1
|
Camacho D, Bhattacharya A, Moore K, Aranda MP, Lukens EP. Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities. METHODOLOGICAL INNOVATIONS 2023; 16:359-373. [PMID: 38469125 PMCID: PMC10927001 DOI: 10.1177/20597991231202866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.
Collapse
Affiliation(s)
- David Camacho
- Department of Disability and Human Development, University of Illinois Chicago, Chicago, IL, USA
| | - Anindita Bhattacharya
- School of Social Work & Criminal Justice, University of Washington Tacoma, Tacoma, WA, USA
| | - Kiara Moore
- Silver School of Social Work, New York University, New York, NY, USA
| | - Maria P Aranda
- USC Suzanne Dworak-Peck School of Social Work, Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| | - Ellen P Lukens
- School of Social Work, Columbia University, New York, NY, USA
| |
Collapse
|
2
|
Mayo D, Lozano A, Williams RS, Safren SA, Harkness A. The Relationship Between Intersectional Oppression and Affirmation and Latino Sexual Minority Men's Mental Health. LGBT Health 2023; 10:629-638. [PMID: 37466482 PMCID: PMC10712364 DOI: 10.1089/lgbt.2022.0212] [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: 07/20/2023] Open
Abstract
Purpose: Latino sexual minority men (LSMM) may experience oppression based on their ethnicity, sexual orientation, and migratory status, yet scientific literature is only beginning to explore the intersection of these experiences. This study examined mental health (MH) in relation to LSMM's experiences of intersectional oppression and affirmation. Methods: We conducted a secondary analysis of baseline data from a cohort study examining LSMM's (n = 290) health care engagement in Miami, FL, from February to September 2020. Latent class analysis (LCA) identified classes based on self-reported multiple identity discrimination (e.g., race, ethnicity, and skin color), sexual orientation stigma/affirmation, and migration-related stress. Logistic and linear regressions examined associations between class membership and anxious, depressive, post-traumatic stress, somatic symptoms, and overall MH burden. Results: The LCA revealed a three-class solution: (1) affirmed LSMM (73.8%), (2) LSMM with intersectional oppression (21.7%), and (3) LSMM with immigration stress (4.5%). The three classes varied in terms of multiple identity discrimination, sexual orientation stigma/affirmation, and migration-related stress. Compared with Class 1, Class 2 had greater conditional probabilities of reporting clinically significant depressive (p = 0.033) and post-traumatic stress symptoms (p = 0.031), and at least one MH concern (p = 0.018). Greater depressive symptoms (p = 0.007), post-traumatic stress symptoms (p = 0.049), somatic symptoms (p = 0.024), and clinically significant MH concerns (p = 0.018) were found among Class 2 than among Class 1. Conclusion: Findings identified three groups of LSMM based on their experiences of intersectional oppression and affirmation. Discrimination at the intersection of multiple identities, sexual orientation stigma/affirmation, and migration-related stress were associated with LSMM's MH outcomes, particularly among immigrants.
Collapse
Affiliation(s)
- Daniel Mayo
- College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Alyssa Lozano
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
| | | | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
3
|
Zhang J, Zheng L. Adverse Childhood Experiences Predict Preference for Male Facial Masculinity in Gay Men in China. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1007/s40806-022-00317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Scheer JR, Clark KA, Talan A, Cabral C, Pachankis JE, Rendina HJ. Longitudinal associations between childhood sexual abuse-related PTSD symptoms and passive and active suicidal ideation among sexual minority men. CHILD ABUSE & NEGLECT 2021; 122:105353. [PMID: 34638046 PMCID: PMC8612966 DOI: 10.1016/j.chiabu.2021.105353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sexual minority men report high rates of childhood sexual abuse (CSA) and adulthood suicidality. However, mechanisms (e.g., PTSD symptoms) through which CSA might drive suicidality remain unknown. OBJECTIVE In a prospective cohort of sexual minority men, we examined: (1) associations between CSA and suicidal thoughts and behaviors; (2) prospective associations between CSA-related PTSD symptoms and suicidal ideation; and (3) interpersonal moderators of these associations. PARTICIPANTS AND SETTING Participants included 6305 sexual minority men (Mage = 33.2, SD = 11.5; 82.0% gay; 53.5% White) who completed baseline and one-year follow-up at-home online surveys. METHODS Bivariate analyses were used to assess baseline demographic and suicidality differences between CSA-exposed participants and non-CSA-exposed participants. Among CSA-exposed participants, multivariable logistic regression analyses were used to regress passive and active suicidal ideation at one-year follow-up on CSA-related PTSD symptoms at baseline. Interactions were examined between CSA-related PTSD symptoms and interpersonal difficulties. RESULTS CSA-exposed sexual minority men reported two-and-a-half times the odds of suicide attempt history compared to non-CSA-exposed men (95% CI = 2.15-2.88; p < 0.001). Among CSA-exposed sexual minority men, CSA-related PTSD symptoms were prospectively associated with passive suicidal ideation (adjusted odds ratio [aOR] = 1.38; 95% CI = 1.19; 1.61). Regardless of CSA-related PTSD symptom severity, those with lower social support and greater loneliness were at elevated risk of active suicidal ideation at one-year follow-up. CONCLUSIONS CSA-related PTSD symptom severity represents a psychological mechanism contributing to CSA-exposed sexual minority men's elevated suicide risk, particularly among those who lack social support and report loneliness.
Collapse
Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse NY 13244, USA.
| | - Kirsty A Clark
- Department of Medicine, Health & Society, Vanderbilt University, Nashville, TN 37212, USA
| | - Ali Talan
- Whitman-Walker Institute, Inc., Washington, DC 20009, USA
| | - Cynthia Cabral
- Counseling and Wellness Center, St. Joseph's College, Brooklyn, NY 11205, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - H Jonathon Rendina
- Whitman-Walker Institute, Inc., Washington, DC 20009, USA; Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| |
Collapse
|
5
|
Siconolfi D, Storholm ED, Vincent W, Pollack L, Rebchook GM, Huebner DM, Peterson JL, Kegeles SM. Prevalence and Correlates of Sexual Violence Experienced by Young Adult Black Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3621-3636. [PMID: 34725750 PMCID: PMC9473496 DOI: 10.1007/s10508-021-02011-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 05/06/2023]
Abstract
Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15-2.77), lower psychological resilience (OR 0.84; 95% CI 0.71-0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80-8.02), recent financial hardship (OR 2.16; 95% CI 1.48-3.14), and recent transactional sex (OR 3.87; 95% CI 2.43-6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.
Collapse
Affiliation(s)
| | - Erik D Storholm
- RAND, Santa Monica, CA, USA
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lance Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David M Huebner
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - John L Peterson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
6
|
Ménard AD, MacIntosh HB. Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:298-331. [PMID: 33403939 DOI: 10.1080/10538712.2020.1869878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Childhood sexual abuse (CSA) is a global problem with serious repercussions for survivors in various domains of adult interpersonal functioning, including sexual risk behavior. This review aimed to summarize findings from the recent literature on the connections between CSA and later adult sexual risk behaviors (e.g., unprotected intercourse, sexually transmitted infection [STSI] diagnosis). The sexual risk behaviors consistently associated with CSA were having sex under the influence of alcohol/substances and reports of concurrent sexual partners/infidelity. Notably, studies investigating the links between CSA and history of STI diagnosis and CSA and reports of unprotected sex (with the exception of samples comprised men who have sex with men) produced inconsistent findings. The methodological limitations of existing studies are considered and suggestions for future research are offered.
Collapse
|
7
|
Jeffries WL, Flores SA, Rooks-Peck CR, Gelaude DJ, Belcher L, Ricks PM, Millett GA. Experienced Homophobia and HIV Infection Risk Among U.S. Gay, Bisexual, and Other Men Who Have Sex with Men: A Meta-Analysis. LGBT Health 2020; 8:1-10. [PMID: 33372845 DOI: 10.1089/lgbt.2020.0274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Experienced homophobia-negative treatment and perceptions that gay, bisexual, and other men who have sex with men (MSM) encounter because of their sexual orientations-may promote HIV infection among MSM. We conducted a rapid review and meta-analysis to examine experienced homophobia in relation to HIV infection risk. Methods: We searched Embase, MEDLINE, PsycINFO, and Sociological Abstracts to acquire data from U.S. studies published during 1992-2017. Studies examined experienced homophobia in relation to sexual risk behavior, poor HIV care continuum engagement, and diagnosed HIV infection. Random-effects models yielded summary odds ratios (ORs) and 95% confidence intervals (CIs). Results: Experienced homophobia was associated with having any sexual risk behavior (OR = 1.33, 95% CI = 1.25-1.42, I2 = 89.2%), receptive condomless anal sex (CAS) (OR = 1.33, 95% CI = 1.14-1.56, I2 = 63.6%), HIV-discordant CAS (OR = 1.66, 95% CI = 1.29-2.13, I2 = 85.3%), an increased number of sex partners (OR = 1.16, 95% CI = 1.13-1.19, I2 = 0.0%), diagnosed HIV infection (OR = 1.34, 95% CI = 1.10-1.64, I2 = 86.3%), and poor HIV care continuum engagement among MSM living with HIV (OR = 1.45, 95% CI = 1.02-2.08, I2 = 47.0%). Effect sizes for any sexual risk behavior were larger in samples with ≥50% Black or Latino (vs. White) MSM and for family-based mistreatment and perceived sexual minority stigma (vs. other homophobia types). Conclusion: Experienced homophobia is associated with HIV infection risk among MSM. Its association with sexual risk behavior may be stronger among Black and Latino (vs. White) MSM and for family-based mistreatment and perceived sexual minority stigma (vs. other homophobia types). Research is needed to better understand causality in these relationships and the role of interventions to reduce homophobia.
Collapse
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, USA
| | - Stephen A Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cherie R Rooks-Peck
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah J Gelaude
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip M Ricks
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregorio A Millett
- amfAR, The Foundation for AIDS Research, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Scheer JR, Antebi-Gruszka N. A Psychosocial Risk Model of Potentially Traumatic Events And Sexual Risk Behavior Among LGBTQ Individuals. J Trauma Dissociation 2019; 20:603-618. [PMID: 30932780 PMCID: PMC7009774 DOI: 10.1080/15299732.2019.1597815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/19/2019] [Indexed: 10/27/2022]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face heightened risk of potentially traumatic events (PTEs) exposure, including hate crimes and childhood abuse. Past research demonstrates associations between PTEs exposure and sexual risk behavior; however, examining the indirect effect of PTEs on sexual risk behavior remains understudied among LGBTQ individuals. This study tested a path analysis model to inform interventions targeted to reduce sexual risk behavior, as conceptualized by condomless sex with casual partners without knowing the person's HIV or sexually transmitted infection (STI) status, among LGBTQ individuals with PTEs exposure. Participants completed an online one-time survey and included 207 LGBTQ adults who experienced at least one PTE during the past year. Indirect effect results indicated that PTEs exposure was related to sexual risk behavior through serial associations between shame, loneliness, and substance use. Direct effect estimates indicated that greater PTEs exposure was associated with greater shame, loneliness, substance use, and sexual risk behavior. Greater shame was associated with greater loneliness, which was associated with greater substance use. Also, greater substance use was associated with greater sexual risk behavior. This study adds to the burgeoning body of literature on the relationship between PTEs exposure and sexual risk behavior among LGBTQ individuals. Clinical and counseling interventions for LGBTQ individuals with PTEs exposure should work to address modifiable psychosocial risk factors associated with sexual risk behavior.
Collapse
Affiliation(s)
- Jillian R. Scheer
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Nadav Antebi-Gruszka
- Department of Psychology, City College of New York, City University of New York (CUNY), New York, NY, USA
| |
Collapse
|
9
|
O'Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs MS, Shipherd JC. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS Behav 2019; 23:2421-2431. [PMID: 30993478 PMCID: PMC7271561 DOI: 10.1007/s10461-019-02482-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.
Collapse
Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- The Fenway Institute of Fenway Health, Boston, MA, USA.
| | - Steven A Safren
- The Fenway Institute of Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - S Wade Taylor
- The Fenway Institute of Fenway Health, Boston, MA, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Brett M Goshe
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Samantha M Marquez
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute of Fenway Health, Boston, MA, USA
| | | | - Jillian C Shipherd
- VA Boston Healthcare System, Boston, MA, USA
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- Department of Veterans Affairs, LGBT Health Program, Washington, DC, USA
- Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
10
|
Harris OO, Dunn LL. "I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1227-1238. [PMID: 29951864 DOI: 10.1007/s10508-018-1219-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.
Collapse
Affiliation(s)
- Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, 2 Koret Way, N 505E, PO Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Leith Lorraine Dunn
- Gender Development Studies, Mona Campus Unit, University of the West Indies, Kingston, Jamaica
| |
Collapse
|
11
|
Taggart TC, Rodriguez-Seijas C, Dyar C, Elliott JC, Thompson RG, Hasin DS, Eaton NR. Sexual orientation and sex-related substance use: The unexplored role of bisexuality. Behav Res Ther 2019; 115:55-63. [PMID: 30594299 PMCID: PMC6409130 DOI: 10.1016/j.brat.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023]
Abstract
Using alcohol and drugs in sexual contexts is associated with negative health consequences, including increased risk for HIV/STIs, sexual victimization, unplanned pregnancies, and overdose. Evidence suggests millions of adults regularly use alcohol in sexual contexts, thus increasing their risk for these consequences. However, no nationally representative estimates exist for rates of regular alcohol and/or drug use in sexual contexts. Additionally, previous studies suggest sexual minority individuals are more likely to use substances in sexual contexts than heterosexuals; however, none of these studies examined for multiple dimensions or subgroups of sexual orientation. Thus, using two distinct datasets-one large, nationally representative sample (N = 17,491) and an Internet-collected convenience sample (N = 1001)-we explored the associations between sexual orientation (dimensions and subgroups) and rates of regular sex-related alcohol and/or drug use in American adults. Results showed that sexual minority individuals were significantly more likely to report regularly using substances in sexual contexts compared to heterosexuals; however, results varied based on dimension of sexual orientation and by sex. Across both samples, bisexual individuals exhibited the highest rates of regular sex-related substance use. Findings suggest that sexual minorities, and bisexual individuals in particular, may be at increased risk for regular sex-related substance use and its associated negative health consequences. Future research should include nuanced and multidimensional assessments of sexual orientation to investigate sex-related alcohol and/or drug use and its associated risks, as well as examine the potential direct and indirect pathways by which these disparities may be conferred.
Collapse
Affiliation(s)
- Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | | | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Well-being, Northwestern University, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
12
|
Mattera B, Levine EC, Martinez O, Muñoz-Laboy M, Hausmann-Stabile C, Bauermeister J, Fernandez MI, Operario D, Rodriguez-Diaz C. Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men. CULTURE, HEALTH & SEXUALITY 2018; 20:607-624. [PMID: 28929893 PMCID: PMC5959808 DOI: 10.1080/13691058.2017.1367420] [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] [Indexed: 06/01/2023]
Abstract
While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.
Collapse
Affiliation(s)
- Brian Mattera
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ethan C. Levine
- College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Miguel Muñoz-Laboy
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | | | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - M. Isa Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
| | | |
Collapse
|
13
|
Levine EC, Martinez O, Mattera B, Wu E, id SA, Rutledge SE, Newman B, Icard L, Muñoz-Laboy M, Hausmann-Stabile C, Welles S, Rhodes SD, Dodge BM, Alfonso S, Fernandez MI, Carballo-Diéguez A. Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men. JOURNAL OF CHILD SEXUAL ABUSE 2018; 27:237-253. [PMID: 28718707 PMCID: PMC5773409 DOI: 10.1080/10538712.2017.1343885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals' likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.
Collapse
Affiliation(s)
- Ethan Czuy Levine
- Department of Sociology, Temple University, Philadelphia, Pennsylvania, USA
| | - Omar Martinez
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Brian Mattera
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Elwin Wu
- School of Social Work, Columbia University, New York, New York, USA
| | | | - Scott Edward Rutledge
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Bernie Newman
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Larry Icard
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Miguel Muñoz-Laboy
- College of Public Health, School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Seth Welles
- School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Scott D. Rhodes
- Wake Forest University Medical Center, Winston-Salem, North Carolina, USA
| | - Brian M. Dodge
- School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, USA
| | - Sarah Alfonso
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - M. Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | | |
Collapse
|
14
|
Downing MJ, Brown D, Steen J, Benoit E. Understanding the Impact of Childhood Sexual Abuse on Men's Risk Behavior: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e62. [PMID: 29483063 PMCID: PMC5847822 DOI: 10.2196/resprot.9071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood sexual abuse (CSA) remains a critical public health issue among black and Latino men who have sex with men (MSM), as it is associated with multiple negative outcomes including substance misuse, poor mental health, revictimization, and high-risk sexual behavior. Most CSA research with MSM relies on quantitative assessment that often precludes consideration of cultural variations in how formative sexual experiences are understood and is based on inconsistent or overly restrictive definitions of abuse, and therefore may fail to detect certain abusive experiences (eg, those involving female perpetrators), which can have harmful health consequences if they remain unrecognized. OBJECTIVE The objective of this study is to overcome existing limitations in the literature by drawing on perspectives of black and Latino MSM and men who have sex with men and women (MSMW), as well as relevant service providers to better understand the role of, and the need to include, sexual abuse histories (eg, CSA) in treatment and counseling settings, with the long-term goal of improving assessment and health outcomes. METHODS We will conduct mixed-methods interviews, framed by an intersectionality approach, with 80 black and Latino men (40 MSM and 40 MSMW) in New York City (NYC), exploring appraisals of their formative sexual experiences, including those described as consensual but meeting criteria for CSA. We will also interview 30 local service providers representing substance abuse treatment, mental health care, and HIV prevention and outreach. RESULTS The study was launched in May 2017. CONCLUSIONS This formative research will inform testable approaches to assessing and incorporating sexual abuse history into substance abuse treatment and other health and mental health services used by men with such histories.
Collapse
Affiliation(s)
| | - Dominique Brown
- National Development and Research Institutes, Inc, New York, NY, United States
| | - Jeffrey Steen
- School of Social Work, Bridgewater State University, Bridgewater, MA, United States
| | - Ellen Benoit
- National Development and Research Institutes, Inc, New York, NY, United States
| |
Collapse
|
15
|
Wells BE, Starks TJ, Robel E, Kelly BC, Parsons JT, Golub SA. From Sexual Assault to Sexual Risk: A Relational Pathway? JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:3377-3395. [PMID: 25944835 PMCID: PMC4635062 DOI: 10.1177/0886260515584353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ2(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.
Collapse
Affiliation(s)
- Brooke E Wells
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Tyrel J Starks
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Erika Robel
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Brian C Kelly
- Hunter College and Graduate Center of the City University of New York, NY, USA
- Purdue University, West Lafayette, IN, USA
| | - Jeffrey T Parsons
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Sarit A Golub
- Hunter College and Graduate Center of the City University of New York, NY, USA
| |
Collapse
|
16
|
Alarcón RD, Parekh A, Wainberg ML, Duarte CS, Araya R, Oquendo MA. Hispanic immigrants in the USA: social and mental health perspectives. Lancet Psychiatry 2016; 3:860-70. [PMID: 27568273 DOI: 10.1016/s2215-0366(16)30101-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Abstract
Hispanic immigration in the USA and its effect on many areas of US society are of great relevance to health care, public health, mental health, and medical and social sciences. In this report, we review and discuss pertinent literature on causes, procedures, and eventual outcomes of Hispanic migration waves throughout the last four decades. Hispanic immigrants do not constitute a monolithic group, despite the clear predominance of Mexican and Mexican-American segments. Common features of Hispanic immigrants include a younger average age, higher presence of married households, and lower educational levels than the overall US population. Differences within the Hispanic immigrant population are present in naturalisation figures, English language fluency, occupational and income status, health insurance coverage, and sense of accomplishment in the host society. We examine most of these aspects in the context of the so-called Hispanic paradox, presented as both a cause and a result of a heavily discussed acculturative process. We investigate prevalence and other data on depression, anxiety, substance abuse, and psychotic syndromes, with emphasis on the need to do further neurobiological, epigenetic, and sociocultural research in the Hispanic population.
Collapse
Affiliation(s)
- Renato D Alarcón
- Mayo Medicine School, Mayo Clinic, Rochester, MN, USA; Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Milton L Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Ricardo Araya
- London School of Hygiene & Tropical Medicine, London, UK
| | - María A Oquendo
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
17
|
Sauceda JA, Wiebe JS, Simoni JM. Childhood sexual abuse and depression in Latino men who have sex with men: Does resilience protect against nonadherence to antiretroviral therapy? J Health Psychol 2016; 21:1096-106. [PMID: 25156387 PMCID: PMC4476931 DOI: 10.1177/1359105314546341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study tested depression as a mediator between childhood sexual abuse and adherence to antiretroviral therapy, an effect moderated by resilience. In total, 149 HIV+ Latino men who have sex with men were recruited for this study. Using a regression-based bootstrap approach, depression mediated the relationship between childhood sexual abuse and antiretroviral therapy adherence, with worse adherence for participants at lowest percentiles of the resilience index. The prevalence of childhood sexual abuse and depression in HIV+ men who have sex with men is high and must be addressed to better prevent disease progression and reduce transmission, especially in expanding Latino populations.
Collapse
|
18
|
De Santis JP, Provencio-Vasquez E, Mata HJ, Martinez J. Depression and Co-Occurring Health Determinants of Hispanic Men with HIV Infection in the U.S.-Mexico Border Region: A Pilot Study. JOURNAL OF SOCIAL SERVICE RESEARCH 2016; 42:305-312. [PMID: 27375306 PMCID: PMC4927083 DOI: 10.1080/01488376.2015.1112872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV infection among Hispanic men is a public health concern. Certain factors have been identified that may contribute to the high rates of HIV infection among Hispanic men such as migration, acculturation, poverty, and depression. Hispanic men with HIV infection are at risk for additional co-occurring health issues. Given limited research few studies have focused specifically on Hispanic men with HIV infection residing in a U.S.-Mexico border community. This pilot study surveyed participants (n = 39), to better understand co-occurrence of health determinants, especially depression among Hispanic men with HIV infection. The study's findings indicate that clinicians need to be aware that factors may influence depression among people with Hispanic men with HIV infection. Clinicians also need awareness of the impact of depression on adherence to HIV care and treatment among Hispanic men with HIV infection. More research is needed to explore the relationship of HIV-related stigma, HIV disclosure, social support, and depression among Hispanic men with HIV infection.
Collapse
Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, FL USA 33146
| | | | - Holly J Mata
- University of Texas at El Paso School of Nursing, El Paso, TX USA 79968
| | - Jacob Martinez
- University of Miami School of Nursing & Health Studies, Coral Gables, FL USA 33146
| |
Collapse
|
19
|
Lopez-Patton M, Kumar M, Jones D, Fonseca M, Kumar AM, Nemeroff CB. Childhood trauma and METH abuse among men who have sex with men: Implications for intervention. J Psychiatr Res 2016; 72:1-5. [PMID: 26519763 PMCID: PMC5473624 DOI: 10.1016/j.jpsychires.2015.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
Methamphetamine (METH) has become one of the most widely abused drugs in South Florida, particularly among MSM who may or may not be HIV seropositive. High rates of childhood trauma have been reported among HIV-infected MSM (Chartier et al., 2010), but, the association of childhood trauma, and mood disorders with methamphetamine use in HIV-infected men, has not been comprehensively explored. A better understanding of the association between these factors could improve existing substance abuse treatment intervention strategies and medical treatment programs (e.g., medication adherence; Carrico, 2010) to enhance positive health outcomes for male meth abusers living with the psychological consequences of childhood abuse. This study, as part of a larger study, examined the occurrence of childhood trauma and depression in a group of HIV seropositive METH abusing MSM. Significantly higher levels of depression symptom severity were found among METH users relative to non-METH users (p < .001). Irrespective of HIV status, METH users also reported higher frequencies of emotional, physical and sexual child abuse relative to non-METH users (p < .001). Among meth users, depression was predicted by childhood emotional neglect. These results suggest that childhood maltreatment may be implicated in the development of emotional distress (e.g., depression) and higher prevalence of methamphetamine/drug abuse in this population. These findings have important implications for substance abuse interventions, specifically targeting METH addiction among MSM. Addressing childhood trauma and depression may play a key role in enhancing the effectiveness of interventions for methamphetamine addiction.
Collapse
Affiliation(s)
- Maria Lopez-Patton
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Blanco L, Nydegger LA, Camarillo G, Trinidad DR, Schramm E, Ames SL. Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review. Neurosci Biobehav Rev 2015; 57:63-9. [PMID: 26363666 DOI: 10.1016/j.neubiorev.2015.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 07/19/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Review literature focused on neurological associations in brain structure among individuals with a history of childhood sexual abuse (CSA). METHODOLOGY A review of literature examining physiological irregularities in brain structures of individuals with a history of CSA was conducted. RESULTS Results revealed that a history of CSA was associated with irregularities in the cortical and subcortical regions of the brain. These irregularities have been recognized to contribute to various cognitive, behavioral, and psychological health outcomes later in life. Age of CSA onset was associated with differential neurological brain structures. CONCLUSION Mental and behavioral health problems such as anxiety, depression, substance abuse, dissociative disorders, and sexual dysfunction are associated with CSA and may persist into adulthood. Research depicting the associations of CSA on neurological outcomes emphasizes the need to examine the biological and subsequent psychological outcomes associated with CSA. Early intervention is imperative for CSA survivors.
Collapse
Affiliation(s)
- Lyzette Blanco
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States; University of California, Davis, CA, United States.
| | - Liesl A Nydegger
- Center for Aids Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, United States; University of California, Davis, CA, United States
| | - Giselle Camarillo
- Center for Aids Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, United States; University of California, Davis, CA, United States
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States; University of California, Davis, CA, United States
| | - Emily Schramm
- Fred Finch Youth Center, Oakland, CA, United States; University of California, Davis, CA, United States
| | - Susan L Ames
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States; University of California, Davis, CA, United States
| |
Collapse
|
21
|
De Santis JP, Valdes B, Provencio-Vasquez E, Gattamorta KA. A Comparison by Sexual Orientation of Sexual Health and Sexual Behaviors among Hispanic Men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2015; 12:15-23. [PMID: 25663832 PMCID: PMC4315939 DOI: 10.1007/s13178-014-0170-9] [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: 05/28/2023]
Abstract
BACKGROUND/SIGNIFICANCE High rates of HIV infection and other sexually transmitted infections (STIs) related to high risk sexual behaviors are a public health problem in the U.S. Hispanics have the second highest rates of HIV infection among racial/ethnic minorities. Previous research with Hispanic men has identified a number of factors that influence sexual risk and render Hispanic men at risk for HIV/STIs. These factors vary by sexual orientation. Despite these differences in sexual risk by sexual orientation, no study to date has compared the sexual behaviors of Hispanic men by sexual orientation. OBJECTIVE The purpose of this study was to compare the sexual behaviors of a sample of Hispanic men by sexual orientation. METHOD A descriptive, cross-sectional design was used to collect data from 163 Hispanic men in South Florida, 80 heterosexual and 83 MSM. Participants completed measures of sexual health, sexual behaviors, and demographics. RESULTS No statistically significant differences were found between the two groups of men in terms of age of sexual debut, number of sexual partners during the previous 3 months, condom usage during the previous 3 months, HIV testing history, and substance use during sex. Statistically significant differences were found between the two groups of men in terms of certain STIs. IMPLICATIONS Hispanic men as a population may engage in high risk sexual behaviors that place them at risk for HIV/STIs. More research is needed to develop both culturally tailored and sexual orientation appropriate interventions to assist Hispanic men reduce high risk sexual behaviors.
Collapse
Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies Coral Gables, FL USA 33146
| | - Beatriz Valdes
- University of Miami School of Nursing & Health Studies Coral Gables, FL USA 33146
| | | | - Karina A Gattamorta
- University of Miami School of Nursing & Health Studies Coral Gables, FL USA 33146
| |
Collapse
|
22
|
Arreola S, Santos GM, Beck J, Sundararaj M, Wilson PA, Hebert P, Makofane K, Do TD, Ayala G. Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide. AIDS Behav 2015; 19:227-34. [PMID: 25086670 DOI: 10.1007/s10461-014-0869-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.
Collapse
|
23
|
Rhodes SD, McCoy TP. Condom use among immigrant Latino sexual minorities: multilevel analysis after respondent-driven sampling. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:27-43. [PMID: 25646728 PMCID: PMC4316741 DOI: 10.1521/aeap.2015.27.1.27] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study explored correlates of condom use within a respondent-driven sample of 190 Spanish-speaking immigrant Latino sexual minorities, including gay and bisexual men, other men who have sex with men (MSM), and transgender person, in North Carolina. Five analytic approaches for modeling data collected using respondent-driven sampling (RDS) were compared. Across most approaches, knowledge of HIV and sexually transmitted infections (STIs) and increased condom use self-efficacy predicted consistent condom use and increased homophobia predicted decreased consistent condom use. The same correlates were not significant in all analyses but were consistent in most. Clustering due to recruitment chains was low, while clustering due to recruiter was substantial. This highlights the importance accounting for clustering when analyzing RDS data.
Collapse
Affiliation(s)
- Scott D. Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake, Forest School of Medicine, Winston-Salem, NC
| | - Thomas P. McCoy
- School of Nursing, University of North Carolina, Greensboro, NC
| |
Collapse
|
24
|
Xu Y, Zheng Y. Prevalence of Childhood Sexual Abuse among Lesbian, Gay, and Bisexual People: A Meta-Analysis. JOURNAL OF CHILD SEXUAL ABUSE 2015; 24:315-331. [PMID: 25942288 DOI: 10.1080/10538712.2015.1006746] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In order to determine the prevalence of childhood sexual abuse among gay, lesbian, and bisexual individuals, we conducted a meta-analysis that compiled the results of 65 articles across 9 countries. The results revealed no significant difference in the prevalence of child sexual abuse between homosexual and bisexual people for both sexes. The prevalence of child sexual abuse among female sexual minorities was significantly higher than that among male sexual minorities. The lowest prevalence was found in South America, followed by Asia. The definition of child sexual abuse, dimension used to measure sexual orientation, year of data collection, and the mean age of participants at the time of assessment influenced the estimated prevalence of child sexual abuse. We conclude that many variables influence the reported prevalence of child sexual abuse among sexual minorities.
Collapse
Affiliation(s)
- Yin Xu
- a Southwest University , Chongqing , China
| | | |
Collapse
|
25
|
Schneeberger AR, Dietl MF, Muenzenmaier KH, Huber CG, Lang UE. Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1427-45. [PMID: 24643297 DOI: 10.1007/s00127-014-0854-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/27/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE Stressful childhood experiences (SCE) are associated with many different health outcomes, such as psychiatric symptoms, physical illnesses, alcohol and drug abuse, and victimization experiences. Lesbian, gay, bisexual, and transgender (LGBT) people are at risk to be victims of SCE and show higher prevalence of SCE when compared with heterosexual controls. METHODS This review analyzed systematically 73 articles that addressed different types of SCE in sexual minority populations and included items of household dysfunction. The samples included adults who identified either their sexual orientation as non-heterosexual or their gender identity as transgender. RESULTS The studies reported childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA), childhood physical neglect, and childhood emotional neglect. Items of household dysfunction were substance abuse of caregiver, parental separation, family history of mental illness, incarceration of caregiver, and witnessing violence. Prevalence of CSA showed a median of 33.5 % for studies using non-probability sampling and 20.7 % for those with probability sampling, the rates for CPA were 23.5 % (non-probability sampling) and 28.7 % (probability sampling). For CEA, the rates were 48.5 %, non-probability sampling, and 47.5 %, probability sampling. Outcomes related to SCE in LGBT populations included psychiatric symptoms, substance abuse, revictimization, dysfunctional behavioral adjustments, and others. CONCLUSIONS LGBT populations showed high prevalence of SCE. Outcomes related to SCE ranged from psychiatric symptoms and disorders to physical ailments. Most studies were based in the USA. Future research should aim to target culturally different LGBT population in the rest of the world.
Collapse
Affiliation(s)
- Andres R Schneeberger
- Psychiatrische Dienste Graubuenden (PDGR), Plazza Paracelsus 2, 7500, St. Moritz, Switzerland,
| | | | | | | | | |
Collapse
|
26
|
Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada. PLoS One 2014; 9:e100501. [PMID: 24963804 PMCID: PMC4070929 DOI: 10.1371/journal.pone.0100501] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/27/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population. Methods We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders. Results Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65–14.48), after controlling for potential confounders. Conclusion Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent need for screening of young gay and bisexual men for histories of violence, and social and structural supports to prevent HIV transmission in this population.
Collapse
|
27
|
Mann L, Valera E, Hightow-Weidman LB, Barrington C. Migration and HIV risk: life histories of Mexican-born men living with HIV in North Carolina. CULTURE, HEALTH & SEXUALITY 2014; 16:820-834. [PMID: 24866206 PMCID: PMC4313377 DOI: 10.1080/13691058.2014.918282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina, a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early-life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV-prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health.
Collapse
Affiliation(s)
- Lilli Mann
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, USA
| | | | - Lisa B. Hightow-Weidman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| |
Collapse
|
28
|
|
29
|
Icard LD, Jemmott JB, Teitelman A, O'Leary A, Heeren GA. Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men. CHILD ABUSE & NEGLECT 2014; 38:234-42. [PMID: 24041455 PMCID: PMC4075286 DOI: 10.1016/j.chiabu.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 05/25/2023]
Abstract
HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18-45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.
Collapse
Affiliation(s)
- Larry D Icard
- Center for Intervention and Practice Research, Temple University, College of Health Professions and Social Work, 1301 Cecil B. Moore Avenue, Ritter Annex, Suite B10, Philadelphia, PA 19121, USA
| | | | | | - Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
30
|
Allen VC, Myers HF, Williams JK. Depression among Black bisexual men with early and later life adversities. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2014; 20:128-37. [PMID: 24099486 PMCID: PMC4058315 DOI: 10.1037/a0034128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study examined the role of adulthood adversities in the relationship between childhood adversities and depression in 117 HIV-positive Black men who have sex with men and women (MSMW) and who have histories of childhood sexual abuse (CSA). Men were participants in the Enhanced Sexual Health Intervention for Men, a 6-session health intervention, and, at baseline, reported their experiences of CSA, childhood adversities, perceived discrimination, chronic stress, social support, and depressive symptoms. The relationship between childhood adversities, including CSA, and depression was mediated by experiences with racial and HIV discrimination, R² = .25, F(3, 112) = 12.67, p < .001, and chronic stress, R² = .17, F(3, 112) = 7.41, p < .001. Social support moderated the mediated effects of both racial and HIV discrimination, b = -.154, t(111) = -2.82, p < .01, and chronic stress, b = -.019, t(111) = -3.759, p < .01. Men's early adverse experiences were predictive of depression in adulthood; however, this relationship was largely affected by adulthood experiences, specifically discrimination, high chronic stress, and low social support. These findings illustrate pathways by which Black MSMW's early vulnerability for depression is either exacerbated or attenuated by their experiences as adults.
Collapse
Affiliation(s)
| | | | - John K Williams
- Department of Psychiatry & Behavioral Sciences, University of California
| |
Collapse
|
31
|
Hwahng SJ, Nuttbrock L. Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City. JOURNAL OF HOMOSEXUALITY 2014; 61:691-713. [PMID: 24294927 PMCID: PMC5711521 DOI: 10.1080/00918369.2014.870439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.
Collapse
Affiliation(s)
- Sel J Hwahng
- a Columbia University/Beth Israel Medical Center , New York , New York , USA
| | | |
Collapse
|
32
|
Anema A, Marshall BD, Stevenson B, Gurm J, Montaner G, Small W, Roth EA, Lima VD, Montaner JS, Moore D, Hogg RS. Intergenerational sex as a risk factor for HIV among young men who have sex with men: a scoping review. Curr HIV/AIDS Rep 2013; 10:398-407. [PMID: 24272070 PMCID: PMC4727934 DOI: 10.1007/s11904-013-0187-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men (YMSM). However, no studies have comprehensively evaluated literature in this area. We applied a scoping review methodology to explore the relationships between age mixing, HIV risk behavior, and HIV seroconversion among YMSM. This study identified several individual, micro-, and meso-system factors influencing HIV risk among YMSM in the context of intergenerational relationships: childhood maltreatment, coming of age and sexual identity, and substance use (individual-level factors); family and social support, partner characteristics, intimate partner violence, connectedness to gay community (micro-system factors); and race/ethnicity, economic disparity, and use of the Internet (meso-system factors). These thematic groups can be used to frame future research on the role of age-discrepant relationships on HIV risk among YMSM, and to enhance public health HIV education and prevention strategies targeting this vulnerable population.
Collapse
Affiliation(s)
- Aranka Anema
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2 Providence, Rhode Island, 02909 USA; t: 401-863-6427; f: 401-863-3713
| | - Benjamin Stevenson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
| | - Jasmine Gurm
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
| | - Gabriela Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive; Burnaby, BC, V5A 1S6; Canada; t:778-7824821;778-782-5927
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, PO Box 1700 STN CSC Victoria, BC; V8W 2Y2; Canada; t: 250-721-7046; f: N/A
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
- Faculty of Medicine, University of British Columbia, Experimental Medicine Program Department of Medicine; 10th Floor, Room 10203; Gordon and Leslie Diamond Health Care Centre; 2775 Laurel Street; Vancouver, BC V5Z 1M9. t: N/A; f: N/A
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
- Faculty of Medicine, University of British Columbia, Experimental Medicine Program Department of Medicine; 10th Floor, Room 10203; Gordon and Leslie Diamond Health Care Centre; 2775 Laurel Street; Vancouver, BC V5Z 1M9. t: N/A; f: N/A
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
- Faculty of Medicine, University of British Columbia, Experimental Medicine Program Department of Medicine; 10th Floor, Room 10203; Gordon and Leslie Diamond Health Care Centre; 2775 Laurel Street; Vancouver, BC V5Z 1M9. t: N/A; f: N/A
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital; 608-1081 Burrard St. Vancouver, British Columbia (BC), V6Z 1Y6, Canada; t: 604-6068477; f: 604-806-9044
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive; Burnaby, BC, V5A 1S6; Canada; t:778-7824821;778-782-5927
| |
Collapse
|
33
|
Male-on-male intimate partner violence and sexual risk behaviors among money boys and other men who have sex with men in Shanghai, China. Sex Transm Dis 2013; 40:362-5. [PMID: 23588124 DOI: 10.1097/olq.0b013e318283d2af] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is known to increase HIV risk among heterosexual women, but less is known about IPV and HIV among men who have sex with men (MSM), with almost no data from non-Western countries. This study examined the prevalence of IPV and links between IPV and HIV risks among MSM in Shanghai, China. METHODS A cross-sectional sample of 404 money boys (male sex workers) and other MSM were recruited via respondent-driven sampling. RESULTS Overall, 51% of the sample reported emotional, physical, or sexual abuse from a male sexual partner. Money boys reported more overall abuse than did other MSM, and more were likely than other MSM to report experiencing multiple types of abuse. MSM who reported violence or abuse from male partners reported more overall sexual risk behavior, and specifically, more unprotected sex and more sex linked to alcohol and other substance use. The association between experience of abuse from male partners and increased HIV risk did not differ between money boys and other Chinese MSM. CONCLUSIONS We conclude that violence and abuse from male partners are highly prevalent among Chinese MSM, and that experience of violence from male sexual partners is linked to increased HIV risk. HIV prevention targeting Chinese MSM must address the increased risk associated with experience of male-on-male IPV. Future research should explore links between HIV risk and MSM's perpetration of violence against male partners, as well as exploring the role of violence in the male-female relationships of men who have sex with and men and women.
Collapse
|
34
|
Pan SW, Ruan Y, Spittal PM, Pearce ME, Qian HZ, Li D, Zhang Z, Shao Y. HIV vulnerabilities and coercive sex at same-sex sexual debut among men who have sex with men in Beijing, China. AIDS Care 2013; 26:742-9. [PMID: 24099311 DOI: 10.1080/09540121.2013.845284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Few studies have examined coercive sex and HIV vulnerabilities among men who have sex with men (MSM) in China. The present study seeks to compare individual characteristics between MSM who did and did not experience coercive sex at their MSM sexual debut and to identify HIV risk factors correlated with coercive sex at MSM sexual debut. In 2007, we recruited 167 MSM in Beijing, China by peer-referred social network sampling. Each participant then completed self-administered questionnaires regarding their sexual experiences and practices. Results show that 14% of participants reported coercive sex at MSM sexual debut, of whom 48% reported recent unprotected anal intercourse (UAI). Coercive sex at MSM sexual debut was significantly associated with UAI [adjusted odds ratio (AOR): 5.38, 95% confidence interval: 1.95-14.87] and lifetime number of male sex partners (AOR: 7.25, 95% CI: 2.39-22.01). Coercive sex is harming MSM in China and should be immediately addressed by researchers, public health officials, and MSM community stakeholders.
Collapse
Affiliation(s)
- Stephen W Pan
- a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
| | | | | | | | | | | | | | | |
Collapse
|
35
|
De Santis JP, Gonzalez-Guarda R, Provencio-Vasquez E, Deleon DA. The Tangled Branches (Las Ramas Enredadas): sexual risk, substance abuse, and intimate partner violence among Hispanic men who have sex with men. J Transcult Nurs 2013; 25:23-32. [PMID: 24084703 DOI: 10.1177/1043659613504110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hispanic men who have sex with men (MSM) experience a number of health disparities including high rates of HIV infection from high-risk sex, substance abuse, and intimate partner violence. Although some research is available to document the relationships of these health disparities in the literature, few studies have explored the intersection of these disparities and the factors that influence them. The purpose of this study was to explore the experiences that Hispanic MSM residing in South Florida have with high-risk sex, substance abuse, and intimate partner violence. Focus groups were conducted and analyzed using grounded theory methodology until data saturation was reached (n = 20). Two core categories with subcategories emerged from the data: The Roots of Risk (Los raices del riesgo) and The Tangled Branches (Las Ramas Enredadas). The results of the study provided some important clinical implications as well as directions for future research with Hispanic MSM.
Collapse
Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, FL, USA
| | | | | | | |
Collapse
|
36
|
Rhodes SD, Martinez O, Song EY, Daniel J, Alonzo J, Eng E, Duck S, Downs M, Bloom FR, Allen AB, Miller C, Reboussin B. Depressive symptoms among immigrant Latino sexual minorities. Am J Health Behav 2013; 37:404-13. [PMID: 23985187 PMCID: PMC3981602 DOI: 10.5993/ajhb.37.3.13] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To estimate the prevalence and identify correlates of depressive symptoms among immigrant Latino sexual minorities. METHODS Respondent-driven sampling (RDS) was used to estimate the prevalence of depressive symptoms, and univariate and multivariable analyses were conducted to identify correlates of depressive symptoms. RESULTS Unweighted and RDS-weighted prevalence estimates of depressive symptoms were 69.2% and 74.8%, respectively. In the multivariable analysis, low social support, sexual compulsivity, and high self-esteem were significantly associated with increased depressive symptoms. CONCLUSIONS A need exists for culturally congruent mental health services for immigrant Latino sexual minorities in the southern United States.
Collapse
Affiliation(s)
- Scott D Rhodes
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, NC, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Finneran C, Stephenson R. Intimate partner violence among men who have sex with men: a systematic review. TRAUMA, VIOLENCE & ABUSE 2013; 14:168-85. [PMID: 23271429 PMCID: PMC4046894 DOI: 10.1177/1524838012470034] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This article presents results from a systematic review of the literature on intimate partner violence (IPV) among U.S. men who have sex with men (MSM). From 576 reviewed studies, a total of 28 met inclusion criteria and were included in the analysis. The population characteristics of each study, definitions of IPV, prevalences of different forms of IPV, and statistically tested correlates of IPV are summarized for each study. The results indicate that all forms of IPV occur among MSM at rates similar to or higher than those documented among women, although data on perpetration rates of IPV are scant, and consensus as to IPV correlates among MSM is absent. This review also finds significant limitations in the reviewed literature, notably the lack of a standardized, validated definition of IPV among MSM; use of unspecific recall periods for IPV; a lack of attention to nonphysical, nonsexual forms of IPV; and near-universal use of cross-sectional, convenience samples of urban MSM. Researchers should develop and validate an MSM-specific definition of IPV, use more rigorous epidemiological methods to measure IPV and its effects, and clarify the mental and physical health outcomes associated with both receipt and perpetration of IPV.
Collapse
Affiliation(s)
- Catherine Finneran
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA.
| | | |
Collapse
|
38
|
Kamen C, Etter D, Flores S, Sharp S, Lee S, Gore-Felton C. Sexual risk behaviors by relationship type and trauma history among HIV-positive men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:257-265. [PMID: 22127728 DOI: 10.1007/s10508-011-9870-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/24/2011] [Accepted: 06/15/2011] [Indexed: 05/31/2023]
Abstract
The association of trauma exposure and coping style to sexual risk behavior has yet to be fully examined in the context of primary and casual sexual partnerships. The current study assessed a high risk sexual behavior-unprotected anal intercourse (UAI)-in a high risk population of HIV-positive men who have sex with men (MSM) with a history of trauma. Using audio computer-assisted self-interview technology, 132 HIV-positive MSM completed measures of trauma exposure, trauma symptoms, coping strategies, and sexual risk behavior. Hierarchical logistic regression analyses indicated that completing more years of education and having experienced sexual abuse were positively associated with UAI with casual partners. Additionally, use of active coping was negatively associated with UAI with casual partners and the final model significantly predicted variance in UAI with casual partners. However, no variables were significantly associated with UAI with primary partners, suggesting that sexual risk behavior with primary partners may be associated with factors not commonly assessed in risk prediction or prevention research. We discuss the results in the context of developing new or modifying existing interventions to address rates of sexual risk in the relationships of HIV-positive MSM.
Collapse
Affiliation(s)
- Charles Kamen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5718, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Mediation of HIV/STI Risk by Mental Health Disorders Among Persons Living in the United States Reporting Childhood Sexual Abuse. J Acquir Immune Defic Syndr 2013; 62:81-9. [DOI: 10.1097/qai.0b013e318273b0c7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Dunkle KL, Decker MR. Gender-based violence and HIV: reviewing the evidence for links and causal pathways in the general population and high-risk groups. Am J Reprod Immunol 2012; 69 Suppl 1:20-6. [PMID: 23216606 DOI: 10.1111/aji.12039] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022] Open
Abstract
A growing body of international research documents strong associations between gender-based violence and HIV, both in the general population and among high-risk subpopulations such as female sex workers. The causal pathways responsible are multiple and complex, thus conceptual clarity is needed to best inform population-based, clinical, and individually oriented interventions. Our brief overview is intended to provide an introduction to the research on the various mechanisms that link GBV to HIV risk. We review the evidence, describe the causal pathways, provide a conceptual framework, and outline prevention and intervention priorities at both the individual and population levels.
Collapse
Affiliation(s)
- Kristin L Dunkle
- Department of Behavioral Sciences and Health Education and Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | |
Collapse
|
41
|
Lloyd S, Operario D. HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:228-41. [PMID: 22676462 DOI: 10.1521/aeap.2012.24.3.228] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Previous research has indicated a high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) in the United States, and has suggested that CSA history is a risk factor for HIV infection in MSM. We conducted a systematic review to identify, synthesize, meta-analyze, and critique the current state of relevant literature. Systematic review methodology was utilized to identify 12 studies that compared MSM with a history of CSA to MSM without a history of CSA on HIV risk indicators including HIV serostatus, sexually transmitted infections (STIs), sexual behaviors, and illicit drug use. Overall, 27.3% (n = 4,263) of the MSM in all included studies (n = 15,622) reported a CSA history. Across the studies that used probabilistic sampling (n = 8,240), the estimated prevalence of CSA was 21.8% (n = 1,800). Meta-analysis indicated that MSM with CSA history were more likely to be HIV positive [odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.22-1.95)] and to engage in recent unprotected anal intercourse (OR = 1.85, 95% CI = 1.36-2.51). Studies also indicated that MSM with a history of CSA were more likely to report frequent casual male partners, substance use, and sex while under the influence of alcohol or other drugs. Trends across studies indicated a need for interventions to assess CSA history and address effects of CSA on sexual risk behavior of MSM. Inconsistencies across studies indicated a need to reach consensus among researchers and providers in defining CSA.
Collapse
Affiliation(s)
- Shane Lloyd
- Brown University, Program in Public Health, 121 South Main Street, 5th Floor, Providence, RI, USA.
| | | |
Collapse
|
42
|
Ugarte Guevara WJ, Valladares Cardoza E, Essén B. Sexuality and risk behavior among men who have sex with men in León, Nicaragua: a mixed methods approach. J Sex Med 2012; 9:1634-48. [PMID: 22489636 DOI: 10.1111/j.1743-6109.2012.02713.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION HIV prevalence among men who have sex with men (MSM) is 38 times higher than among the general population in Nicaragua. There are little data about the sexuality and sexual behaviors of MSM. It is essential to gain a better understanding of this understudied population. AIMS The nature of sexual relationships among MSM, their reasons for engaging in risky sexual behaviors, and the sociocultural context in León, Nicaragua, were investigated through in-depth interviews. Our findings resulted in a structured overview of sociodemographic characteristics and HIV-related knowledge, attitudes, and risk behaviors. METHODS Fifteen participants recruited by purposive sampling completed an in-depth interview that was then thematically analyzed. An additional 104 participants were surveyed by means of an interviewer-administered questionnaire. MAIN OUTCOME MEASURES The in-depth interview guide and the survey covered topics related to sociodemographics, childhood, social and sexual relationships, knowledge and attitudes toward HIV and AIDS, identity, and networks. RESULTS The resulting ecological model explored sexuality and behaviors in four categories. It showed that despite a homophobic and heterosexist society, there is an increasing gay community and greater social acceptance of homosexuality. Nevertheless, interpersonal and intrapersonal factors continue to negatively influence MSM behavior. Quantitative findings demonstrate a satisfactory understanding of HIV transmission among this population, 75% of whom reported concerns of becoming infected with HIV in the future. Approximately one-half claimed that they always used condoms when having sex with men, but only one-third of the time with women, indicating inconsistent condom use. Negative attitudes toward HIV/AIDS were seldom heard. CONCLUSIONS This study is the first mixed methods approach in a Nicaraguan context that shows the interrelations among sex, sexuality, and identity at various levels of MSM life, and how they influence the sexual risk behaviors of individuals. Engaging in unprotected sex and postponing HIV testing are seen as cognitive dissonances.
Collapse
|
43
|
Associations of Sexual Identity or Same-Sex Behaviors With History of Childhood Sexual Abuse and HIV/STI Risk in the United States. J Acquir Immune Defic Syndr 2012; 59:400-8. [DOI: 10.1097/qai.0b013e3182400e75] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Bedoya CA, Mimiaga MJ, Beauchamp G, Donnell D, Mayer KH, Safren SA. Predictors of HIV transmission risk behavior and seroconversion among Latino men who have sex with men in Project EXPLORE. AIDS Behav 2012; 16:608-17. [PMID: 21390540 DOI: 10.1007/s10461-011-9911-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the US, Latino MSM are disproportionately affected by HIV, yet there is a paucity of data for this risk group. To this end, we examined data on Latino and non-Latino white MSM who participated across six cities in a 2-year randomized behavioral intervention study-Project EXPLORE. At baseline, Latinos reported significantly more serodiscordant unprotected anal intercourse (SDUA) than non-Latinos. Longitudinal predictors of SDUA included marijuana, poppers, amphetamines and heavy drinking, as well as lower self-efficacy, poorer communication skills, weaker safe-sex norms and more enjoyment of risky sex. For HIV infection, Latinos had significantly higher seroconversion rate over follow-up than non-Latinos. Longitudinal predictors of seroconversion among Latinos included poppers and SDUA. Intervention effects did not significantly differ between Latino and non-Latinos. Findings support HIV intervention work with Latino MSM that includes skills training/counseling to address attitudes about safe sex and impact of substance use on HIV-risk behavior and acquisition.
Collapse
|
45
|
Arreola SG, Ayala G, Díaz RM, Kral AH. Structure, agency, and sexual development of Latino gay men. JOURNAL OF SEX RESEARCH 2012; 50:392-400. [PMID: 22435920 DOI: 10.1080/00224499.2011.648028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexuality by enhancing or inhibiting a sense of agency. Agency is essential for making decisions that are in line with their intentions to have healthy sexual lives. Findings suggest that interventions should focus on developing a sense of sexual agency among Latino gay men by (a) increasing their recognition of structural factors that contribute to feelings of worthlessness in order to relocate internalized blame and homophobia to external structural forces, (b) facilitating awareness of the social structural oppressions that lead to psychological and sexual risk in order to enhance their options for sexual health, and (c) shifting from individually focused constructions of sexual health to those that consider the structural factors that reduce agency and contribute to diminished sexual health among Latino gay men.
Collapse
Affiliation(s)
- Sonya G Arreola
- Urban Health Program, RTI International, San Francisco, CA 94104, USA.
| | | | | | | |
Collapse
|
46
|
Klein H. Using a syndemics theory approach to study HIV risk taking in a population of men who use the internet to find partners for unprotected sex. Am J Mens Health 2011; 5:466-76. [PMID: 21406487 PMCID: PMC6192255 DOI: 10.1177/1557988311398472] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examines the value of using syndemics theory as a model for understanding HIV risk taking in a population of men who are at great risk for acquiring and/or transmitting HIV. The principal aim is to provide an empirical test of the applicability of the theory to sexual risk behaviors in this particular research population. The study was based on a national random sample of 332 men who have sex with men, or MSM, who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. As hypothesized in the syndemics theory model, attitudes toward condom use were central to understanding men's involvement in risky sex. As hypothesized, these attitudes depended on various demographic, psychological/psychosocial functioning, and sex-related preference measures. Also as hypothesized, psychological and psychosocial functioning were found to be very important to the overall model, and as expected, these factors were shaped greatly by factors such as demographic characteristics and childhood maltreatment experiences. The structural equation assessing the fit of the overall model indicated solid support for the syndemics theory approach. Overall, syndemics theory seems to apply fairly well to understanding the complexity of the factors that underlie men's risk-taking practices. The complicated interplay among factors such as attitudes toward condom use, childhood maltreatment experiences, psychological and psychosocial functioning, and substance use and abuse-all of which are central to a syndemics theory approach to studying risk-was demonstrated.
Collapse
Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD 20910, USA.
| |
Collapse
|
47
|
Markowitz SM, O’Cleirigh C, Hendriksen ES, Bullis JR, Stein M, Safren SA. Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use. AIDS Behav 2011; 15:1554-60. [PMID: 21161362 DOI: 10.1007/s10461-010-9857-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Childhood sexual abuse (CSA) is related to poorer health outcomes, associated with increased risk for HIV acquisition, and prevalent among HIV risk groups. Links between CSA and health behavior are an important health concern. We examined the relationship between CSA and transmission risk behavior and medication adherence in 119 HIV-infected individuals with an injection drug use history. 47% reported CSA, with no gender difference. Individuals who experienced CSA were more likely to report sexual HIV transmission risk behavior in the past 6 months, more sexual partners, use of heroin in the past 30 days, and worse adherence to HIV medication than those who did not. These findings confirm that rates of CSA are high in this population, and suggest that a history of CSA may place people managing both HIV and opioid dependence at increased risk for HIV transmission, poor adherence to medication, and vulnerability to substance use relapse.
Collapse
|
48
|
Rothman EF, Exner D, Baughman AL. The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review. TRAUMA, VIOLENCE & ABUSE 2011; 12:55-66. [PMID: 21247983 PMCID: PMC3118668 DOI: 10.1177/1524838010390707] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This article systematically reviews 75 studies that examine the prevalence of sexual assault victimization among gay or bisexual (GB) men, and lesbian or bisexual (LB) women, in the United States. All studies were published between 1989 and 2009 and report the results of quantitative research. The authors reviewed the reported prevalence of lifetime sexual assault victimization (LSA), and where available, childhood sexual assault (CSA), adult sexual assault (ASA), intimate partner sexual assault (IPSA), and hate crime-related sexual assault (HC). The studies were grouped into those that used a probability or census sampling technique (n=25) and those that used a non-probability or ''community-based'' sampling technique (n=50). A total of 139,635 gay, lesbian, and bisexual (GLB) respondents participated in the underlying studies reviewed. Prevalence estimates of LSA ranged from 15.6-85.0% for LB women and 11.8-54.0% for GB men. Considering the median estimates derived from the collective set of studies reviewed, LB women were more likely to report CSA, ASA, LSA, and IPSA than GB men, whereas GB men were more likely to report HC than LB women. Across all studies, the highest estimates reported were for LSA of LB women (85.0%), CSA of LB women (76.0%), and CSA of GB men (59.2%). With some exceptions, studies using non-probability samples reported higher sexual assault prevalence rates than did population-based or census sample studies. The challenges of assessing sexual assault victimization with GLB populations are discussed, as well as the implications for practice, policy, and future research.
Collapse
Affiliation(s)
- Emily F Rothman
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
| | | | | |
Collapse
|
49
|
Rhodes SD, Hergenrather KC, Aronson RE, Bloom FR, Felizzola J, Wolfson M, Vissman AT, Alonzo J, Boeving Allen A, Montano J, McGuire J. Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews. CULTURE, HEALTH & SEXUALITY 2010; 12:797-812. [PMID: 20582764 PMCID: PMC2924443 DOI: 10.1080/13691058.2010.492432] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18-48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.
Collapse
Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|