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Schnarrs PW, Dorri AA, Yockey RA, Stone AL, Russell ST, Rosenberger JG. The Sexual and Gender Minority Adverse Childhood Experiences Scale. Am J Prev Med 2023; 65:1050-1058. [PMID: 37572853 DOI: 10.1016/j.amepre.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Sexual and gender minority (SGM) adverse childhood experiences (ACEs) are identity-based forms of early life adversity. Exposure to SGM ACEs is associated with increased odds of depression, anxiety, and post-traumatic stress disorder in SGM adults. The purpose of this study was to further test a revised version of the measure in a U.S. sample with more robust and clinically relevant mental health outcomes. METHODS In May and June 2022, a national sample of SGM adults (N=4,445) was recruited from a Qualtrics Panel to complete a 20-minute online survey that included questions regarding ACEs, SGM ACEs, depression, anxiety, and post-traumatic stress disorder. Exploratory factor analysis and confirmatory factor analysis were used to examine factor structure. Multivariable regression was used to assess criterion validity, and a sensitivity analysis was conducted. Data were analyzed in February 2023. RESULTS Respondents indicate that vicarious trauma (81%) and school bullying (67%) were the most common experiences and that all SGM ACEs were frequently occurring before adulthood. Confirmatory factor analysis determined a 1-factor solution. Participants with more SGM adverse childhood experiences exposure had worse anxiety, depression, and post-traumatic stress disorder symptoms (β=0.16, β=0.18, β=0.26, respectively, p<0.0001) after controlling for ACEs exposure and demographic factors. A sensitivity analysis indicated that estimates were similar in terms of magnitude and direction. CONCLUSIONS SGM ACEs commonly and frequently occur before adulthood and impact adult SGM mental health. Overall, the measure had good-to-excellent psychometric properties. Future research should consider integrating SGM ACEs and Minority Stress Theory.
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Affiliation(s)
- Phillip W Schnarrs
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Armin A Dorri
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, Texas
| | - Stephen T Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park
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2
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Exten C, Vasilenko SA, Rosenberger JG. How Old Is He Really? The Association Between "Gay Age" and Sexual Behaviors Among Men Who Have Sex With Men. Sex Transm Dis 2023; 50:107-111. [PMID: 36630417 PMCID: PMC10494284 DOI: 10.1097/olq.0000000000001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Men who have sex with men (MSM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs), with sexual behaviors acting as a primary predictor of disease acquisition. Predictors of engagement in specific sexual behaviors may act as key targets for preventive strategies. We hypothesized that time since first engaging in oral or anal sex with another man, or one’s “gay age”, is associated with sexual behavior among MSM. Methods: We examined 5,280 MSM, aged 18–40, who were recruited from social and sexual connection websites. We used modified Poisson regression to examine associations between gay age and four sexual behaviors (enema use, group sex, receptive anal intercourse, insertive anal intercourse). We used time-varying effect models (TVEM) to examine how the prevalence of these behaviors varies across gay age. Results: In total, 76% of participants reported receptive anal intercourse in the past year and 76% reported insertive anal intercourse. Group sex and enema use in the past year were reported by 39% and 36%, respectively. Modified Poisson and TVEM analyses indicated that prevalence of enema use, group sex, and insertive anal intercourse significantly increased with increasing gay age. Conclusions: Gay age may serve as an important marker of engagement in sexual behaviors associated with STI/HIV acquisition among MSM. Time since first engaging in oral or anal sex with another man may act as a marker of engagement in sexual behaviors associated with STI/HIV transmission among MSM.
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Affiliation(s)
- Cara Exten
- From the Ross & Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
| | - Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University, Syracuse, NY
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
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3
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Calabrese SK, Kalwicz DA, Modrakovic D, Earnshaw VA, Edelman EJ, Bunting SR, Del Río-González AM, Magnus M, Mayer KH, Hansen NB, Kershaw TS, Rosenberger JG, Krakower DS, Dovidio JF. An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments. AIDS Behav 2022; 26:1393-1421. [PMID: 34750695 PMCID: PMC9434708 DOI: 10.1007/s10461-021-03495-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/16/2023]
Abstract
Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - E Jennifer Edelman
- Department of General Internal Medicine, Yale University, New Haven, CT, USA
| | - Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ana María Del Río-González
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - John F Dovidio
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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4
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Rao S, Reed AE, Parchem B, Edelman EJ, Magnus M, Hansen NB, Kershaw TS, Earnshaw VA, Krakower DS, Dovidio JF, Mayer KH, Underhill K, Rosenberger JG, Ogburn DF, Betancourt JR, Calabrese SK. Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade. AIDS Behav 2022; 26:218-231. [PMID: 34287754 PMCID: PMC8294250 DOI: 10.1007/s10461-021-03375-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives.
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Affiliation(s)
- Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA.
| | - Ashley E Reed
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | | | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Kristen Underhill
- Population and Family Health and Law, Columbia University, New York City, NY, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
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5
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Gioia SA, Russell MA, Zimet GD, Stupiansky NW, Rosenberger JG. The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men. Patient Educ Couns 2021; 104:1712-1718. [PMID: 33451881 DOI: 10.1016/j.pec.2020.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/07/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Gay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients' perceptions of their provider's sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients' disclosure of sexual orientation to providers. METHODS Data were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18-26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance. RESULTS Participants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics. CONCLUSIONS Findings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men's health. PRACTICE IMPLICATIONS Dyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients' sexual minority statuses.
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Affiliation(s)
- Sarah A Gioia
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, USA.
| | - Michael A Russell
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
| | - Nathan W Stupiansky
- Health Behavior Consultants International, 7575 E Indian Bend Rd, Scottsdale, AZ 85250, USA.
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, USA.
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6
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Bennett CL, Marks SJ, Rosenberger JG, Bauermeister JA, Clark MA, Liu T, Mayer KH, Merchant RC. Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2021; 19:2325958220919260. [PMID: 32314651 PMCID: PMC7175048 DOI: 10.1177/2325958220919260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Among HIV-uninfected, social media-using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as "unlikely" and 12% as "impossible." Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.
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Affiliation(s)
- Christopher L Bennett
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | | | - Melissa A Clark
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Kenneth H Mayer
- Fenway Health and Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Schnarrs PW, Jones SS, Parsons JT, Baldwin A, Rosenberger JG, Lunn MR, Rendina HJ. Sexual Subcultures and HIV Prevention Methods: An Assessment of Condom Use, PrEP, and TasP Among Gay, Bisexual, and Other Men Who Have Sex with Men Using a Social and Sexual Networking Smartphone Application. Arch Sex Behav 2021; 50:1781-1792. [PMID: 32728870 PMCID: PMC10388693 DOI: 10.1007/s10508-020-01784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Despite being grouped together in epidemiological risk categories, gay, bisexual, and other men who have sex with men (GBM) are not a homogenous group. In addition to traditional segmentation along race, ethnicity, and socioeconomic status, many GBM also identify with sexual subcultural communities. Previous research has shown differences across a variety of health outcomes between these sexual subcultural communities. The purpose of this study was to determine whether HIV prevention practices among GBM differed according to sexual subcultural community. The study was conducted in collaboration with a popular social and sexual networking smartphone application company. A total of 23,577 GBM responded to the survey. A latent class analysis identified 6 distinct classes related to sexual subcultural community identification. We found significant differences across sociodemographic characteristics, HIV prevention practices, and condomless anal sex in the past 6 months related to sexual subculture identification. Findings suggest that sexual subcultural identity is related to decision-making around HIV prevention among GBM. Differences in HIV prevention strategies are likely a function of group norms, unique shared experiences among GBM identifying with a particular sexual subculture community, and sociodemographic characteristics associated with these groups. As such, sexual subculture identity should be considered in developing interventions and social marketing campaigns to increase uptake of biomedical HIV prevention tools among GBM. Identifying group norms and shared experiences related to HIV prevention practices among sexual subcultures is necessary to understand the role these identities play in lives of GBM, especially as it relates to their sexual health and well-being.
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Affiliation(s)
- Philip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building 4.814, 1601 Trinity Street, Austin, TX, 78712, USA.
- The Population Research Center, The University of Texas at Austin, Austin, TX, USA.
| | - Stephen Scott Jones
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Aleta Baldwin
- Department of Public Health, California State University at Sacramento, Sacramento, CA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, CA, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
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8
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Vasilenko SA, Exten C, Rosenberger JG. Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men. Arch Sex Behav 2021; 50:1047-1055. [PMID: 32472239 PMCID: PMC7704918 DOI: 10.1007/s10508-020-01738-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University, 144 White Hall, Syracuse, NY, 13244, USA.
| | - Cara Exten
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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9
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Fontenot HB, White BP, Rosenberger JG, Lacasse H, Rutirasiri C, Mayer KH, Zimet G. Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study. J Med Internet Res 2020; 22:e22878. [PMID: 33146621 PMCID: PMC7673982 DOI: 10.2196/22878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices.
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Affiliation(s)
- Holly B Fontenot
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, United States.,The Fenway Institute, Boston, MA, United States.,Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | | | - Joshua G Rosenberger
- College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Hailee Lacasse
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Chokdee Rutirasiri
- Proper Villains, Boston, MA, United States.,School of Arts and Sciences, Boston College, Chestnut Hill, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,School of Medicine, Harvard University, Boston, MA, United States
| | - Gregory Zimet
- Division of Adolescent Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
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10
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Fontenot HB, Abuelezam NN, Rosenberger JG, Novak D, Mayer KH, Zimet G. The Impact of Advertisement Messaging on Enrollment of Young Men Who Have Sex With Men for Web-Based Research: Observational Study. J Med Internet Res 2020; 22:e16027. [PMID: 31929103 PMCID: PMC6996771 DOI: 10.2196/16027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/26/2022] Open
Abstract
Background Recruiting young men who have sex with men (YMSM) in community settings is difficult. The use of Web-based social networks and dating apps for recruitment can be successful approaches, although little work has been done on the impact of study advertisement content on recruitment. Objective The aim of this study was to evaluate the effects of advertisement message content on the recruitment of YMSM (aged 18-26 years) for a Web-based focus group study, examining perspectives and preferences for a mobile app that was designed to support sexual health among YMSM. Methods Between March and April 2017, a recruitment campaign to promote human papillomavirus vaccination was launched on a popular social networking and dating app for YMSM, with 3 different text-based advertisement themes (technology, cancer prevention, and sexual innuendo). The campaign recruited YMSM across 3 states (Massachusetts, New York, and Pennsylvania). We examined the click-through rates, conversion rates, and enrollment rates of each of the advertisements and examined differences in views and clicks by age, state, and time of day. Results The sexual innuendo advertisement had the highest click rates when compared with both the technology (click rate ratio [CRR] 2.06, 95% CI 1.74-2.45) and cancer prevention (CRR 1.62, 95% CI 1.38-1.90) advertisements. The sexual innuendo advertisement also had higher study enrollment rates compared with the technology (CRR 1.90, 95% CI 1.23-2.83) and cancer prevention (CRR 2.06, 95% CI 1.37-3.13) advertisements. No differences were observed in clicks or enrollment by age, state, or time of day. Conclusions Our marketing campaign, targeting YMSM, was effective in recruiting participants for a qualitative study, using Web-based focus groups. The sexual innuendo advertisement was the most effective and cost-efficient advertisement of the 3 approaches trialed. Different populations need different targeted strategies for study recruitment. Researchers should work with key representatives to develop and test culturally relevant messaging and approaches that utilize current and popular technologies.
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Affiliation(s)
- Holly B Fontenot
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States.,The Fenway Institute, Boston, MA, United States
| | - Nadia N Abuelezam
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, United States
| | - David Novak
- DSN Consulting, LLC, Quincy, MA, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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11
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Vasilenko SA, Espinosa-Hernández G, Rice CE, Biello KB, Novak DS, Mayer KH, Mimiaga MJ, Rosenberger JG. Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico. J Sex Res 2019; 56:1168-1178. [PMID: 30638395 PMCID: PMC6626694 DOI: 10.1080/00224499.2018.1563667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals' specific patterns of sexual behavior.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University
| | | | - Cara E Rice
- The Methodology Center, Pennsylvania State University
| | - Katie B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University, and The Fenway Institute
| | | | - Kenneth H Mayer
- The Fenway Institute and Department of Global Health and Population, Harvard University
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University and The Fenway Institute
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12
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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13
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Fontenot HB, Rosenberger JG, McNair KT, Mayer KH, Zimet G. Perspectives and preferences for a mobile health tool designed to facilitate HPV vaccination among young men who have sex with men. Hum Vaccin Immunother 2019; 15:1815-1823. [PMID: 30625049 DOI: 10.1080/21645515.2019.1568156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We sought to understand young men who have sex with men (YMSM) perspectives and preferred features for a mobile health (mHealth) tool designed to facilitate human papillomavirus (HPV) vaccination. YMSM were recruited on a popular social/sexual networking app to participate in online focus groups. Discussions were designed to elicit what the men would want in a mHealth tool specific for sexual health and HPV. Demographic data were analyzed using descriptive statistics and focus group data were analyzed using conventional content analysis. Forty-eight YMSM participated. Mean age was 23.4 years, and 70.0% reported their race as Black. Qualitative themes included general HPV knowledge and awareness, current patterns in technology use, desired app qualities, and desired app content. Youth described varying levels of HPV knowledge, utilized apps to engage socially, and for travel, banking, gaming, news and entertainment, and few used apps to facilitate personal health or engage with healthcare systems. Participants desired credible, relatable, secure, and easy to use interfaces that provided sexual health and HPV information in a positive context. They described ways to creatively engage and directly connect youth to health providers. We identified a culturally relevant youth driven approach to facilitate HPV vaccination and sexual health among YMSM.
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Affiliation(s)
- Holly B Fontenot
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA.,b Fenway Health/The Fenway Institute , Boston , MA , USA
| | - Joshua G Rosenberger
- c Department of Behavioral Health, Penn State University , University Park , PA , USA
| | - Katelyn T McNair
- a Connell School of Nursing, Boston College , Chestnut Hill , MA , USA
| | - Kenneth H Mayer
- b Fenway Health/The Fenway Institute , Boston , MA , USA.,d Beth Israel Deaconess Medical Center, Department of Medicine, Boston MA/Harvard Medical School , Boston , MA , USA
| | - Gregory Zimet
- e Section of Adolescent Medicine, Indiana University School of Medicine , Indianapolis , IN , USA
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14
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Wentz AE, Merchant RC, Clark MA, Liu T, Rosenberger JG, Bauermeister JA, Mayer KH. Blood Donation, Sexual Practices, and Self-Perceived Risk for HIV in the United States Among Young Adult Men Who Have Sex With Men. Public Health Rep 2018; 134:36-46. [PMID: 30526313 PMCID: PMC6304728 DOI: 10.1177/0033354918815182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In the United States, all men who have sex with men (MSM) were banned from donating blood from 1985 through 2015. In 2016, the guideline was amended such that men who had sexual contact with other men within the previous 12 months could not donate blood. We aimed to identify blood donation practices and their relationship with HIV risk and testing among young adult MSM (YMSM) at risk for having HIV. METHODS In 2014, we recruited HIV-negative non-Hispanic black, Hispanic, and non-Hispanic white YMSM aged 18-24 from across the United States through social media platforms to complete an online survey. Among these YMSM who previously donated blood, we conducted a secondary analysis examining the relationship between having donated blood within the past 12 months and sexual risk behavior from recent condomless anal intercourse (CAI), HIV testing, and self-perceived risk of having an undiagnosed HIV infection. RESULTS Of the 2261 YMSM surveyed, 1104 (48.8%) had ever previously donated blood and 305 (13.5%) had donated blood within the past 12 months. Of the 305 blood donors, 50 (16.4%) had ever had CAI before their most recent blood donation. Among YMSM who donated blood, past-12-month blood donation was more likely among YMSM who never had CAI (adjusted odds ratio [aOR] = 1.84; 95% confidence interval [CI], 1.24-2.73) than among YMSM who had CAI and more likely among YMSM who believed it was not possible at all that they had an undiagnosed HIV infection (aOR = 1.57; 95% CI, 1.14-2.16) than among YMSM who believed there was any possibility of having an undiagnosed HIV infection; it was not related to past-12-month HIV testing. CONCLUSIONS YMSM donated blood frequently, suggesting that the deferral process in place did not prevent YMSM from donating blood. The current donor screening process should be reconsidered if it is to prevent YMSM from donating blood. Future research could identify screening questions that permit YMSM with a low risk of HIV infection to donate blood while maintaining the safety of the blood supply.
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Affiliation(s)
- Anna E. Wentz
- Department of Epidemiology, School of Public Health, Brown University,
Providence, RI, USA
| | - Roland C. Merchant
- Department of Epidemiology, School of Public Health, Brown University,
Providence, RI, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA,
USA
| | - Melissa A. Clark
- Department of Quantitative Health Sciences and Center for Health Policy and
Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of
Public Health, Brown University, Providence, RI, USA
| | | | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of
Pennsylvania, Philadelphia, PA, USA
| | - Kenneth H. Mayer
- Fenway Health, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, USA
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15
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Roth AM, Rosenberger JG, Hensel DJ, Wiehe SE, Fortenberry JD, Wagner KD. Love moderates the relationship between partner type and condom use among women engaging in transactional vaginal sex. Sex Health 2018; 13:170-6. [PMID: 26615499 DOI: 10.1071/sh15167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Relationship characteristics and day-to-day variation in affective state have been associated with HIV risk behaviour. However, no research has assessed the impact of these factors on event-level condom use among women engaging in transactional sex. METHODS Twenty-six women engaging in transactional sex were enrolled in a prospective study of their sexual health. They completed diaries about multi-level predictors of condom use during vaginal sex twice, daily. RESULTS Over 4 weeks, 18 participants reported 87 paid/traded vaginal intercourse events. Of these, 51.7% were condom protected. The majority of paid/traded events (81.5%) occurred with a non-romantic partner. After controlling for partner type, feeling in love on a given day was associated with higher odds of condom use during paid/traded sexual events, while having sex on the weekend and at night were associated with lower odds of condom use (all P≤0.05). There was a significant interaction between being in love and using condoms during transactional sex (P<0.01). In paid/traded sexual events with romantic partners, the frequency of condom use was 71.4% (5/7) when women did not report love and 40% (4/10) when love was reported. In sexual events with non-romantic partners, the frequency of condom use was 43.8% (14/32) when women did not report love and 59.5% (22/37) when love was reported. CONCLUSIONS Women were less likely to report protected sex with romantic partners and more likely to report protected sex with non-romantic partners when they are in love. Interventions focusing on the link between day-to-day variation in affective state on condom use may help women with risk management across partner types.
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Affiliation(s)
- Alexis M Roth
- Department of Community Health and Prevention, School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, Pennsylvania 19104, USA
| | - Joshua G Rosenberger
- Pennsylvania State University, 149Biobehavioral Health Building, University Park, PA 16802, USA
| | - Devon J Hensel
- Indiana University Purdue University Indianapolis, 410W. 10 Street, Indianapolis, IN 46202, USA
| | - Sarah E Wiehe
- Indiana University Purdue University Indianapolis, 410W. 10 Street, Indianapolis, IN 46202, USA
| | - J Dennis Fortenberry
- Indiana University Purdue University Indianapolis, 410W. 10 Street, Indianapolis, IN 46202, USA
| | - Karla D Wagner
- University of Nevada, 1664N. Virginia Street MS 0274, Reno, NV 89557-0274, USA
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16
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Anderson K, Biello K, Rosenberger JG, Novak D, Mayer K, Carey K, Mimiaga MJ. The impact of social support and partner relationship dynamics on engagement in HIV care and antiretroviral treatment adherence among MSM in Latin America. AIDS Care 2018; 30:1406-1412. [PMID: 29587490 DOI: 10.1080/09540121.2018.1456641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In Latin America (LA), HIV prevalence among MSM is estimated at thirty times greater than in the general male population. Little is known about the role of social support or disclosure status in relation to the HIV care continuum among LA MSM. Using multivariable logistic generalized estimation equations, we assessed the impact of social support satisfaction and disclosure status on engagement in HIV care, ART initiation, and ART adherence with data from an online, multinational sample of HIV infected MSM in Latin America (N = 2,350). 80.0% were engaged in HIV care, 71% initiated ART, and among those, 37% reported missing at least one dose in the past month. In multivariable models, compared to being very satisfied with social support, being somewhat satisfied (aOR = 0.73, 95% CI 0.56, 0.95) or somewhat dissatisfied (aOR = 0.83, 95% CI 0.70, 0.98) were associated with reduced odds of reporting 100% ART adherence. Disclosure of status was associated with a greater odds of HIV care engagement (OR = 1.63, 95% CI 1.28, 2.07) and ART initiation (OR = 1.55, 95% CI 1.30, 1.84). Greater satisfaction with social support and comfort disclosing HIV status to these sources were associated with improved engagement in HIV care and greater initiation of ART among MSM in LA.
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Affiliation(s)
- Kelsey Anderson
- a Brown University School of Public Health , Providence , RI , USA
| | - Katie Biello
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,c Departments of Behavioral and Social Health Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA
| | - Joshua G Rosenberger
- d Department of Biobehavioral Health , Penn State University , Middletown , PA , USA
| | - David Novak
- e OLB Research Institute, Online Buddies, Inc. , Cambridge , MA , USA
| | - Kenneth Mayer
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,f Division of Infectious Disease, Department of Medicine , Harvard Medical School/Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Kate Carey
- g Center for Alcohol and Addiction Studies , School of Public Health, Brown University , Providence , RI , USA
| | - Matthew J Mimiaga
- b The Fenway Institute , Fenway Health , Boston , MA , USA.,c Departments of Behavioral and Social Health Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA.,h Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA
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17
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Merchant RC, Clark MA, Liu T, Romanoff J, Rosenberger JG, Bauermeister J, Mayer KH. Comparison of Home-Based Oral Fluid Rapid HIV Self-Testing Versus Mail-in Blood Sample Collection or Medical/Community HIV Testing By Young Adult Black, Hispanic, and White MSM: Results from a Randomized Trial. AIDS Behav 2018; 22:337-346. [PMID: 28540562 DOI: 10.1007/s10461-017-1802-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to determine in a randomized trial if young adult black, Hispanic, and white men-who-have-sex-with-men (YMSM) are more likely to complete home-based oral fluid rapid HIV self-testing than either mail-in blood sample collection or medical facility/community organization-based HIV testing. Stratified by race/ethnicity, participants were randomly assigned to use a free oral fluid rapid HIV self-test (n = 142), a free mail-in blood sample collection HIV test (n = 142), or be tested at a medical facility/community organization of their choice (n = 141). Of the 425 participants, completion of assigned test (66% oral fluid vs. 40% mail-in blood sample vs. 56% medical facility/community), willingness to refer (36% oral fluid vs. 20% mail-in blood sample vs. 26% medical facility/community), and legitimate referrals (58% oral fluid vs. 43% mail-in blood sample vs. 43% medical facility/community) were greater in the oral fluid rapid HIV self-test than the mail-in blood sample collection HIV test arm, but not the medical facility/community testing arm. There were no differences in assigned test completion by race/ethnicity. Although free home-based oral fluid rapid HIV self-testing showed moderate promise in facilitating HIV testing among black, Hispanic, and white YMSM, it did not lead to greater testing than directing these YMSM to medical facility/community HIV testing venues. ClinicalTrials.gov Identifier: NCT02369627.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, USA.
- Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick Bldg., Providence, RI, 02903, USA.
| | - Melissa A Clark
- Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, USA
| | - Justin Romanoff
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, State College, USA
| | - Jose Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Kenneth H Mayer
- Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, USA
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18
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Marks SJ, Merchant RC, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:470-478. [PMID: 29087744 DOI: 10.1089/apc.2017.0171] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.
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Affiliation(s)
- Sarah J. Marks
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roland C. Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Melissa A. Clark
- Department of Quantitative Health Sciences, Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Joshua G. Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania
| | - Jose Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth H. Mayer
- Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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19
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Alexovitz KA, Merchant RC, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Discordance of voluntary HIV testing with HIV sexual risk-taking and self-perceived HIV infection risk among social media-using black, Hispanic, and white young-men-who-have-sex-with-men (YMSM). AIDS Care 2017; 30:81-85. [PMID: 28959902 DOI: 10.1080/09540121.2017.1381327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Discordance between self-perceived HIV risk and actual risk-taking may impede efforts to promote HIV testing among young adult men-who-have-sex-with-men (YMSM) in the United States (US). Understanding the extent of, and reasons for, the discordance of HIV risk self-perception, HIV risk-taking and voluntary HIV testing among black, Hispanic and white YMSM could aid in the development of interventions to increase HIV testing among this higher HIV risk population. HIV-uninfected 18-24-year-old black, Hispanic, and white YMSM were recruited from across the US through multiple social media websites. Participants were queried about their voluntary HIV testing history, perception of currently having an undiagnosed HIV infection, and condomless anal intercourse (CAI) history. We assessed the association between previous CAI and self-perceived possibility of currently having an HIV infection by HIV testing status using Cochran-Mantel-Haenszel testing. Of 2275 black, Hispanic and white social media-using 18-24 year-old YMSM, 21% had never been tested for HIV voluntarily, 87% ever had CAI with another man, 77% believed that it was perhaps possible (as opposed to not possible at all) they currently could have an undiagnosed HIV infection, and 3% who reported CAI with casual or exchange partners, but had not been tested for HIV, self-perceived having no possibility of being HIV infected. Of 471 YMSM who had not been HIV tested, 57% reported CAI with casual or exchange partners, yet self-perceived having no possibility of being HIV infected. Per the Cochran-Mantel-Haenszel test results, among those reporting HIV risk behaviors, the self-perception of possibly being HIV-infected was not greater among those who had never been tested for HIV, as compared to those who had been tested. Future interventions should emphasize promoting self-realization of HIV risk and translating that into seeking and accepting voluntary HIV testing among this higher HIV risk population.
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Affiliation(s)
- Kelsey A Alexovitz
- a Department of Biostatistics , Center for Statistical Sciences, Brown University School of Public Health , Providence , RI , USA
| | - Roland C Merchant
- b Department of Emergency Medicine , Alpert Medical School, Brown University , Providence , RI , USA.,c Department of Epidemiology , Brown University , School of Public Health, Providence , RI , USA
| | - Melissa A Clark
- d Department of Quantitative Health Sciences and Center for Health Policy and Research , University of Massachusetts Medical School , Worcester , MA , USA
| | - Tao Liu
- a Department of Biostatistics , Center for Statistical Sciences, Brown University School of Public Health , Providence , RI , USA
| | - Joshua G Rosenberger
- e Department of Biobehavioral Health , Pennsylvania State University, University Park , PA , USA
| | - Jose Bauermeister
- f Department of Family and Community Health, School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
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20
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Merchant RC, Romanoff J, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM). Am J Mens Health 2017; 11:1342-1357. [PMID: 28691552 PMCID: PMC5675213 DOI: 10.1177/1557988317717383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered.
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Affiliation(s)
- Roland C Merchant
- 1 Department of Emergency Medicine and Department of Epidemiology, Alpert Medical School and the School of Public Health, Brown University, Providence, RI, USA
| | - Justin Romanoff
- 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Melissa A Clark
- 3 Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tao Liu
- 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- 4 Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Jose Bauermeister
- 5 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth H Mayer
- 6 Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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21
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Wang K, White Hughto JM, Biello KB, O’Cleirigh C, Mayer KH, Rosenberger JG, Novak DS, Mimiaga MJ. The role of distress intolerance in the relationship between childhood sexual abuse and problematic alcohol use among Latin American MSM. Drug Alcohol Depend 2017; 175:151-156. [PMID: 28432938 PMCID: PMC5487024 DOI: 10.1016/j.drugalcdep.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/07/2017] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) and its well-documented association with substance use in adulthood, little research has examined the psychological mechanisms underlying this association. The current study utilized a large, multinational sample of MSM in Latin America to examine the role of distress intolerance (i.e., decreased capacity to withstand negative psychological states) in the relationship between childhood sexual abuse history and problematic alcohol use. METHODS As part of an online survey conducted among members of the largest social/sexual networking website for MSM in Latin America, participants (n=19,451) completed measures of childhood sexual abuse history, distress intolerance, and problematic alcohol use (CAGE score>=2). RESULTS Participants who reported a history of childhood sexual abuse indicated higher levels of distress intolerance, which was in turn associated with greater odds of engaging in problematic alcohol use. A mediation analysis further showed that distress intolerance partially accounted for the significant association between childhood sexual abuse history and problematic alcohol use. CONCLUSION These findings provide initial evidence for the role of distress intolerance as a process through which early trauma shapes MSM health later in life. These findings also underscore the potential utility of addressing distress intolerance in alcohol use prevention and intervention efforts that target MSM with a history of childhood sexual abuse.
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Affiliation(s)
- Katie Wang
- Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA.
| | - Jaclyn M. White Hughto
- Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Departments of Epidemiology and Behavioral and Social Health Sciences, Brown University, School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Department of Psychology, Harvard Medical School/Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA, 02114, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Division of Infectious Disease, Department of Medicine, Harvard Medical School/Beth Israel, Deaconess Medical Center, 110 Francis Street, Boston, MA, 02215, USA
| | - Joshua G. Rosenberger
- Department of Biobehavioral Health, Penn State University, 114 Biobehavioral Health Building University Park, PA, 16802, USA
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., 215 First Street, Cambridge, MA, 02142, USA
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA,Departments of Epidemiology and Behavioral and Social Health Sciences, Brown University, School of Public Health, 121 South Main Street, Providence, RI, 02912, USA,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, Providence, RI, 02912, USA
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22
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Maloney KM, Krakower DS, Ziobro D, Rosenberger JG, Novak D, Mayer KH. Culturally Competent Sexual Healthcare as a Prerequisite for Obtaining Preexposure Prophylaxis: Findings from a Qualitative Study. LGBT Health 2017; 4:310-314. [PMID: 28514200 DOI: 10.1089/lgbt.2016.0068] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Men who have sex with men (MSM) experience stigma in healthcare settings, which impedes disclosure of sexual behavior, potentially limiting uptake of preexposure prophylaxis (PrEP). The purpose of this study was to describe the context of this limitation and explore geographical variability. METHODS To understand how discomfort in healthcare settings affects PrEP utilization, we conducted two online focus groups with geographically diverse samples of MSM. RESULTS Respondents identified primary care providers as preferred sources for PrEP, but potential uptake was limited by barriers to establishing nonjudgmental relationships with these providers. CONCLUSION Improved patient-provider communication about sexual behaviors might increase PrEP use among MSM.
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Affiliation(s)
- Kevin M Maloney
- 1 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,2 Department of Epidemiology, Emory University , Atlanta, Georgia
| | - Douglas S Krakower
- 1 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,3 The Fenway Institute , Fenway Health, Boston, Massachusetts.,4 Harvard Medical School , Boston, Massachusetts
| | - Dale Ziobro
- 1 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Joshua G Rosenberger
- 5 Department of Biobehavioral Health, Pennsylvania State University , University Park, Pennsylvania
| | - David Novak
- 6 OLB Research Institute , Online Buddies, Inc., Cambridge, Massachusetts
| | - Kenneth H Mayer
- 1 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,3 The Fenway Institute , Fenway Health, Boston, Massachusetts.,4 Harvard Medical School , Boston, Massachusetts
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23
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Abstract
Men who have sex with men (MSM) are disproportionally affected by HIV. Although some theoretical models created to explain why individuals engage in risky sexual behavior contain an affective component, there has been relatively little focus on the influence of affect on sexual risk-taking. The goal of this study is to investigate the association between affect and condom use among MSM using an archival dataset from a survey of users of a popular sex-oriented website. Multilevel modeling was used to analyze daily diary data from 2871 MSM. At the within-person level, positive affect was positively related to condomless anal sex (CAS), whereas negative affect was negatively related to CAS. However, these results were qualified by interactions of trait affect and relationship to sex partner. These findings suggest that interventions focused on emotional regulation may have the potential to reduce CAS among MSM.
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Affiliation(s)
- Elissa L Sarno
- Department of Psychology, University of Maryland, Biology-Psychology Building, College Park, MD, 20742, USA.
| | - Jonathan J Mohr
- Department of Psychology, University of Maryland, Biology-Psychology Building, College Park, MD, 20742, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
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24
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Williams CJ, Weinberg MS, Rosenberger JG. Erratum to: Trans Women Doing Sex in San Francisco. Arch Sex Behav 2016; 45:1679. [PMID: 27316443 DOI: 10.1007/s10508-016-0792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Colin J Williams
- Department of Sociology, Indiana University-Purdue University at Indianapolis, 425 University Boulevard, Cavanaugh Hall 303, Indianapolis, IN, 46202, USA
| | - Martin S Weinberg
- Department of Sociology, Indiana University, 1020 E. Kirkwood Ave., BH 744, Bloomington, IN, 47405, USA.
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, 114 Biobehavioral Health Bldg., University Park, PA, 16802, USA
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25
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Williams CJ, Weinberg MS, Rosenberger JG. Trans Women Doing Sex in San Francisco. Arch Sex Behav 2016; 45:1665-78. [PMID: 27091188 DOI: 10.1007/s10508-016-0730-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 02/16/2016] [Accepted: 02/26/2016] [Indexed: 05/25/2023]
Abstract
This research investigates the sexuality of trans women (individuals who were assigned male status at birth who currently identify as women), by focusing on the "bodily techniques" (Crossley, 2006) they use in "doing" sexuality. The "doing sexuality" framework not only is modeled after the "doing gender" approach of West and Zimmerman (1987), but also utilizes the idea of "sexual embodiment" to emphasize the agency of trans women as they conceptualize and organize their sexuality in a socially recognized way. This is often difficult as they confront discrimination from medical and legal professionals as well as intimate partners who may find it difficult to adapt to the trans woman's atypical body and conception of gender. However, with a study group of 25 trans women from San Francisco, we found the study participants to be adept at overcoming such hurdles and developing techniques to "do" their sexuality. At the same time, we found trans women's agency constrained by the erotic habitus (Green, 2008) of the wider society. The interplay between innovation and cultural tradition provides an opportunity to fashion a more general model of "doing" sexuality.
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Affiliation(s)
- Colin J Williams
- Department of Sociology, Indiana University-Purdue University at Indianapolis, 425 University Boulevard, Cavanaugh Hall 303, Indianapolis, IN, 46202, USA
| | - Martin S Weinberg
- Department of Sociology, Indiana University, 1020 E. Kirkwood Ave., BH 744, Bloomington, IN, 47405, USA.
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, 114 Biobehavioral Health Bldg., University Park, PA, 16802, USA
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26
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Arrington-Sanders R, Rosenberger JG, Matson P, Novak DS, Fortenberry JD. Factors Associated With Emotional Satisfaction During First Anal Intercourse in a Sample of YMSM. J Homosex 2016; 63:968-984. [PMID: 26571213 DOI: 10.1080/00918369.2015.1113836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We sought to determine, in a sample of 2,813 HIV seronegative young men who had sex with other men age 18-24, whether physical satisfaction would explain emotional satisfaction during first anal intercourse and whether emotional satisfaction would impact having sex with a partner a second time. Emotional satisfaction was explained mostly by physical satisfaction during the event, but partner type also had direct impact on emotional satisfaction. Our findings suggest that first anal intercourse experiences in young men are both emotionally and physically satisfying and may impact subsequent sexual behavior and partner decision-making.
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Affiliation(s)
- Renata Arrington-Sanders
- a Division of General Pediatrics and Adolescent Medicine , Johns Hopkins University , Baltimore , Maryland , USA
| | - Joshua G Rosenberger
- b Department of Global and Community Health, College of Health and Human Services , George Mason University , Fairfax , Virginia , USA
| | - Pamela Matson
- a Division of General Pediatrics and Adolescent Medicine , Johns Hopkins University , Baltimore , Maryland , USA
| | - David S Novak
- c OLB Research Institute , Online Buddies, Inc. , Boston , Massachusetts , USA
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27
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Schnarrs PW, Rosenberger JG, Schick V, Delgado A, Briggs L, Dodge B, Reece M. Difference in Condom Use Between Bear Concordant and Discordant Dyads During the Last Anal Sex Event. J Homosex 2016; 64:195-208. [PMID: 27175792 DOI: 10.1080/00918369.2016.1174024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to understand how bear identity influenced condom use during the last anal sex event. Participants were recruited to complete an online, anonymous self-report survey through bear-related sexual and social networking websites. A total of 1,080 men who identified as gay or bisexual and as a member of the bear community and were 18 years or older completed the survey. Overall, fewer than a third of men reported condom use during the most recent receptive (28%) and insertive (30%) anal sex event. Men in bear concordant pairings were less likely to use a condom during receptive and insertive anal sex compared to those is discordant pairings (p < .05). Findings suggest that bear identity concordance influences condom use during anal sex after accounting for an individual's relationship to their most recent partner as well as other confounding variables.
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Affiliation(s)
- Phillip W Schnarrs
- a Department of Kinesiology, Health and Nutrition , The University of Texas at San Antonio , San Antonio , Texas , USA
- b The South Texas Consortium for HIV & STI Research , San Antonio , Texas , USA
| | - Joshua G Rosenberger
- c Department of Biobehavioral Health , Pennsylvania State University, University Park , Pennsylvania , USA
| | - Vanessa Schick
- d Division of Management, Policy and Community Health , The University of Texas School of Public Health , Houston , Texas , USA
| | - Adolph Delgado
- a Department of Kinesiology, Health and Nutrition , The University of Texas at San Antonio , San Antonio , Texas , USA
- e San Antonio AIDS Foundation , San Antonio , Texas , USA
| | - Lindsay Briggs
- f Department of Health and Community Services , California State University at Chico , Chico , California , USA
| | - Brian Dodge
- g Department of Applied Health Science , Indiana University School of Public Health at Bloomington , Bloomington , Indiana , USA
| | - Michael Reece
- g Department of Applied Health Science , Indiana University School of Public Health at Bloomington , Bloomington , Indiana , USA
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28
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Schick VR, Rosenberger JG, Herbenick D, Collazo E, Sanders SA, Reece M. The Behavioral Definitions of "Having Sex With a Man" and "Having Sex With a Woman" Identified by Women Who Have Engaged in Sexual Activity With Both Men and Women. J Sex Res 2016; 53:578-587. [PMID: 26421511 DOI: 10.1080/00224499.2015.1061632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A sizable minority of women report lifetime sexual behavior with both men and women. In the present study, a multinational sample of women who reported genital contact with at least one man and one woman in their lifetime (N = 2,751) were asked to provide their behavioral definitions of "having sex with a woman" and "having sex with a man." Replicating previous research, participants were asked "Would you say you 'had sex' with a woman/man if the most intimate behavior you engaged in with her/him was …" followed by a list of behaviors that differed based on the hypothetical partner gender. While most participants indicated that they would consider "having had sex" if they engaged in a variety of behaviors, behaviors involving genital contact were most often included within the participants' definitions of having sex, regardless of partner gender. The percentage of behaviors included in the participants' definitions of having sex with a woman (M = 59.40%, SD = 20.77%) was higher than the percentage of behaviors included in their definition of having sex with a man (M = 37.26%, SD = 28.97%). Broadening our understanding of "having sex" for individuals with diverse sexual experiences may have important implications for clinicians and researchers.
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Affiliation(s)
- Vanessa R Schick
- a Division of Management, Policy and Community Health , The University of Texas Health Science Center at Houston
| | | | - Debby Herbenick
- d Center for Sexual Health Promotion , Indiana University , Bloomington
| | - Erika Collazo
- e Department of Health Sciences , James Madison University
| | - Stephanie A Sanders
- c The Kinsey Institute for Research in Sex, Gender, and Reproduction , Indiana University , Bloomington
- d Center for Sexual Health Promotion , Indiana University , Bloomington
| | - Michael Reece
- d Center for Sexual Health Promotion , Indiana University , Bloomington
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29
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Biello KB, Oldenburg CE, Safren SA, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ. Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America. AIDS Care 2016; 28 Suppl 1:84-91. [PMID: 26883009 PMCID: PMC4828614 DOI: 10.1080/09540121.2016.1146205] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America. Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIV-related medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose–response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions.
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Affiliation(s)
- Katie B Biello
- a Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA.,b The Fenway Institute, Fenway Health , Boston , MA , USA
| | | | - Steven A Safren
- d Department of Psychology , University of Miami , Miami , FL , USA
| | - Joshua G Rosenberger
- e Department of Biobehavioral Health, Penn State University, University Park , PA , USA
| | - David S Novak
- f OLB Research Institute, Online Buddies, Inc ., Cambridge , MA , USA
| | - Kenneth H Mayer
- b The Fenway Institute, Fenway Health , Boston , MA , USA.,g Department of Infectious Disease , Harvard Medical School/Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Matthew J Mimiaga
- a Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA.,b The Fenway Institute, Fenway Health , Boston , MA , USA
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30
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Calabrese SK, Rosenberger JG, Schick VR, Novak DS. Pleasure, affection, and love among Black men who have sex with men (MSM) versus MSM of other races: countering dehumanizing stereotypes via cross-race comparisons of reported sexual experience at last sexual event. Arch Sex Behav 2015; 44:2001-14. [PMID: 25604209 PMCID: PMC4510043 DOI: 10.1007/s10508-014-0405-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/06/2014] [Accepted: 09/18/2014] [Indexed: 05/12/2023]
Abstract
Black men have historically been stereotyped as hedonistic, aggressive, and animalistic in their sexual interactions. This study sought to describe pleasure, affection, and love experienced by Black men who have sex with men (MSM) during their last male-partnered sexual event and to examine differences relative to White, Latino, and Asian MSM. A total of 21,696 (793 Black, 18,905 White, 1,451 Latino, and 547 Asian) U.S. men ages 18-87 (M Age = 39) were recruited from social/sexual networking sites targeting MSM in 2010-2011. Participants reported multiple dimensions of sexual experience (pleasure, affection, and love) occurring at their last male-partnered sexual event, partner relationship, and sociodemographic characteristics. Across relationship categories, a sizeable percentage of Black MSM reported pleasure (72-87 % orgasmed, 57-82 % experienced high subjective pleasure) and affection (70-91 % kissed, 47-90 % cuddled). Love was primarily reported for events involving main partners (felt love for partner: 96 %; felt loved by partner: 97 %; verbalized love to partner: 89 %). Latent class analysis with MSM of all races, adjusting for partner relationship and sociodemographic characteristics, revealed three distinct profiles of sexual experience: affection and love (Class 1); affection in the absence of love (Class 2); and neither affection nor love (Class 3). Pleasure was probable across profiles. Some racial differences in profile probability were present, but no overall pattern emerged. Contrary to Black male stereotypes, Black MSM commonly reported pleasure, affection, and love at their last male-partnered sexual event and did not show a meaningful pattern of difference from other-race MSM in their likelihood of experiencing all three.
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Affiliation(s)
- Sarah K Calabrese
- Yale School of Public Health and Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA,
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31
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Mimiaga MJ, Biello KB, Robertson AM, Oldenburg CE, Rosenberger JG, O'Cleirigh C, Novak DS, Mayer KH, Safren SA. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Arch Sex Behav 2015; 44:1869-78. [PMID: 26159862 DOI: 10.1007/s10508-015-0488-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 05/08/2023]
Abstract
The HIV epidemic in Latin America is highly concentrated in men who have sex with men (MSM). In the United States, multiple co-occurring psychosocial conditions have been shown to act as intertwined epidemics to potentiate HIV transmission among MSM. To date, no study has examined the role of syndemics and condomless sex among MSM in Latin America. In 2012, an online survey was conducted among members of the largest social/sexual networking website for MSM in Latin America. Participants were asked about demographics, sexual behaviors, HIV/STI diagnoses, and psychosocial well-being, including depression, suicidal ideation, hazardous alcohol use, hard drug use during sex, history of childhood/adolescent sexual abuse, intimate partner violence, and sexual compulsivity. Multivariable logistic generalized estimation equations were used to assess the relationship of syndemic factors and (1) engagement in higher risk condomless anal sex and (2) self-report of prior HIV diagnosis. Among 24,274 survey respondents, 74.6 % of the sample had at least one syndemic factor. In an additive model, syndemics were associated with increased odds of higher risk condomless anal sex, ranging from adjusted odds ratio of 1.31 (95 % CI 1.20, 1.43) for one syndemic factor to 4.06 (95 % CI 3.25, 5.09) for 6/7 syndemic factors. Similarly, syndemics were associated with increased odds of HIV infection (p < .0001). This study provides initial evidence that intertwined syndemics increase HIV risk behavior and HIV infection among MSM in Latin America. In the Latin American context, comprehensive HIV prevention interventions for MSM should be developed and tested that simultaneously address co-occurring psychosocial conditions and HIV risk.
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Affiliation(s)
- Matthew J Mimiaga
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital Behavioral Medicine, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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32
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Perez-Brumer AG, Oldenburg CE, Biello KB, Novak DS, Rosenberger JG, Mimiaga MJ. HIV prevalence, sexual behaviours and engagement in HIV medical care among an online sample of sexually active MSM in Venezuela. Int J STD AIDS 2015; 27:790-7. [PMID: 26378188 DOI: 10.1177/0956462415596298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Abstract
In Venezuela, members of a social and sexual partner networking site for men who have sex with men (MSM) completed an online survey regarding sexual behaviours and HIV medical care. Among the 2851 respondents, self-reported HIV prevalence was 6.6%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR = 1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with a sexually transmitted infection in the previous year (aOR 3.26, 95% CI: 2.11, 5.04). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions.
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Affiliation(s)
- Amaya G Perez-Brumer
- The Fenway Institute, Fenway Community Health, Boston, MA, USA Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | - Catherine E Oldenburg
- The Fenway Institute, Fenway Community Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Katie B Biello
- The Fenway Institute, Fenway Community Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - David S Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Community Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
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33
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Roth AM, Wagner KD, Hensel DJ, Truong Q, Wiehe SE, Rosenberger JG, Fortenberry JD. P04.21 Event-level analysis of condom use and love during transactional vaginal intercourse among women living in the midwestern united states. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health 2015; 105:e95-e102. [PMID: 25790381 DOI: 10.2105/ajph.2014.302402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed factors associated with engagement in transactional sex among men who have sex with men recruited from one of the largest Internet sites for men seeking social or sexual interactions with other men in Latin America. METHODS We constructed multilevel logistic regression models to analyze factors associated with engagement in transactional sex in 17 Latin American countries in 2012. RESULTS Of 24 051 respondents, 1732 (7.2%) reported being paid for sexual intercourse in the past 12 months. In a multivariable model, higher country-level unemployment was associated with increased odds of transactional sex (adjusted odds ratio [AOR] = 1.07 per 1% increase in unemployment; 95% confidence interval [CI] = 1.00, 1.13). Individual or interpersonal factors associated with increased odds of engagement in transactional sex included self-reported HIV (AOR = 1.33; 95% CI = 1.04, 1.69) or sexually transmitted infection (AOR = 1.33; 95% CI = 1.11, 1.59), childhood sexual abuse history (AOR = 1.75; 95% CI = 1.48, 2.06), intimate partner violence (past 5 years, AOR = 1.68; 95% CI = 1.45, 1.95), and sexual compulsivity (AOR = 1.77; 95% CI = 1.49, 2.11). CONCLUSIONS Structural-level economic interventions and those that address individual and interpersonal factors may improve HIV prevention efforts among men who have sex with men who engage in transactional sex.
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Affiliation(s)
- Catherine E Oldenburg
- Catherine E. Oldenburg is with the Department of Epidemiology, Harvard School of Public Health, Boston, MA. Amaya G. Perez-Brumer is with the Department of Sociomedical Sciences, Columbia University, New York, NY. Katie B. Biello and Kenneth H. Mayer are with the Fenway Institute, Fenway Health, Boston, MA. Stewart J. Landers is with John Snow, Inc., Boston, MA. Joshua G. Rosenberger is with the Department of Global and Community Health, George Mason University, Fairfax, VA. David S. Novak is with the OLB Research Institute, Online Buddies, Inc., Cambridge, MA. Matthew J. Mimiaga is with the Department of Psychiatry, Massachusetts General Hospital, Boston
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Magidson JF, Biello KB, Safren SA, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ. Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America. AIDS Care 2015; 27:1055-62. [PMID: 25738655 DOI: 10.1080/09540121.2015.1017796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n=28,779), approximately 75% reported ever being tested for HIV, and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR=1.29; 95% CI=1.01-1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR=1.18; 95% CI=0.94-1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR=1.55; 95% CI=1.26-1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.
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Affiliation(s)
- Jessica F Magidson
- a Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
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Reisner SL, Biello K, Rosenberger JG, Austin SB, Haneuse S, Perez-Brumer A, Novak DS, Mimiaga MJ. Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Arch Sex Behav 2014; 43:1503-14. [PMID: 25030120 PMCID: PMC4199875 DOI: 10.1007/s10508-014-0314-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/13/2013] [Accepted: 04/07/2014] [Indexed: 05/12/2023]
Abstract
Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54%; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.
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Affiliation(s)
- Sari L Reisner
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave., Kresge 7th floor, Boston, MA, 02115, USA,
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Magidson JF, Biello KB, Safren SA, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ. HIV Care Continuum among MSM in Latin America Using Online Sexual Networking: Is Engagement in Care Related to Sexual Risk-taking? AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5207.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica F. Magidson
- Massachusetts General Hospital/Harvard Medical School, Psychiatry, Boston, MA, United States
| | - Katie B. Biello
- The Fenway Institute, Boston, MA, United States
- Harvard School of Public Health, Boston, MA, United States
| | - Steven A. Safren
- Massachusetts General Hospital/Harvard Medical School, Psychiatry, Boston, MA, United States
- The Fenway Institute, Boston, MA, United States
| | - Joshua G. Rosenberger
- George Mason University, Department of Global and Community Health, Fairfax, VA, United States
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, MA, United States
| | - Kenneth H. Mayer
- The Fenway Institute, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Matthew J. Mimiaga
- Massachusetts General Hospital/Harvard Medical School, Psychiatry, Boston, MA, United States
- The Fenway Institute, Boston, MA, United States
- Harvard School of Public Health, Boston, MA, United States
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Biello KB, Rosenberger JG, Novak DS, Robertson AM, Mayer KH, Mimiaga MJ. Epidemiology of sexual health in the virtual environment: a multinational online survey of Spanish- and Portuguese-speaking men who use an internet sexual networking site. AIDS Behav 2014; 18:1675-85. [PMID: 24980249 DOI: 10.1007/s10461-014-0844-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is limited data on the sexual health of users of sexual networking websites for men who have sex with men (MSM) in Latin America. Members of a MSM-targeted social/sexual networking website in Latin America, Spain, and Portugal participated in an online sexual health survey. Among 36,063 respondents, nearly 90 % reported having anal or vaginal intercourse in the past 3 months. Among sexually active men, 53.2 % used condoms inconsistently. In the past year, 54 % of respondents reported undergoing sexually transmitted infections (STI) testing and 67 % reported testing yearly or more often for HIV. Self-reported HIV prevalence was 9.1 %. Differences were seen by geographic region. Unprotected intercourse with partners of different or unknown HIV status was associated with recent STI diagnosis (OR = 1.83, t = 13.15, d.f. = 21, p < .001) and HIV diagnosis (OR = 2.20, t = 14.00, d.f. = 21, p < .001). Online surveys are a promising tool for HIV/STI surveillance and prevention internationally to reach an important subset of MSM.
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Affiliation(s)
- Katie B Biello
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,
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Abstract
There is a need to understand better the complex interrelationship between the adoption of masculinity during adolescence and the development of early romantic and sexual relationships. The purpose of this study was to describe features of adolescent masculinity and how it is expressed in the contexts of early to middle adolescent males' romantic and sexual relationships. Thirty-three 14- to 16-year-old males were recruited from an adolescent clinic serving a community with high sexually transmitted infection rates and were asked open-ended questions about their relationships-how they developed, progressed, and ended. Participants described a high degree of relationally oriented beliefs and behaviors related to romantic and sexual relationships, such as a desire for intimacy and trust. The males also described a more limited degree of conventionally masculine beliefs and behaviors. These beliefs and behaviors often coexisted or overlapped. Implications for the clinical care of similar groups of adolescents are described.
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Affiliation(s)
| | | | - Mary A Ott
- Indiana University School of Medicine, Indianapolis, IN, USA
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Rosenberger JG, Schick V, Schnarrs P, Novak DS, Reece M. Sexual behaviors, sexual health practices, and community engagement among gay and bisexually identified men living in rural areas of the United States. J Homosex 2014; 61:1192-1207. [PMID: 24344718 DOI: 10.1080/00918369.2014.872525] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Limited research has focused on the sexual behaviors of men who have sex with men (MSM) from rural communities. We examined the sexual and health-related behaviors of MSM living in rural areas of the United States in order to understand the sexual health repertoire of this population. A total of 5,357 participants living in rural settings were recruited online and completed an anonymous Internet-based survey that assessed sexual behaviors, condom use, and men's engagement with various community activities and events. These data provide a greater understanding of sexual health profiles that exist among rural MSM and will help inform the design of effective programs for men in these often underserved communities.
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Affiliation(s)
- Joshua G Rosenberger
- a Department of Global and Community Health , George Mason University , Fairfax , Virginia , USA
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Abstract
We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.
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Affiliation(s)
- Christian Grov
- Brooklyn College and the Graduate Center of CUNY, New York, NY. USA
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY. USA
| | - Aaron S. Breslow
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY. USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua G. Rosenberger
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Jose A Bauermeister
- The Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA
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Rosenberger JG, Herbenick D, Novak DS, Reece M. What's love got to do with it? Examinations of emotional perceptions and sexual behaviors among gay and bisexual men in the United States. Arch Sex Behav 2014; 43:119-128. [PMID: 24287965 DOI: 10.1007/s10508-013-0223-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Men who have sex with men (MSM) continue to be disproportionately impacted by STIs and HIV. In addition to traditional risk factors, increasing attention has been given to the potential role of affective components of a sexual encounter, including mood state. To date, no study has described sexual behaviors engaged in by those who report being in love (or not) during a given sexual event. Internet-based survey data were collected from 24,787 gay and bisexual men who were members of online websites facilitating social or sexual interactions with other men. Measures included sociodemographics, recent sexual behavior history, sexual event characteristics, and perceptions of "love" with men's most recent male sexual partner. Participants' mean age was 39.2 years; ethnicities included white (84.6 %), Latino (6.4 %), and African American (3.6 %). Nearly all men (91 %) were matched by presence (I love him/he loves me), absence (I don't love him/he doesn't love me), or uncertainty (I don't know if I do/I don't know if he does) of love with their most recent sexual partner. Men who reported love for their partner and believed their partner loved them were significantly more likely to have engaged in behaviors such as cuddling and kissing on the mouth. Differences were also seen in regard to love and men's reports of anal intercourse and oral sex. Findings highlight differences in sexual behaviors based on perceptions of love and suggest the need to further explore how these differences influence sexual health.
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Affiliation(s)
- Joshua G Rosenberger
- Department of Global and Community Health, George Mason University, 4400 University Drive, MSN 5B7, Fairfax, VA, 22030, USA,
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Roth AM, Rosenberger JG, Reece M, Van Der Pol B. Expanding sexually transmitted infection screening among women and men engaging in transactional sex: the feasibility of field-based self-collection. Int J STD AIDS 2013; 24:323-8. [PMID: 23970665 DOI: 10.1177/0956462412472791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Routine screening is a key component of sexually transmitted infection (STI) prevention and control; however, traditional programmes often fail to effectively reach men and women in hidden communities. To reduce prevalence, we must understand the programmatic features that would encourage utilization of services among asymptomatic individuals. Using incentivized snowball sampling, 44 women and men recently engaging in transactional sex were recruited (24 women, 20 men); median age 37 years. Respondents were offered the opportunity to collect genital, oropharyngeal and rectal samples for STI testing and completed a face-to-face interview about their experience with self-obtained sampling. Interviews were analysed using qualitative methods. Participants were unaware of potential risk for STI, but found self-sampling in non-clinical settings to be acceptable and preferable to clinic-based testing. All participants collected genital specimens; 96% and 4% collected oropharyngeal and rectal specimens, respectively. The burden of disease in this population was high: 38% tested positive for at least one STI. We detected multiple concomitant infections. Incorporating field collection of self-obtained samples into STI control programmes may increase utilization among high-risk populations unlikely to access clinic-based services. High infection rates indicate that individuals engaging in transactional sex would benefit from, and be responsive to, community-based self-sampling for STI screening.
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Affiliation(s)
- A M Roth
- Division of Global Public Health, University of California at San Diego School of Medicine, CA, USA.
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Calabrese SK, Rosenberger JG, Schick VR, Novak DS, Reece M. An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STDS 2013; 27:77-84. [PMID: 23373663 DOI: 10.1089/apc.2012.0355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM (n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention.
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Affiliation(s)
- Sarah K. Calabrese
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Joshua G. Rosenberger
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Vanessa R. Schick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts
| | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
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Abstract
There are limited contextual data regarding first sexual experiences of younger adolescent men. Yet these data that are needed to inform sexually-transmitted-infection and early-fatherhood-prevention efforts, particularly in lower-income communities. Using qualitative methods, 14 adolescent men (ages 14-16, all low-income, most African American) from a mid-sized US city were asked about relationships and sexual experiences in a one-hour face-to-face semi-structured interview, with two follow-up interviews at six- to nine-month intervals. Story-telling was encouraged. Descriptions of first sex were identified and then analysed for narrative structure and shared concepts. The dominant narrative of first sex proceeded through three steps: (1) preparation, which involved identification of a sexualised space, mentoring and pre-planning, (2) the event, which involved looking for cues indicating sexual interest and consent from a female partner, feelings of fear/nervousness and first sex itself and (3) afterwards, which involved a return to prior activities, minimal verbal exchange and a general positive feeling, sometimes accompanied by later disappointment. Mentorship, initiation by the female and idealising sex as a romantic experience, played important roles in constructing the context of first sex. These factors should be incorporated in harm-reduction interventions for young men in similar contexts.
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Affiliation(s)
- Mary A Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
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Schnarrs PW, Rosenberger JG, Schick VR, Novak DS, Herbenick D, Reece M. Gay and Bisexual Latino Men's Sexual Health and Behaviors: A National Online Sample. ACTA ACUST UNITED AC 2012. [DOI: 10.3149/jmh.1101.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schick V, Rosenberger JG, Herbenick D, Reece M. Sexual behaviour and risk reduction strategies among a multinational sample of women who have sex with women. Sex Transm Infect 2012; 88:407-12. [DOI: 10.1136/sextrans-2011-050404] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rosenberger JG, Schick V, Herbenick D, Novak DS, Reece M. Sex toy use by gay and bisexual men in the United States. Arch Sex Behav 2012; 41:449-58. [PMID: 21203811 DOI: 10.1007/s10508-010-9716-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 08/21/2010] [Accepted: 11/27/2010] [Indexed: 05/25/2023]
Abstract
Recent studies have documented that vibrators are an important part of the sexual repertoires of both men and women and have demonstrated positive sexual health outcomes among individuals who use such products. However, little is known about the use of other sexual enhancement products, particularly among gay and bisexually identified men. This study sought to document the extent to which gay and bisexually identified men report using sex toys and the sexual and relational situations within which they used them. Data were collected via an internet-based survey from 25,294 gay and bisexually identified men throughout the U.S. recruited from an Internet site popular among men seeking social or sexual interactions with other men. A majority (78.5%) of gay and bisexually identified men reported having used at least one type of sex toy, including dildos (62.1%), non-vibrating cock rings (51.9%), vibrators (49.6%), butt plugs (34.0%), masturbation sleeves (27.9%), and anal beads or balls (19.3%). Among users, toys such as dildos or butt plugs were commonly inserted into one's own anus during masturbation (95.7%, n = 11,781) and insertion into their partners anus (72.0% n = 4,197) during partnered sexual activities. These data suggest that sex toy use is common among gay and bisexual men during both solo and partnered sexual activities and considered by these men as enhancing the quality of their sexual experiences.
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Affiliation(s)
- Joshua G Rosenberger
- Center for Sexual Health Promotion, Indiana University, 1025 East Seventh Street, HPER 116, Bloomington, IN 47405, USA.
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Rosenberger JG, Reece M, Schick V, Herbenick D, Novak DS, Van Der Pol B, Fortenberry JD. Condom Use during Most Recent Anal Intercourse Event among a U.S. Sample of Men Who Have Sex with Men. J Sex Med 2012; 9:1037-47. [DOI: 10.1111/j.1743-6109.2012.02650.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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