness of oppressive cultural scripts operating on interpersonal and intrapersonal levels and to take action against these oppressive messages to reclaim identity, restore relationships, and build community. This paper summarizes the theory and selected sociodramatic components of the intervention that promote healing in action to reduce HIV/STI risk among heterosexually identified, low-income African American men and women with multiple sex partners. Lessons learned in theory, research and practice are also discussed.
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Affiliation(s)
- Alexis Jemal
- Silberman School of Social Work at Hunter College
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14
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Mthembu J, Hamilton AB, Milburn NG, Sinclair D, Mkabile S, Mashego M, Manengela T, Wyatt GE. "It Had a Lot of Cultural Stuff in It": HIV-Serodiscordant African American Couples' Experiences of a Culturally Congruent Sexual Health Intervention. Ethn Dis 2020; 30:269-276. [PMID: 32346272 DOI: 10.18865/ed.30.2.269] [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] [Indexed: 01/06/2023] Open
Abstract
Objective The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention. Participants Participants (n=17) who completed at least half of the eight intervention sessions. Methods Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains. Results Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Participants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the sessions, including the emphasis on learning from one another as couples. Conclusions Couples at risk for HIV transmission benefit from strengthening skills and knowledge related to healthy sexuality. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also reducing risk.
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Affiliation(s)
- Jacqueline Mthembu
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, South Africa
| | - Alison B Hamilton
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Norweeta G Milburn
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Deborah Sinclair
- Child and Family Studies, University of the Western Cape, South Africa.,Department of Special Needs Education, Ghent University, Belgium
| | - Siyabulela Mkabile
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mmathabo Mashego
- University of Venda, Limpopo, South Africa.,Department of Community Strengthening Systems, HIV South Africa, South Africa
| | | | - Gail E Wyatt
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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15
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A Randomized Controlled Trial to Reduce HIV-Related Risk in African American Men Who Have Sex with Men and Women: the Bruthas Project. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:115-125. [PMID: 30478804 DOI: 10.1007/s11121-018-0965-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
African American men who have sex with men and women (MSMW) are among the populations with the highest need for HIV prevention programs in the USA. We tested a theory-based, community participatory behavioral intervention aiming to reduce sexual risk for HIV transmission in this population. A randomized clinical trial involving 396 African American MSMW who were assigned to a 4-session intervention involving HIV testing and counseling (n = 199) or to a HIV testing and counseling only (n = 197) control. In the 4-session intervention program, counselors provided education on HIV and STI risk, condom use, HIV testing, interpersonal sexual dynamics with both male and female partners, and motivational "triggers" of condomless sex. Participants completed baseline, 6-month, and 9-month assessments, and changes in HIV behavioral risk indicators were examined by condition and time. There were no statistically significant differences in sexual risk between the intervention condition and the control condition. Regardless of condition, participants reported significant reductions in mean number of condomless sex events with female casual partners from baseline (6.04) to 6 months (2.58) and 9 months (1.47), and with male casual partners from baseline (2.61) to 6 months (1.18) and 9 months (0.60). Condition-by-time interaction effects and condition main effects were non-significant. Although there were no significant differences by condition, findings support the effects of brief behavioral counseling and HIV testing on reducing condomless sex with casual female and male partners among African American MSMW. Future research should examine further the potential for brief behavioral counseling to promote biomedical HIV prevention and to reduce co-morbid health issues such as substance use among African American MSMW.
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16
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Wheeler DP, Fields SD, Beauchamp G, Chen YQ, Emel LM, Hightow-Weidman L, Hucks-Ortiz C, Kuo I, Lucas J, Magnus M, Mayer KH, Nelson LE, Hendrix CW, Piwowar-Manning E, Shoptaw S, Watkins P, Watson CC, Wilton L. Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study. J Int AIDS Soc 2020; 22:e25223. [PMID: 30768776 PMCID: PMC6376611 DOI: 10.1002/jia2.25223] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/23/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. METHODS The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. RESULTS Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 -6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). CONCLUSIONS Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.
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Affiliation(s)
- Darrell P Wheeler
- School of Social Welfare, University at Albany - SUNY, Albany, NY, USA
| | - Sheldon D Fields
- School of Health Professions, New York Institute of Technology, New York, NY, USA
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ying Q Chen
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Vaccine and Infectious Disease Division (VIDD) and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lynda M Emel
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Jonathan Lucas
- Science Facilitation Department, FHI 360, Durham, NC, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - LaRon E Nelson
- School of Nursing, University of Rochester, Rochester, NY, USA.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Craig W Hendrix
- Department of Medicine (Clinical Pharmacology), John Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | | | | | - Leo Wilton
- Department of Human Development, State University of New York at BinghamtonBinghamton, NY, USA.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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17
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 DOI: 10.1007/s10508-019-1428-3)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/24/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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18
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 PMCID: PMC7018582 DOI: 10.1007/s10508-019-01468-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/02/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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19
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Feinstein BA, Dodge B, Korpak AK, Newcomb ME, Mustanski B. Improving the health of cisgender men who identify as bisexual: What do they want from interventions? SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:385-391. [PMID: 31692994 PMCID: PMC6831095 DOI: 10.1007/s13178-019-0380-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors.
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Affiliation(s)
- Brian A. Feinstein
- Northwestern University, Institute for Sexual and Gender Minority Health, Chicago, IL
| | - Brian Dodge
- Indiana University School of Public Health-Bloomington, Bloomington, IN
| | - Aaron K. Korpak
- Northwestern University, Institute for Sexual and Gender Minority Health, Chicago, IL
| | - Michael E. Newcomb
- Northwestern University, Institute for Sexual and Gender Minority Health, Chicago, IL
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL
| | - Brian Mustanski
- Northwestern University, Institute for Sexual and Gender Minority Health, Chicago, IL
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL
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Abstract
HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including game-based elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 min during the 3-month intervention period (n = 50, 25.8%), we estimated 4.85 (95% CI 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.
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HIV Care Continuum Disparities Among Black Bisexual Men and the Mediating Effect of Psychosocial Comorbidities. J Acquir Immune Defic Syndr 2019; 77:451-458. [PMID: 29337847 DOI: 10.1097/qai.0000000000001631] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Differences across the HIV care continuum between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) are emerging in recent literature but have not been comprehensively documented among black MSM. Although MSMW have lower HIV prevalence than MSMO, they are more likely to be HIV-positive unaware and be virally unsuppressed. Explanatory factors for these differences have not previously been assessed. METHODS Between 2014 and 2016, we surveyed sexually active black MSM 18 years or older at Black Gay Pride events in 6 U.S. cities (n = 3881), 1229 of whom either self-reported HIV-positive status or tested HIV-positive onsite. We compared HIV-positive MSMW (n = 196) with HIV-positive MSMO (n = 1033) by HIV-positive unaware status, HIV care uptake, and viral load suppression. We conducted multivariable logistic regressions and built a structural equation model assessing mediating effects of psychosocial comorbidities (violence victimization, depression, and polydrug use) on the relationship between MSMW status and unsuppressed virus. RESULTS MSMW were more likely than MSMO to be HIV-positive unaware [adjusted odds ratio (aOR) = 2.17; 95% confidence interval (CI): 1.58 to 3.00]. Among those who were HIV-positive aware (n = 720), MSMW were more likely to report never receiving HIV care (aOR = 2.74; 95% CI: 1.05 to 7.16) and to report detectable viral loads (aOR = 2.34; 95% CI: 1.31 to 4.19). Psychosocial comorbidities significantly mediated (P = 0.01) the relationship between MSMW status and unsuppressed virus. DISCUSSION Black MSMW were less likely than black MSMO to uptake biomedical care and secondary prevention. Biobehavioral intervention development specific to HIV-positive black MSMW will be most successful if psychosocial comorbidities are also addressed.
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Muñoz-Laboy M. Ethnic and Racial Specificity, or Not, in Bisexuality Research: A Practical Commentary. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:317-325. [PMID: 30397832 DOI: 10.1007/s10508-018-1318-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
This commentary focuses on reflecting on how we, as bisexuality researchers, consider the effects of, and contribute toward addressing, systemic racism and ethnic discrimination affecting bisexual individuals in different global contexts. This commentary is intended to provoke critical thinking among bisexuality and other sex researchers on how we may best consider (or not) racism and ethnic oppression when dealing with ethnically, racially, or culturally diverse bisexual samples of individuals. In this commentary, I argue that current social and behavioral science researchers who focus on bisexuality tend to follow one or more of the following three approaches: a "color blind" approach, an inclusive approach or, a racially-ethnically specific approach. I will identify the advantages and considerations for taking one approach versus another.
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Affiliation(s)
- Miguel Muñoz-Laboy
- School of Social Work, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 5th Floor Ritter Annex, Rm 553, Philadelphia, PA, 19122, USA.
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Harawa NT, Guentzel-Frank H, McCuller WJ, Williams JK, Millet G, Belcher L, Joseph HA, Bluthenthal RN. Efficacy of a Small-Group Intervention for Post-Incarcerated Black Men Who Have Sex with Men and Women (MSMW). J Urban Health 2018; 95. [PMID: 29541962 PMCID: PMC5906387 DOI: 10.1007/s11524-018-0227-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We conducted a randomized controlled trial of a six-session behavioral intervention designed to reduce frequency of condomless sex and numbers of sex partners among recently incarcerated, bisexual Black men. One hundred participants were assigned to the small-group intervention, Men in Life Environments (MILE), and 112 were assigned to the control condition. Among those assigned to MILE, 69% attended at least one session, 88% of whom attended all sessions. At 3-months' follow-up, large reductions in risk behaviors were reported by both groups. Means for episodes of condomless sex in the previous 3 months declined from 27.7 to 8.0 for the intervention and 25.6 to 6.7 for the control group. Reductions were not greater for the intervention than those of the control group. Regression to the mean, respondent burden, and implementation issues, such as moving from office-based to field-based survey administration at follow-up, may have contributed to the large declines reported by both groups.
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Affiliation(s)
- Nina T Harawa
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA. .,Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA. .,, Los Angeles, USA.
| | | | - William Jason McCuller
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John K Williams
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | | | - Lisa Belcher
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.,Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | - Heather A Joseph
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.,Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | - Ricky N Bluthenthal
- Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Lauby J, Milnamow M, Joseph HA, Hitchcock S, Carson L, Pan Y, Mendoza M, Millett G. Evaluation of Project RISE, an HIV Prevention Intervention for Black Bisexual Men Using an Ecosystems Approach. AIDS Behav 2018; 22:164-177. [PMID: 28871506 DOI: 10.1007/s10461-017-1892-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Black men who have sex with men and women (MSMW) are among the populations at highest risk for HIV infection. We describe the evaluation of Project RISE, a six-session individual-level intervention developed for black MSMW using an ecosystems approach. A randomized controlled trial was used to test the effect of the intervention on sexual risk outcomes. Eligibility criteria included having both male and female sex partners in the past 12 months. Complete data at 5-month follow-up were collected from 86.7% of the 165 participants. In analyses controlling for HIV status, age, and baseline risk, intervention participants were found to have significantly greater reductions in number of female partners (p < 0.05) and total male and female partners (p < 0.05) at follow-up, compared to the control group. Intervention participants also were significantly more likely to report a reduction in number of sex episodes without a condom with female partners (p < 0.05) and with all partners (p < 0.02) at follow-up, compared to the control group.
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Affiliation(s)
- Jennifer Lauby
- Research & Evaluation Group, Public Health Management Corp., Philadelphia, PA, USA.
- , 84 Peregrine Dr., Voorhees, NJ, 08043, USA.
| | - Mary Milnamow
- Research & Evaluation Group, Public Health Management Corp., Philadelphia, PA, USA
| | | | - Shannon Hitchcock
- Research & Evaluation Group, Public Health Management Corp., Philadelphia, PA, USA
| | - Lee Carson
- The COLOURS Organization, Philadelphia, PA, USA
| | - Yi Pan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Mendoza
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Greg Millett
- amfAR, The Foundation for AIDS Research, Washington, DC, USA
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Joseph HA, Pan Y, Mendoza M, Harawa NT, Lauby J, Hosek SG, Bluthenthal RN, Milnamow M, Fernandez MI, Jeffries WL, Belcher L, Millett GA. HIV Acquisition and Transmission Potential Among African American Men Who Have Sex with Men and Women in Three U.S. Cities. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:183-194. [PMID: 29124541 PMCID: PMC8386249 DOI: 10.1007/s10508-017-1052-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/14/2017] [Accepted: 07/24/2017] [Indexed: 06/02/2023]
Abstract
Black men who have sex with men and women (BMSMW) are at increased HIV risk, but few efficacious interventions meet their unique needs. Three HIV prevention interventions were evaluated with a common protocol. Baseline data were pooled to describe sexual behavior involving transmission risk with male, female, and male-to-female transgender partners and identify factors associated with transmission risk. BMSMW from Los Angeles, Philadelphia, and Chicago who reported sexual risk and bisexual behavior in the past year were recruited via modified chain referral sampling and community recruitment. Baseline assessments were conducted via audio computer-assisted interview and sexual behaviors assessed over the past 3 months. From December 2010 to November 2012, 584 BMSMW were enrolled across the three cities. More than half (55%) were recruited by other participants. Overall, the mean age was 43 years. Seventy-five percent reported an annual income <$10,000 and selling sex was prevalent (31%). Three-quarters identified as bisexual. Thirty-nine percent were HIV-positive. Among HIV-positive participants, 46% reported sex without condoms with HIV-negative or unknown male partners and 45% with HIV-negative or unknown female partners. Overall, factors associated with sex without condoms included network size, education, income, sexual orientation identification, HIV status, exchange sex, homonegativity, and social support. Findings support the need for enhanced HIV prevention efforts for this population. Future studies should examine contextual factors in addition to individual risk behaviors to inform the development and implementation of promising strategies to prevent HIV and promote the overall health and wellness of BMSMW and their sexual partners.
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Affiliation(s)
- Heather A Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Yi Pan
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Maria Mendoza
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Nina T Harawa
- College of Medicine, Charles Drew University, Los Angeles, CA, USA
| | - Jennifer Lauby
- Public Health Management Corporation, Philadelphia, PA, USA
| | - Sybil G Hosek
- Research Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Mary Milnamow
- Public Health Management Corporation, Philadelphia, PA, USA
| | | | | | - Lisa Belcher
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
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Li MJ, Frank HG, Harawa NT, Williams JK, Chou CP, Bluthenthal RN. Racial Pride and Condom Use in Post-Incarcerated African-American Men Who Have Sex With Men and Women: Test of a Conceptual Model for the Men in Life Environments Intervention. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:169-181. [PMID: 27115618 PMCID: PMC5153365 DOI: 10.1007/s10508-016-0734-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/25/2016] [Accepted: 03/06/2016] [Indexed: 05/06/2023]
Abstract
African-American men who have sex with men and women (MSMW) are among those most heavily impacted by HIV in the United States, and those who have histories of incarceration are at further risk of infection. The Men in Life Environments (MILE) HIV prevention intervention was developed to provide culturally appropriate skills-based education and support for African-American MSMW with recent histories of incarceration. The MILE's conceptual framework was informed by three theories: Theory of Reasoned Action and Planned Behavior, Critical Thinking and Cultural Affirmation Model, and Empowerment Theory. The theory-based framework posits that improving racial pride is crucial in building self-efficacy and intentions that in turn promote health-protective behaviors. Therefore, our study aimed to assess whether baseline associations between racial pride and condom use self-efficacy, intentions, and behaviors among African-American MSMW with histories of incarceration align with our conceptual model. We report data on 212 participants recruited from Los Angeles County Sheriff's Department Men's Central Jail and the local community. Using structural equation modeling, we tested two separate models: one with female sexual partners and one with male sexual partners, while stratifying by participant's HIV status. Only among HIV-negative participants was greater racial pride associated with less condomless intercourse with men. In this group, greater self-efficacy and intentions-but not racial pride-predicted less condomless intercourse with women. Our findings suggest that racial pride is an important factor to address in HIV prevention interventions for post-incarcerated African-American MSMW.
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Affiliation(s)
- Michael J Li
- Division of Health Behavior Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032-3628, USA.
| | | | - Nina T Harawa
- Department of Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - John K Williams
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, UCLA, Los Angeles, CA, USA
| | - Chih-Ping Chou
- Division of Health Behavior Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032-3628, USA
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ricky N Bluthenthal
- Division of Health Behavior Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032-3628, USA
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Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities. J Acquir Immune Defic Syndr 2017; 75:290-298. [PMID: 28368951 DOI: 10.1097/qai.0000000000001385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. METHODS We used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations. RESULTS Overall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P < 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P < 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates. CONCLUSIONS The intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.
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Abstract
PURPOSE OF REVIEW Bisexual individuals are at increased risk for negative health outcomes compared to heterosexual individuals and often compared to gay/lesbian individuals as well. The goal of this article is to summarize the current evidence-base on bisexual health disparities, to describe factors that influence them, and to review interventions designed to improve the health of bisexual individuals. RECENT FINDINGS Based on our review of the literature, we conclude that there is strong evidence that bisexual individuals are at increased risk for mental health and substance use problems. These disparities are evident across dimensions of bisexuality (identity, attraction, and behavior), but there are important nuances to these findings. There is also evidence that bisexual men are at increased risk for sexually transmitted infections (STIs) compared to heterosexual men and that bisexual women are at increased risk for STIs compared to both lesbians and heterosexual women. Although there are numerous causes of these disparities, a leading contributor is stress related to stigma and discrimination. Most of the interventions that have been developed for bisexual individuals are HIV prevention programs for behaviorally bisexual men of color. Despite less attention to mental health and substance use interventions for bisexual individuals, recent developments show promise in their potential application to this population. SUMMARY Bisexual individuals are at increased risk for mental health, substance use, and sexual health problems, and this is due, in part, to stigma and discrimination. Future research should continue to examine how different dimensions of bisexuality relate to health disparities and factors that influence them. There is also an urgent need to develop, test, and disseminate interventions to improve the health of bisexual individuals.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine
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Abstract
PURPOSE OF REVIEW Bisexual individuals are at increased risk for negative health outcomes compared to heterosexual individuals and often compared to gay/lesbian individuals as well. The goal of this article is to summarize the current evidence-base on bisexual health disparities, to describe factors that influence them, and to review interventions designed to improve the health of bisexual individuals. RECENT FINDINGS Based on our review of the literature, we conclude that there is strong evidence that bisexual individuals are at increased risk for mental health and substance use problems. These disparities are evident across dimensions of bisexuality (identity, attraction, and behavior), but there are important nuances to these findings. There is also evidence that bisexual men are at increased risk for sexually transmitted infections (STIs) compared to heterosexual men and that bisexual women are at increased risk for STIs compared to both lesbians and heterosexual women. Although there are numerous causes of these disparities, a leading contributor is stress related to stigma and discrimination. Most of the interventions that have been developed for bisexual individuals are HIV prevention programs for behaviorally bisexual men of color. Despite less attention to mental health and substance use interventions for bisexual individuals, recent developments show promise in their potential application to this population. SUMMARY Bisexual individuals are at increased risk for mental health, substance use, and sexual health problems, and this is due, in part, to stigma and discrimination. Future research should continue to examine how different dimensions of bisexuality relate to health disparities and factors that influence them. There is also an urgent need to develop, test, and disseminate interventions to improve the health of bisexual individuals.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine
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30
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A Randomized Controlled Trial of POWER: An Internet-Based HIV Prevention Intervention for Black Bisexual Men. AIDS Behav 2016; 20:1951-60. [PMID: 27085548 DOI: 10.1007/s10461-016-1403-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
POWER is a theory-based, on-line HIV prevention intervention developed specifically for Black men who have sex with men and women (BMSMW), an understudied group significantly impacted by HIV. To test its efficacy, we recruited 224 BMSMW using chain referral methods and randomly assigned 108 to POWER and 103 to a health information comparison condition. Three months after the intervention, participants assigned to POWER had lower odds of reporting any condomless vaginal or condomless anal intercourse (CVAI) compared to those in the comparison group (aOR = 0.49; 95 % CI 0.25-0.98; p = 0.044). The intervention was associated with significantly lower odds of condomless anal intercourse with male partners (aOR = 0.55; 95 % CI 0.34-0.91; p = 0.020) but not with female partners and serodiscordant sex with male partners but not with female partners. Future studies are needed to replicate these findings in larger and more diverse samples of BMSMW and to understand the underlying mechanisms through which intervention efficacy was achieved.
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Equality in sexual health promotion: a systematic review of effective interventions for black and minority ethnic men who have sex with men. BMC Public Health 2016; 16:810. [PMID: 27534390 PMCID: PMC4989329 DOI: 10.1186/s12889-016-3418-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decade, new diagnoses of HIV have increased eightfold among men who have sex with men (MSM) of other or of mixed ethnicity in the UK. Yet there is little intervention research on HIV among black and minority ethnic (BME) MSM. This article aimed to identify effective HIV and sexual health prevention strategies for BME MSM. METHODS We searched three databases PubMed, Scopus and PsychInfo using a combination of search terms: MSM or men who have sex with men and women (MSMW); Black and Minority Ethnic; HIV or sexual health; and evaluation, intervention, program* or implementation. We identified a total of 19 studies to include in the review including those which used randomised control, pre/post-test and cross-sectional design; in addition, we included intervention development studies. RESULTS A total of 12 studies reported statistically significant results in at least one of the behavioural outcomes assessed; one study reported significant increases in HIV knowledge and changes in safer sex practices. In 10 studies, reductions were reported in unprotected anal intercourse (UAI), number of sexual partners, or in both of these measures. Six out of the 13 studies reported reductions in UAI; while seven reported reductions in number of sexual partners. Seven were intervention development studies. CONCLUSIONS Research into the mechanisms and underpinnings of future sexual health interventions is urgently needed in order to reduce HIV and other sexually transmitted infection (STI) among UK BME MSM. The design of interventions should be informed by the members of these groups for whom they are targeted to ensure the cultural and linguistic sensitivity of the tools and approaches generated.
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An evaluation of factors associated with sexual risk taking among Black men who have sex with men: a comparison of younger and older populations. J Behav Med 2016; 39:665-74. [PMID: 27001255 DOI: 10.1007/s10865-016-9734-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/14/2016] [Indexed: 01/23/2023]
Abstract
In the United States, rates of human immunodeficiency virus (HIV) infection are highest among Black men who have sex with men (BMSM). Prior research indicates that younger BMSM in particular (i.e., BMSM 29 years of age and younger) are most at risk for HIV infection, and that HIV incidence in this subpopulation has risen in recent years. It remains unclear, however, why younger BMSM, relative to BMSM 30 years of age and older, are at increased risk for HIV infection. For the current study, we surveyed 450 BMSM located in the Atlanta, GA metropolitan and surrounding areas. We assessed BMSM's depressive symptoms, substance use during sex, psycho-social risk factors (i.e., HIV risk perceptions, condom use self-efficacy, internalized homophobia, and perceived HIV stigmatization), and sexual risk taking (i.e., condomless anal intercourse [CAI]). We found that younger BMSM (YBMSM) and older BMSM (OBMSM) differed with respect to factors associated with CAI. In multivariable models, alcohol use before or during sex, lower educational attainment, and sexual orientation (i.e., bisexual sexual orientation) were significantly associated with increased CAI for YBMSM, while HIV risk perceptions and internalized homophobia were significantly, negatively associated with CAI among OBMSM. Rates of engaging in CAI were similar across the two age cohorts; however, factors related to CAI varied by these two groups. Findings emphasize the need to consider targeted interventions for different generational cohorts of BMSM.
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Williams JK, Wilton L, Magnus M, Wang L, Wang J, Dyer TP, Koblin BA, Hucks-Ortiz C, Fields SD, Shoptaw S, Stephenson R, O'Cleirigh C, Cummings V. Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV Among Black Men Who Have Sex With Men in 6 US Cities. Am J Public Health 2015; 105:2473-81. [PMID: 26469666 DOI: 10.2105/ajph.2015.302878] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM). METHODS Participants were 1522 Black MSM recruited from 6 US cities between July 2009 and December 2011. Univariate and multivariable logistic regression models were used. RESULTS Participants reported sex before age 12 years with someone at least 5 years older (31.1%), unwanted sex when aged 12 to 16 years (30%), IPV (51.8%), and depression (43.8%). Experiencing CSA when aged 12 to 16 years was inversely associated with any receptive condomless anal sex with a male partner (adjusted odds ratio [AOR] = 0.50; 95% confidence interval [CI] = 0.29, 0.86). Pressured or forced sex was positively associated with any receptive anal sex (AOR = 2.24; 95% CI = 1.57, 3.20). Experiencing CSA when younger than 12 years, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were positively associated with having more than 3 male partners in the past 6 months. Among HIV-positive MSM (n = 337), CSA between ages 12 and 16 years was positively associated with having more than 3 male partners in the past 6 months. CONCLUSIONS Rates of CSA, IPV, and depression were high, but associations with HIV sexual risk outcomes were modest.
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Affiliation(s)
- John K Williams
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Leo Wilton
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Manya Magnus
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lei Wang
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jing Wang
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Typhanye Penniman Dyer
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Beryl A Koblin
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christopher Hucks-Ortiz
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sheldon D Fields
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Steve Shoptaw
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rob Stephenson
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Conall O'Cleirigh
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Vanessa Cummings
- John K. Williams is with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Leo Wilton is with College of Community and Public Affairs, Department of Human Development, Binghamton University, Binghamton, NY. Manya Magnus is with the Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC. Lei Wang and Jing Wang are with the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Typhanye Penniman Dyer is with the Department of Epidemiology and Biostatistics, University of Maryland, College Park. Beryl A. Koblin is with New York Blood Center, Laboratory of Infectious Disease Prevention, New York, NY. Christopher Hucks-Ortiz is with the Department of Family Medicine, UCLA. Sheldon D. Fields is with the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Steve Shoptaw is with the departments of Family Medicine and Psychiatry and Biobehavioral Sciences, UCLA. Rob Stephenson is with the Rollins School of Public Health, Emory University, Atlanta, GA. Conall O'Cleirigh is with Fenway Institute HIV Clinical Research Support (CRS), Fenway Community Health Center, Boston, MA. Vanessa Cummings is with the Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
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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: 17] [Impact Index Per Article: 1.9] [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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Asare Bempong G, Ramamurthi HC, McCuller J, Williams JK, Harawa NT. Recruiting Black Men Who Have Sex with Men and Women (BMSMW) in an Urban Setting for HIV Prevention Research. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 6:408. [PMID: 25984392 PMCID: PMC4433157 DOI: 10.4172/2155-6113.1000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Concerns related to stigma and confidentiality limit HIV-related study recruitment and retention of Black men who have sex with men and women (MSMW). This paper examines lessons learned from recruitment strategies utilized in enrolling 437 participants between 2007 and 2011 for a randomized controlled trial to test a culturally specific HIV risk-reduction intervention for Black MSMW. METHODS Interested respondents completed a brief screener and participants completed surveys at baseline and at post, 3 and 6 months follow-up. Recruitment patterns were assessed by examining the source of study information reported when respondents were asked how they learned about the study. Chi-square tests were then conducted to examine differences in the distribution of participants by self-reported HIV status, age group and socio-economic status (SES) for each type of study information source. RESULTS Regardless of HIV or SES, study respondents were more likely to have received information about the study through a service agency than from other sources. Participants ages 30-49 and 50+ years were most likely to have learned about the study from an agency (34.9% and 27.0%, respectively) or another participant/friend (20.1%, 23.1%) and least likely to have found out from bus (0.8%, 0.0%) or radio (1.3%, 0.0%) advertisements; whereas younger participants were more likely to have heard about the study through a friend/participant (23.4%) than an agency (15.4%). Although, 14.1% of participants' ages less than 30 years reported the Internet as their source of study information, this compared to just 2.7% and 4.8% for participants in the 30-49 and 50-plus age groups. CONCLUSIONS While agencies and referrals from personal networks appear to be the most significant recruitment source for potential HIV research participants, there is evidence that Internet based tools may enhance recruitment, particularly among younger Black MSMW.
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Affiliation(s)
| | - Hema C. Ramamurthi
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Jason McCuller
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John K Williams
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Nina T Harawa
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Harawa NT, Obregon NB, McCuller WJ. Partnerships between Black Women and Behaviorally Bisexual Men: Implications for HIV Risk and Prevention. SEXUALITY & CULTURE 2014; 18:570-891. [PMID: 25422580 PMCID: PMC4239658 DOI: 10.1007/s12119-014-9227-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Although an estimated 87% of new HIV infections in Black/African American women are attributed to sex with men, many women are unaware of their male partners' HIV risk factors. Research on women who are aware of a high-risk male partner may inform HIV prevention. We analyzed transcripts from semi-structured interviews with 20 Black women who reported sex with at least one man who had sex with men and women (MSMW) in the prior 5 years. We applied Choice and Sexual Network theories to the interpretation. The majority described their partnerships as committed and involving emotional or instrumental support. Substance abuse was a common component of the relationships and very few involved consistent condom use. Although nearly all respondents described it as alarming to learn of their partners' involvement with other men and several ended the relationships, many continued the relationships without protective changes in their sex behavior. These narratives indicate that although many leave, many other women remain in relationships after learning of a male partners' high-risk activity. Substance abuse, financial instability, and a desire to remain in intimate partnerships may discourage preventive actions in these women.
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Affiliation(s)
- Nina T Harawa
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Nora B Obregon
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - William J McCuller
- Department of Research, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
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Jeffries WL. Beyond the bisexual bridge: sexual health among U.S. men who have sex with men and women. Am J Prev Med 2014; 47:320-9. [PMID: 24970239 DOI: 10.1016/j.amepre.2014.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 03/28/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Men who have sex with both men and women (MSMW) experience health problems in ways that distinguish them from men who only have sex with men (MSM) and men who only have sex with women (MSW). Historically, an undue focus on MSMW's potential role in transmitting HIV to women has resulted in limited understanding of these men's unique sexual health needs. This article discusses the sexual health of MSMW in the U.S. EVIDENCE ACQUISITION The author searched PubMed, Sociological Abstracts, PsycINFO, and GoogleScholar to acquire peer-reviewed studies pertaining to MSMW that were published during January 2008 and December 2013. Reference lists for these studies provided additional studies not acquired through this search. EVIDENCE SYNTHESIS MSMW are more likely than MSW to be infected with HIV. MSMW may be at increased risk for some other sexually transmitted infections (STIs) compared with both MSW and MSM. Some factors that affect their sexual health include unprotected sex, early sexual debut, forced sexual encounters, increased numbers of sexual partners, substance use, exchange sex, risk behaviors of their male and female partners, and pregnancy-related considerations. These factors uniquely shape MSMW's vulnerability to HIV/STIs and other sexual health problems. Anti-bisexual sentiment, socioeconomic marginalization, culturally specific masculine ideologies, and sexual identity can negatively influence their sexual partnerships and likelihood of disease acquisition. CONCLUSIONS Risk-reduction interventions alone are likely insufficient to improve MSMW's sexual health. Efforts should also address the social contexts affecting MSMW in order to decrease HIV/STI vulnerability and mitigate other barriers to MSMW's sexual health.
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Affiliation(s)
- William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Harawa N, Wilton L, Wang L, Mao C, Kuo I, Penniman T, Shoptaw S, Griffith S, Williams JK, Cummings V, Mayer K, Koblin B. Types of female partners reported by black men who have sex with men and women (MSMW) and associations with intercourse frequency, unprotected sex and HIV and STI prevalence. AIDS Behav 2014; 18:1548-59. [PMID: 24523006 DOI: 10.1007/s10461-014-0704-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We used baseline data from a study of Black MSM/MSMW in 6 US cities to examine the association of female partnership types with disease prevalence and sexual behaviors among the 555 MSMW participants. MSMW reported more than three times as many total and unprotected sex acts with each primary as they did with each non-primary female partner. We compared MSMW whose recent female partners were: (1) all primary ("PF only", n = 156), (2) both primary and non-primary ("PF & NPF", n = 186), and (3) all non-primary ("NPF only", n = 213). HIV/STI prevalence did not differ significantly across groups but sexual behaviors did. The PF only group had the fewest male partners and was the most likely to have only primary male partners; the PF & NPF group was the most likely to have transgender partners. PF & NPF men reported the most sex acts (total and unprotected) with females; NPF only men reported the fewest. Implications for HIV risk and prevention are discussed.
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Affiliation(s)
- N Harawa
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90059, USA,
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HIV risk-reduction counseling and testing on behavior change of MSM. PLoS One 2013; 8:e69740. [PMID: 23922787 PMCID: PMC3726787 DOI: 10.1371/journal.pone.0069740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/11/2013] [Indexed: 12/02/2022] Open
Abstract
HIV and AIDS incidence in China is high among men who have sex with men (MSM) and ours was one of few studies in China to evaluate the role of HIV risk reduction counseling and testing. Respondent-driven sampling (RDS) was used to recruit 430 MSM. Participants were followed up at 6, 12 and 18 months to evaluate behavioral changes after counseling to reduce risk behaviors. At baseline, HIV prevalence was 4.7%, whereas HIV incidence was 5.2 per 100 person-years. The incidence was 3.8 during six to 12 months, and 1.1 during 12 to 18 months. During the study period, the reported unprotected anal intercourse (UAI) significantly decreased from 60.9% to 42.9%. The proportion of participants who had one or no partner significantly increased from 40.9% to 48.0%. The study also found that some risk behaviors decreased between baseline and 12 months, followed by a slight increase between 12 and 18 months. Reductions in UAI can be achieved through counseling and testing, but may wane over time. Future programs should consider HIV risk-reduction counseling and testing for interventions in MSM in China.
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