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McCauley PS, Morgan E, Caba AE, Renley BM, Eaton LA, Watson RJ. Perceptions of bias in HIV prevention services, happiness with social support, and anticipated PrEP stigma among Black and Latine/x sexual and gender diverse individuals. AIDS Care 2024; 36:682-691. [PMID: 38451740 DOI: 10.1080/09540121.2024.2326126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
Although pre-exposure prophylaxis (PrEP) is a highly effective preventive treatment for HIV, anticipated PrEP stigma can hinder uptake. Perceptions of bias in HIV prevention and evaluations (e.g., happiness) tied to social support among Black and Latine/x sexual and gender diverse (SGD) individuals could be important correlates of anticipated PrEP stigma. To further this line of inquiry, a national sample of 872 Black and Latine/x SGD individuals who had and had never taken PrEP (Mage = 25.1, SD = 2.8) reported how they perceived HIV prevention and how happy they were with their social support. Multivariable linear regressions revealed that greater perceptions of bias in HIV prevention services were associated with higher anticipated PrEP stigma among Black and Latine/x SGD individuals who have never taken PrEP. Greater happiness with friend support was associated with lower PrEP stigma, whereas greater happiness with family support was associated with higher PrEP stigma among individuals who have taken PrEP. Findings highlight the need for PrEP and HIV interventions to address the intersectional stigma attached to prevention and for researchers to understand how evaluations of social support may contribute to stigma among Black and Latine/x SGD individuals.
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Affiliation(s)
- Peter S McCauley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, US
- Infectious Disease Institute, The Ohio State University, Columbus, OH, US
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
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Caba AE, Christophe NK, Renley BM, Simon KA, Feinstein BA, Eaton LA, Watson RJ. Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth. J Res Adolesc 2024. [PMID: 38616300 DOI: 10.1111/jora.12937] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.
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Affiliation(s)
- Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | | | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | - Kay A Simon
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
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El-Krab R, Kalichman SC, Eaton LA, Shkembi B, Kalichman MO. Stigmatization of food insecurity helps explain the association between food insecurity and medication nonadherence among people living with HIV. PSYCHOL HEALTH MED 2024:1-11. [PMID: 38493507 DOI: 10.1080/13548506.2024.2329911] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
Food insecurity is an established barrier to antiretroviral therapy (ART) adherence among people living with HIV (LWHIV). While insufficient access to food reliably impedes medication adherence, the link between food insecurity and ART nonadherence has not been fully explained. In addition, depression is reliably associated with both food insecurity and ART nonadherence, but again the link between food insecurity and depression is not understood. A potential explanatory mechanism in the associations among food insecurity, depression and ART nonadherence is the experience of food insecurity stigma (FI-stigma). The current study tested FI-stigma in relation to depression as explanatory mechanisms in the association between food insecurity and ART nonadherence. Men and women (n = 495) LWHIV in the southeastern United States completed confidential surveys that included measures of food insecurity, FI-stigma, depression, and ART adherence. Results from the serial mediation model indicated significant direct effects of food insecurity and depression on ART adherence. In addition, food insecurity was indirectly associated with ART adherence through FI-stigma and depression symptoms. Results suggest that the stigmatization of food insecurity predicts increased depression which in turn predicts ART nonadherence, with both FI-stigma and depression symptoms partially mediating the relationship between food insecurity and ART nonadherence. Interventions aimed to reduce food insecurity should include it's associated stigma to improve treatment adherence among people LWHIV.
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Affiliation(s)
- Renee El-Krab
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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McCauley PS, Del Farno AJ, Caba AE, Renley BM, Shuler S, Eaton LA, Watson RJ. Stress of being outed to parents, LGBTQ family support, and depressive symptoms among sexual and gender diverse youth. J Res Adolesc 2024; 34:205-221. [PMID: 38282552 DOI: 10.1111/jora.12912] [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: 04/06/2023] [Revised: 12/08/2023] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
Limited scholarship has explored how a lack of agency in identity disclosure (being "outed") to parents is associated with mental health experiences of sexual and gender diverse youth (SGDY). With a national sample of SGDY (N = 9272; 66.8% White non-Hispanic) aged 13-17 (Mage = 15.63, SD = 1.24), this study first compared social position differences between SGDY who were outed to their parents compared to those not outed, and second, investigated how the stress from being outed to parents was associated with LGBTQ family support and depressive symptoms. Results revealed that SGDY who were outed to their parents reported higher levels of depressive symptoms and lower amounts of LGBTQ family support than SGDY who were not outed to their parents. In addition, greater stress from being outed to parents was indirectly associated with higher depressive symptoms through lower LGBTQ family support. These relationships significantly varied across gender identity. Findings highlight the importance of instilling greater agency in disclosure experiences among SGDY.
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Affiliation(s)
- Peter S McCauley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Alexander J Del Farno
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Shaylynne Shuler
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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McCauley PS, Lessard LM, Babcock N, Sun N, Eaton LA, Watson RJ. Sexual Minority Youth Reporting SOGIE-Based Harassment to Adults at School: The Roles of Experienced Harassment, Outness, Safety, and Adult Support at School. J Youth Adolesc 2024; 53:669-684. [PMID: 38055135 DOI: 10.1007/s10964-023-01914-3] [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] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
Despite a proliferation of bullying prevention programs in recent time, limited work has investigated support-seeking behaviors in response to elevated bullying levels among sexual minority youth (SMY). To address this gap, the current study examined how harassment targeting SOGIE (sexual orientation, gender identity, and gender expression), sexual identity outness, school safety, and perceptions of teacher/staff support were associated with SMY talking to an adult at school about harassment. A large contemporary national sample of SMY (N = 5538) between the ages 13-18 (Mage = 15.53, SD = 1.33) who experienced at least one form of SOGIE-based harassment in the past year was leveraged for analyses. Hierarchical multivariable logistic regressions revealed more frequent SOGIE-based harassment was associated with greater odds of reporting harassment to school personnel, particularly among SMY who felt safe at school. Findings highlight the need for school-based interventions to foster school safety among SMY who experience peer harassment to promote their reporting of this behavior.
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Affiliation(s)
- Peter S McCauley
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., Storrs, CT, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA
| | - Nikole Babcock
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., Storrs, CT, USA
| | - Nora Sun
- Harvard University, Cambridge, MA, 02138, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., Storrs, CT, USA
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Kalwicz DA, Rao S, Modrakovic DX, Zea MC, Dovidio JF, Eaton LA, Holt M, MacGibbon J, Zaheer MA, Garner A, Calabrese SK. The Implications of PrEP Use, Condom Use, and Partner Viral Load Status for Openness to Serodifferent Partnering Among US Sexual Minority Men (SMM). AIDS Behav 2024; 28:524-534. [PMID: 38329558 PMCID: PMC10999131 DOI: 10.1007/s10461-023-04241-7] [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] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
PrEP has been reported to facilitate openness to serodifferent sexual partnerships among sexual minority men (SMM). However, other aspects of a sexual scenario likely come into play, including whether or not condoms are used and whether or not the partner living with HIV has an undetectable viral load. This online survey study evaluated the association between PrEP status and openness to serodifferent partnering, as well as the effects of various sexual scenario variables (condom use and partner's viral load) among 268 HIV-negative SMM in the US. Each participant reported their PrEP status and rated their openness to serodifferent partnering in four sexual scenarios, which varied by condom use (with/without) and partner viral load status (detectable/undetectable). Analyses of covariance (ANCOVAs) were conducted to assess differences in openness to serodifferent partnering by PrEP status in each scenario, adjusting for background characteristics. A two-way repeated measures ANCOVA and a three-way mixed factorial ANCOVA, including PrEP status as a between-subjects variable, were also performed to assess the effects of condom use and partner viral load status on openness. Across all scenarios, current PrEP users expressed significantly greater openness to serodifferent partnering compared to participants who had never used PrEP. Current PrEP users were also more likely than former PrEP users to consider partnering with someone with an undetectable viral load without using condoms. Both PrEP users and PrEP-inexperienced individuals had greater openness to serodifferent partnering with a partner having an undetectable (vs. detectable) viral load, which was magnified by condom use among the latter.
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Affiliation(s)
- David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
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Calabrese SK, Kalwicz DA, Zaheer MA, Dovidio JF, Garner A, Zea MC, Treloar C, Holt M, Smith AKJ, MacGibbon J, Modrakovic DX, Rao S, Eaton LA. The Potential Role of Undetectable = Untransmittable (U = U) in Reducing HIV Stigma among Sexual Minority Men in the US. AIDS Behav 2024; 28:741-757. [PMID: 38285293 DOI: 10.1007/s10461-023-04263-1] [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] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
The Undetectable = Untransmittable (U = U) message and its scientific underpinnings have been widely suggested to reduce HIV stigma. However, misunderstanding and skepticism about U = U may prevent this destigmatizing potential from being fully realized. This cross-sectional study examined associations between U = U belief (belief that someone with a sustained undetectable viral load has zero risk of sexually transmitting HIV) and HIV stigma among US sexual minority men. Differences by serostatus and effects of brief informational messaging were also explored. The survey was completed online by 106 men living with HIV and 351 HIV-negative/status-unknown men (2019-2020). Participants were 18-83 years old (M[SD] = 41[13.0]). Most were non-Hispanic White (70.0%) and gay (82.9%). Although nearly all participants (95.6%) were aware of U = U, only 41.1% believed U = U. A greater percentage of participants living with HIV (66.0%) believed U = U compared with HIV-negative/status-unknown participants (33.6%). Among participants living with HIV, U = U belief was not significantly associated with perceived, internalized, or experienced HIV stigma or with viral load prejudice (prejudice against people who have a detectable HIV viral load). Among HIV-negative/status-unknown participants, U = U belief was associated with less frequently enacted HIV discrimination, more positive feelings toward people with an undetectable viral load, and lower personal endorsement of stigmatizing beliefs. Brief informational messaging about U = U did not affect most stigma dimensions and did not favorably affect any. Interventions are needed to correct commonly held, outdated misconceptions about HIV transmission risk. Such initiatives must not only engage people living with HIV but also engage HIV-negative/status-unknown people to maximize the destigmatizing potential of U = U.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
- MPact Global Action for Gay Men's Health and Rights, West Hollywood, CA, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Simon KA, Driver R, Rathus T, Cole A, Kalinowski J, Watson RJ, Eaton LA. HIV Information Avoidance, HIV Stigma, and Medical Mistrust among Black Sexual Minority Men in the Southern United States: Associations with HIV Testing. AIDS Behav 2024; 28:12-18. [PMID: 37955807 DOI: 10.1007/s10461-023-04218-6] [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] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Uptake of HIV testing is a critical step in the HIV prevention and treatment care cascade. Barriers to HIV testing, however, remain and innovative research in this area is warranted to improve uptake of testing. As such, we investigated the role of HIV information avoidance - a novel construct potentially related to HIV testing. We analyzed this construct in relation to other factors known to impact HIV testing, namely HIV stigma and medical mistrust. Multiple linear regression analyses indicated that HIV information avoidance was negatively associated with HIV testing, while medical mistrust was positively associated with HIV testing. HIV testing stigma was not associated with HIV testing. This work contributes to the developing literature on HIV information avoidance and its relationships with HIV stigma and HIV testing uptake. Further, these findings can inform HIV testing interventions which often do not focus on HIV information avoidance. Future research on the mechanisms of information avoidance that are amenable to intervention, and the temporal ordering of the relationship between information avoidance and HIV testing is warranted.
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Affiliation(s)
- Kay A Simon
- Department of Family Social Science, University of Minnesota, 1985 Buford Ave St. Paul, Minneapolis, MN, 55108, USA.
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, Psychiatric Institute, Columbia University, New York, New York State, NY, USA
| | - Taylor Rathus
- Department of Human Development and Family Sciences Storrs, University of Connecticut, Storrs, CT, USA
| | - Ayeisha Cole
- Department of Human Development and Family Sciences Storrs, University of Connecticut, Storrs, CT, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences Storrs, University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences Storrs, University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences Storrs, University of Connecticut, Storrs, CT, USA
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Watson RJ, Caba AE, Lawrence SE, Renley BM, McCauley PS, Wheldon CW, Eaton LA, Russell ST, Eisenberg ME. Examining Mental Health and Bullying Concerns at the Intersection of Sexuality, Gender, Race, and Ethnicity Among a National Sample of Sexual and Gender Diverse Youth. LGBT Health 2024; 11:20-27. [PMID: 37668602 DOI: 10.1089/lgbt.2023.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/06/2023] Open
Abstract
Purpose: Most extant scholarship that examines the health experiences of sexual and gender diverse youth (SGDY) is limited in the ability to apply an intersectional framework due to small sample sizes and limitations in analytic methods that only analyze the independent contribution of social identities. To address this gap, this study explored the well-being of youth at the intersection of ethnic, racial, sexual, and gender identities in relation to mental health and bullying. Methods: Data were from a U.S. national survey of SGDY aged 13-18 years, collected in 2022 (N = 12,822). Exhaustive Chi-square Automatic Interaction Detection analysis identified intersectional social positions bearing the greatest burden of negative health-related experiences (depression, anxiety, and past 30-day in-person victimization). Results: Transgender boys were among those at the highest prevalence for compromised mental health and peer-based in-person victimization. Although the primary distinguishing factor was transgender identity for depression and anxiety, there were no racial/ethnic distinctions, corroborating some previous scholarship. Asian cisgender and transgender girl SGDY shared the lowest burden of peer-based in-person victimization in school. Conclusion: Our findings suggest a need for scholars, health professionals, and other stakeholders to better understand the mechanisms that drive negative health experiences and in-person victimization experiences at the intersections of sexual, gender, racial, and ethnic identities.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Samantha E Lawrence
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Peter S McCauley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Stephen T Russell
- Department of Human Development and Family Sciences, College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Morgan E, Eaton LA, Watson RJ. Cannabis Use Frequency is Associated with PrEP Cessation and Self-reported HIV Diagnosis. AIDS Behav 2023; 27:4033-4040. [PMID: 37422575 DOI: 10.1007/s10461-023-04117-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/10/2023]
Abstract
To achieve stated targets in the United States of Ending the HIV Epidemic by 2030, it is necessary to decrease rates of pre-exposure prophylaxis use (PrEP) cessation. In particular, it is key to assess PrEP use and cannabis use frequency given the recent wave of cannabis decriminalization across the U.S., particularly among sexual minority men and gender diverse (SMMGD) individuals. We used data from the baseline visit of a national study of Black and Hispanic/Latino SMMGD. Among participants reporting any lifetime cannabis use, we further assessed the association between frequency of cannabis use in the past 3 months and: (1) self-reported PrEP use, (2) recency of last PrEP dose, and (3) HIV status using adjusted regression models. Compared to those who never used cannabis, odds of PrEP cessation were higher among those who used it once or twice (aOR 3.27; 95% CI 1.38, 7.78), those who used it monthly (aOR 3.41; 95% CI 1.06, 11.01), and those who used it weekly or more frequently (aOR 2.34; 95% CI 1.06, 5.16). Similarly, those reporting cannabis use 1-2 times in the past 3 months (aOR 0.11; 95% CI 0.02, 0.58) and those reporting weekly or more frequent use (aOR 0.14; 95% CI 0.03, 0.68) were each more likely to report more recent PrEP cessation. These results suggest that cannabis users in general may be a population at elevated risk of HIV diagnosis although more research regarding these findings is needed with nationally representative populations.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA.
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Kalichman SC, Kalichman MO, Eaton LA. Phone-Delivered Intervention to Improve HIV Care for Young People Living With HIV: Trial to Inform Implementation and Utility. J Acquir Immune Defic Syndr 2023; 94:227-234. [PMID: 37643392 PMCID: PMC10578518 DOI: 10.1097/qai.0000000000003279] [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] [Received: 02/06/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Phone-delivered counseling has demonstrated improved health outcomes for people living with HIV. However, counseling is hampered by a lack of guidance on the frequency and duration of intervention in relation to clinical benefits. The added benefits of bidirectional (ie, interactive) vs. unidirectional (ie, passive) text messages to augment counseling are also unknown. We conducted a clinical trial of adaptive phone counseling along with either bidirectional or unidirectional text messaging for people living with HIV. METHODS A community sample of 425 young people (aged 16-36 years) living with HIV in Georgia, USA, received weekly phone counseling sessions with the number of sessions determined by the participant and their counselor. Participants were subsequently randomized to either (1) weekly bidirectional text messages with their counselor or (2) weekly automated unidirectional text message reminders. Participants were followed for 16 months to assess 3 primary outcomes: antiretroviral therapy (ART) adherence, HIV care engagement, and HIV suppression. RESULTS Participants demonstrated improved clinical outcomes over the follow-up period, with 74% of those who were not taking ART initiating treatment, 65% of those on ART improving adherence, and 47% who had detectable viral loads at baseline attaining viral suppression. The number of sessions completed predicted improved ART adherence, greater care engagement, and HIV suppression over follow-ups. Bidirectional text messages impacted care engagement by moderating the effects of counseling sessions on HIV suppression. CONCLUSIONS Phone counseling augmented by bidirectional text messages has the potential to improve HIV care for young adults living with HIV.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lisa A. Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
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12
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Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. Prev Sci 2023:10.1007/s11121-023-01603-4. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
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13
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Kalichman SC, Kalichman MO, Shkembi B, Eaton LA. COVID-19 health information trust and prejudicial attitudes predict healthcare disruptions in the first year of COVID-19 among people living with HIV. J Behav Med 2023; 46:812-820. [PMID: 36881251 PMCID: PMC9989585 DOI: 10.1007/s10865-023-00399-6] [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] [Received: 09/08/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Cross-sectional studies have reported that people living with HIV experienced disruptions to social relationships and healthcare during the first year of the COVID-19 pandemic. Furthermore, individuals with less trust in public health sources of COVID-19 information as well as those who held greater COVID-19 prejudicial attitudes experienced greater healthcare disruptions in the early months of COVID-19. To examine changes in trust and prejudicial attitudes in relation to healthcare disruptions during the first year of COVID-19, we followed a closed cohort of 115 men and 26 women ages 18 to 36 living with HIV over the first year of the COVID-19 pandemic. Findings confirmed that a majority of individuals continued to experience disruptions to their social relationships and healthcare over the course of the first year of COVID-19. In addition, trust in COVID-19 information from the CDC and state health department diminished over the year as did COVID-19 prejudicial attitudes. Regression models showed that lower trust in the CDC and health department and greater prejudicial attitudes toward COVID-19 early in the pandemic predicted greater healthcare disruptions over the year. In addition, greater trust in the CDC and health department early in COVID-19 predicted better antiretroviral therapy adherence later in the year. Results support an urgent need to regain and sustain trust in public health authorities among vulnerable populations.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA.
| | - Moira O Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
| | - Bruno Shkembi
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, InCHIP 2006 Hillside Road, 06269, Storrs, CT, USA
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14
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Brousseau NM, Kalichman SC, Watson RJ, Eaton LA. Amphetamine use and its associations with antiretroviral adherence and viral load among sexual minority men and transgender women living with HIV. AIDS Care 2023; 35:1472-1479. [PMID: 37139536 PMCID: PMC10524564 DOI: 10.1080/09540121.2023.2206096] [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] [Received: 07/18/2022] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
Substance use has complex associations to HIV disease progression. The current study tested the associations between several substances and HIV viral load while accounting for confounders relevant to HIV disease progression and substance use. Young sexual minority men and transgender women living with HIV (LWH) in Georgia (N = 385) completed measures and biological tests for HIV viral load and substance use. Multivariable regression models tested the role of specific drugs (i.e., alcohol, cannabis/THC, cocaine, and combined amphetamine and methamphetamine) directly on viral load and indirectly through antiretroviral (ART) adherence. ART adherence and HIV care self-efficacy were consistently associated with greater HIV suppression. Alcohol and cocaine were not associated with ART adherence or viral load. Cannabis was negatively associated with ART adherence (B = -.053, p = .037) but not viral load. Amphetamine/methamphetamine demonstrated significant direct effects on higher viral load (B = .708, p = .010) while indirectly influencing viral load through a negative association with ART adherence. Our findings support previous research demonstrating amphetamine/methamphetamine use impacts viral load both directly and indirectly through ART adherence. Interventions addressing amphetamine/methamphetamine use by young sexual minority men and transgender women LWH are urgently needed, and future research should focus on determining the mechanisms by which formulations of amphetamine impact HIV replication.Trial registration: ClinicalTrials.gov identifier: NCT03665532.
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Affiliation(s)
- Natalie M Brousseau
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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15
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Eaton LA, Layland EA, Driver R, Kalichman SC, Kalichman MO, Watson RJ, Kalinowski J, Chandler CJ, Earnshaw VA. Novel Latent Profile Analysis of a Test of Concept, Stigma Intervention to Increase PrEP Uptake Among Black Sexual Minority Men. J Acquir Immune Defic Syndr 2023; 94:1-9. [PMID: 37195906 PMCID: PMC10524435 DOI: 10.1097/qai.0000000000003223] [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] [Received: 07/01/2022] [Accepted: 03/07/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) has demonstrated efficacy for HIV prevention, yet uptake of PrEP among populations in urgent need of prevention tools (eg, Black sexual minority men) is limited, and stigma and medical mistrust remain strong barriers to accessing PrEP. PURPOSE To evaluate a test of concept brief intervention to address stigma and medical mistrust as barriers to PrEP uptake using novel latent profile analysis. METHODS Participants (N = 177) residing in the southeastern US were randomized to 1 of 4 arms to establish the potential impact of a brief, stigma focused counseling intervention (referred to as Jumpstart ) to increase PrEP uptake. We estimated intervention effect size (Cramer's V) for PrEP uptake and then explored differential intervention effects across latent profiles of psychosocial barriers to PrEP use. RESULTS The intervention resulted in small, but meaningful effect size, with self-reported PrEP uptake increasing across Jumpstart conditions with the control condition reporting 24% uptake and Jumpstart plus text/phone calls (the most intensive intervention arm) reporting 37% uptake, and a similar pattern emerging for biologically confirmed PrEP use. Among participants 30 and older, Jumpstart participants were more likely to move to a postintervention profile with fewer barriers than control participants and reported the highest uptake of PrEP. CONCLUSIONS Addressing social/emotional barriers to PrEP uptake is an essential component of bridging the gap between advances being made in biomedical forms of HIV prevention, and establishing and supporting access to those advances.
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Affiliation(s)
- Lisa A. Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Eric A. Layland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | | | - Ryan J. Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Cristian J. Chandler
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Chandler CJ, Liu Q, Brown AL, Matthews DD, Tsai AC, Bukowski LA, Eaton LA, Stall RD, Friedman MR. Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black Sexual Minority Men. Stigma Health 2023; 8:372-380. [PMID: 37789829 PMCID: PMC10545331 DOI: 10.1037/sah0000435] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This secondary analysis of a mixed serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status or some "other" reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality and Resilience (POWER), a serial, cross-sectional study conducted between 2014-2017 (N=4430). Experiences of multiple stigmas were reported by n=938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with "other" stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and SES, particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM, but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Qimin Liu
- Psychological Sciences, Vanderbilt University 2301 Vanderbilt Place · Nashville, TN 37240-7817, USA
| | - Andre L. Brown
- Behavioral and Community Health Science, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Derrick D. Matthews
- Health Behavior, Gillings School of Public Health, University of North Carolina, 361 Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital 100 Cambridge St Suite 1600, Boston, MA 02114, USA
| | - Leigh A. Bukowski
- Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Scaife Hall, Suite 600 Pittsburgh, PA 15213, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Rd, Storrs, CT 06269-1248, USA
| | - Ronald D. Stall
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
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17
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Abstract
Vaccine hesitancy is a significant threat to public health and the anti-vaccination movement has played a significant role in communicable disease outbreaks. This commentary discusses the history and tactics of vaccine denialists and anti-vaccination groups. Anti-vaccination rhetoric is robust on social media platforms, and vaccine hesitancy has proven to impede the uptake of both established and new vaccines. Effective counter-messaging is needed to preemptively discredit vaccine denialists and reduce their influence on vaccine uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut
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18
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Simon KA, Hanna-Walker V, Clark AN, Driver R, Kalinowski J, Watson RJ, Eaton LA. "This Is To Help Me Move Forward": The Role of PrEp in Harnessing Sex Positivity and Empowerment Among Black Sexual Minority Men in the Southern United States. J Sex Res 2023; 60:741-751. [PMID: 36239604 PMCID: PMC10102248 DOI: 10.1080/00224499.2022.2131704] [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] [Indexed: 05/12/2023]
Abstract
In the United States (U.S.), Black sexual minority men (BSMM) are disproportionately burdened by HIV. Prevention advances, such as HIV pre-exposure prophylaxis (PrEP), play a key role in reducing HIV transmission and improving our understanding of sexual expression and health. Despite these advances, little is known regarding the potential link between PrEP use and positive sexuality, including the benefits that BSMM see in accessing PrEP. We conducted a thematic analysis of 32 interviews with BSMM in the Southern U.S. regarding their PrEP beliefs. We developed five themes: (1) Sexual freedom, (2) Agency and empowerment, (3) Making PrEP normative, (4) Behavioral health practices, and (5) Committed relationship tensions. Our findings suggest that BSMM are increasingly concerned about freedom of choice and invested in sexual empowerment as related to their PrEP use. Further, unanticipated benefits, community support, and relationship tensions are salient factors in considerations of PrEP use among BSMM. These findings have implications for how we might understand a broader movement toward sexual empowerment and positivity, and the pivotal role that PrEP serves in this movement.
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Affiliation(s)
- Kay A. Simon
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Veronica Hanna-Walker
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Alyssa N. Clark
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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19
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Brousseau NM, Driver R, Simon K, Watson RJ, Earnshaw VA, Chandler CJ, Kalichman S, Eaton LA. PrEP-Related Interactive Toxicity Beliefs: Associations With Stigma, Substance Use, and PrEP Uptake. AIDS Educ Prev 2023; 35:114-125. [PMID: 37129594 DOI: 10.1521/aeap.2023.35.2.114] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite documented efficacy in reducing HIV transmission, pre-exposure prophylaxis (PrEP) uptake among Black sexual minority men (BSMM) is limited. One understudied factor which may impede PrEP uptake is PrEP-related interactive toxicity beliefs (i.e., believing it is hazardous to use alcohol/drugs while taking PrEP). Data from N = 169 HIV negative BSMM over 4 months showed high rates of agreement with at least one alcohol (78%) or drug (84%) interactive toxicity belief. Univariate analyses showed increased alcohol or drug interactive toxicity beliefs predicted lower PrEP uptake. Multivariable regression suggested those with PrEP-related alcohol or drug interactive toxicity beliefs were more likely to report high PrEP stigma, more negative PrEP beliefs (e.g., concern that taking PrEP disrupts life), and were more likely to use alcohol/drugs (respectively) prior to/during sex. Findings warrant intervention work targeting interactive toxicity beliefs with tailored messaging to mitigate PrEP stigma and correct concerns around substance use and PrEP.
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Affiliation(s)
- Natalie M Brousseau
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Kay Simon
- Department of Family Social Science, University of Minnesota, St. Paul, Minnesota
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - Cristian J Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Seth Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
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20
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Kalichman SC, Eaton LA, Kalichman MO, Sam SS, Caliendo AM. Prepandemic Predictors of Medication Adherence and HIV Viral Load During the First Year of COVID-19. J Acquir Immune Defic Syndr 2023; 92:242-249. [PMID: 36730771 PMCID: PMC9911104 DOI: 10.1097/qai.0000000000003129] [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] [Received: 05/23/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Studies have reported significant immediate impacts of the COVID-19 pandemic on the social relationships and health care of people living with HIV. This study followed a closed cohort of young people living with HIV over the first year of the COVID-19 pandemic. Participants were men and women (N = 140) age 36 years and younger who were living with HIV and had demonstrated suboptimal adherence to antiretroviral therapy, unsuppressed HIV viral load, or active substance use in a run-in study. The results confirmed that participants continued to experience significant disruptions to their social relationships and health care over the course of the first year of the COVID-19 pandemic. There was evidence for sustained impacts on transportation, housing stability, and food security during the first year of COVID-19. Multivariable models showed that greater pre-COVID-19 social support predicted greater antiretroviral therapy adherence and greater HIV suppression (lower viral load) over the first year of the COVID-19 pandemic. Efforts to plan and prepare people living with HIV for future social crises, including future pandemics, should emphasize building and sustaining social support.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lisa A. Eaton
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Moira O. Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Soya S. Sam
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI; and
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Angela M. Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
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21
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Wiginton JM, Eaton LA, Kalinowski J, Watson RJ, Kalichman SC. Lifetime prevalence of syphilis infection among predominantly Black sexual and gender minorities living with HIV in Atlanta, Georgia: a cross-sectional analysis. Ethn Health 2023; 28:159-169. [PMID: 34818951 PMCID: PMC9126996 DOI: 10.1080/13557858.2021.2007225] [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: 07/18/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Syphilis infection disproportionately impacts Black sexual and gender minorities (SGM) in the United States. The extent of this impact among those living with HIV has been minimally examined. This study sought to examine lifetime syphilis prevalence and associated factors in a community sample of predominantly Black SGM living with HIV in the Southeastern US. DESIGN Participants (N = 174) enrolled in a stigma-mitigation trial for people living with HIV in Atlanta, Georgia, completed a sub-study involving testing for Treponema pallidum antibodies, indicative of lifetime syphilis infection. We performed chi-square and Fisher's exact tests to assess sociodemographic and healthcare differences by presence/absence of lifetime syphilis infection. RESULTS Most participants identified as non-Hispanic Black (n = 142/174; 81.6%) and cisgender male (n = 146/174; 83.9%). More than two thirds (n = 120/174) identified as gay/homosexual. We documented a 55.7% (n = 97/174) lifetime prevalence of syphilis infection and observed differences by sexual identity, with 77.3% (n = 75/97) of those screening positive reporting gay/homosexual identity relative to 58.4% (n = 45/77) of those screening negative (chi-square[1] = 7.8, p < 0.010). CONCLUSION Findings underscore how syphilis prevention efforts have missed the most marginalized, warranting a renewed, comprehensive strategy for improving the sexual health of Black SGM. Embedding targeted, respectful community engagement, expanded testing access, and healthcare provider training into broader sexual health and psychosocial wellness efforts is needed.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Seth C. Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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22
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Wheldon CW, Eaton LA, Watson RJ. Predisposing, Enabling, and Need-Related Factors Associated with Human Papillomavirus Vaccination Intentions and Uptake Among Black and Hispanic Sexual and Gender Diverse Adults in the USA. J Racial Ethn Health Disparities 2023; 10:237-243. [PMID: 34981465 PMCID: PMC8722661 DOI: 10.1007/s40615-021-01214-1] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
The purpose of the current study was to identify predisposing, enabling, and need-based factors associated with human papillomavirus (HPV) or HPV vaccination intentions among ethnoracial minority men who have sex with men (MSM) and gender expansive natal males. This was a secondary analysis of survey data from 299 Black and Hispanic MSM and gender expansive young (aged 18-30 years) adults living in the USA. Variable selection was informed by Anderson's model of healthcare utilization. Outcomes were self-reported HPV vaccination and vaccine intentions. Less than half of the sample (45.5%) reported initiating (i.e., receiving at least 1 dose) HPV vaccination. Hierarchical multiple regression was used to identify relevant theoretical predictors. Among those who were unvaccinated, 14.2% were unlikely, 56.3% were undecided, and 29.4% likely to initiate HPV vaccination within the next 12 months. More favorable vaccine attitudes (adjusted prevalence ratio [aPR] = 1.55; 95% CI: 1.12-2.15), past year routine check-up (aPR = 1.50; 95% CI: 1.14-1.97), and ever being diagnosed with anogenital warts (aPR = 1.55; 95% CI: 1.12-2.15) were independently associated with the probability of HPV vaccination. Several enabling factors (e.g., testing for sexually transmitted infections) were not associated with HPV vaccination, suggesting routine missed opportunities. There were no associations between predictor variables and HPV vaccine intentions. Targeted efforts are needed to decrease anal cancer disparities experienced by ethnoracial minority MSM. Leveraging enabling factors already present this population (e.g., STI testing and pre-exposure prophylaxis use) are potential targets for interventions to increase the reach of HPV vaccination.
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Affiliation(s)
- Christopher W. Wheldon
- grid.264727.20000 0001 2248 3398Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA USA
| | - Lisa A. Eaton
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
| | - Ryan J. Watson
- grid.63054.340000 0001 0860 4915Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT USA
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23
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Berman M, Eaton LA, Watson RJ, Earnshaw VA, Wiginton JM, Layland E. Factors Associated with Disclosure of Sexual Orientation Among Black Sexual Minority Men. LGBT Health 2023; 10:51-61. [PMID: 36099207 PMCID: PMC10039276 DOI: 10.1089/lgbt.2021.0446] [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: 01/25/2023] Open
Abstract
Purpose: This study evaluated the characteristics associated with sexual orientation disclosure among HIV-negative Black sexual minority men (BSMM) in the greater Atlanta, Georgia area. Survey data were collected from 475 HIV-negative BSMM from 2017 to 2019 as part of a larger behavioral intervention study focused on stigma, prejudice, and HIV-testing uptake. Methods: Participants reported their levels of sexual orientation disclosure globally, to their community, and to their family. Data were analyzed using one-way analysis of variance and multinomial logistic regression to determine whether demographic, minority stress, substance use, and mental health were associated with sexual orientation disclosure globally, to community members, and to family members. Results: Findings revealed that participants with older age, bisexual identity, and higher levels of internalized homophobia had higher odds of global, community, and family sexual orientation nondisclosure. Furthermore, participants with higher levels of resilience had lower odds of partial sexual orientation disclosure compared with their fully disclosed counterparts. Conclusions: These findings reveal variations associated with sexual orientation disclosure across varying contexts among HIV-negative BSMM, particularly among family member disclosure.
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Affiliation(s)
- Marcie Berman
- Department of Psychological Science, Central Connecticut State University, New Britain, Connecticut, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Layland
- Department of Public Health, Yale University, New Haven, Connecticut, USA
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Hanna-Walker V, Simon KA, Lawrence SE, Driver R, Kalinowski J, Watson RJ, Eaton LA. Black Sexual Minority Men's Stigma-Based Experiences Surrounding Pre-exposure Prophylaxis in the Southern United States. LGBT Health 2022; 10:245-251. [PMID: 36516136 PMCID: PMC10079246 DOI: 10.1089/lgbt.2022.0118] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Intersecting experiences of stigma related to pre-exposure prophylaxis (PrEP) influence PrEP uptake among Black sexual minority men (BSMM) living in the southern United States; however, it is unclear what stigmatized identities and behaviors are impacted when accessing human immunodeficiency virus prevention options. To inform identity-specific PrEP interventions, this study examined stigma in BSMM's lives relating to intersecting experiences of PrEP stigma. Methods: We conducted 32 virtual, semistructured qualitative interviews with BSMM residing in the southeastern United States between February and April 2019. Results: We identified three themes (anticipated stigma, experiences of prejudice and stereotyping, and negative attitudes) and one subtheme within negative attitudes (othering social/sexual groups). Across all themes, PrEP stigma was often manifested through stigma against BSMM's sexual orientation or sexual behavior. BSMM in othering social/sexual groups displayed instances of cognitive dissonance by regularly expressing negative attitudes about and explicitly distancing themselves from social/sexual groups based on sexual orientation and sexual behavior. BSMM's race and gender were rarely mentioned as being stigmatized. Conclusions: Interventions focused on PrEP use could benefit from expanding their definition of PrEP stigma to include a stronger emphasis on intersecting identities and work to reduce cognitive dissonance in BSMM in the form of internalized homophobia.
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Affiliation(s)
- Veronica Hanna-Walker
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Kay A Simon
- Family Social Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samantha E Lawrence
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Watson RJ, Chang CJ, Feinstein BA, Moody R, Caba A, Eaton LA. PrEP Stigma and logistical barriers remain significant challenges in curtailing HIV transmission among Black and Hispanic/Latinx cisgender sexual minority men and transgender women in the US. AIDS Care 2022; 34:1465-1472. [PMID: 35848490 PMCID: PMC9842805 DOI: 10.1080/09540121.2022.2098908] [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] [Received: 12/26/2021] [Accepted: 06/30/2022] [Indexed: 01/19/2023]
Abstract
Despite advancements in HIV prevention, such as pre-exposure prophylaxis (PrEP), there remain inequities in accessing PrEP among Black and Hispanic/Latinx cisgender sexual minority men and transgender women (SMMTW). Researchers have documented multiple barriers to PrEP uptake, yet the relative impacts of PrEP internalized stigma and logistical barriers (e.g., Cost; time) to PrEP use are understudied. It may be meaningful to investigate potential interactions between internalized stigma and logistical barriers to PrEP use. We utilized data from 827 Black and Hispanic/Latinx SMMTW (Mage = 25.09) in the US and found that greater PrEP-related internalized stigma and greater PrEP logistical barriers were independently significantly associated with lower likelihood of current PrEP use, but PrEP-related internalized stigma became a non-significant predictor when included in a multivariable model. We found a significant interaction between PrEP-related internalized stigma and logistical barriers to PrEP use, such that the association between internalized stigma and likelihood of current PrEP use was only significant at lower levels of logistical barriers to PrEP use. Findings highlight the need to reduce logistical barriers to PrEP use, and for clinicians to acknowledge the role of stigma for individuals who otherwise do not report logistical barriers.
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Affiliation(s)
- Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Cindy J. Chang
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, US
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, US
| | - Raymond Moody
- Mailman School of Public Health, Columbia University, New York, NY, US
| | - Antonia Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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Morgan E, Caba AE, Eaton LA, Watson RJ. PrEP Access Affected by COVID-19 Is Associated With Increased Odds of HIV Seroconversion. J Acquir Immune Defic Syndr 2022; 91:138-143. [PMID: 36094479 PMCID: PMC10284373 DOI: 10.1097/qai.0000000000003036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 02/15/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals report lower uptake and adherence to pre-exposure prophylaxis (PrEP) compared with White SMMGD. For some, the COVID-19 pandemic has resulted in reduced access to PrEP prescriptions and related changes to PrEP use, yet little is known how pandemic-related changes to PrEP access and sexual activity might influence sexually transmitted infection (STI) status and HIV seroconversion among SMMGD of color. We used data from 4 waves of a national study of Black and Hispanic/Latino SMMGD's HIV, PrEP, and health experiences to assess whether self-reported changes to sexual activity were associated with STI status, and whether self-reported changes to PrEP access were associated with HIV seroconversion. Those who reported greater impact to their sexual activity during the pandemic [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI): 1.10 to 1.40] and a greater number of sexual partners (aOR = 1.29; 95% CI: 1.21 to 1.38) were more likely to report a positive STI test. In addition, we found that compared with those who did not report pandemic-related changes to PrEP access, those who did report changes to PrEP access had significantly higher odds of HIV seroconversion during the study period (aOR = 2.80; 95% CI: 1.02 to 7.68). These findings have implications for HIV and STI prevention and highlight the importance of novel interventions to improve PrEP access among Black and Hispanic/Latino SMMGD. Importantly, these findings also demonstrate the need to stay focused on key populations at risk of HIV infection during emerging public health crises to avoid an increase in rates of new diagnoses.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH
- Infectious Disease Institute, The Ohio State University, Columbus, OH
| | - Antonia E. Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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27
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Caba AE, Rathus T, Burson E, Chan PA, Eaton LA, Watson RJ. Who is using PrEP on-demand? Factors associated with PrEP use modality among Black and Hispanic/Latino emerging adults. AIDS Behav 2022; 26:3411-3421. [PMID: 35438349 PMCID: PMC9912752 DOI: 10.1007/s10461-022-03684-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/04/2022] [Indexed: 01/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly efficacious HIV prevention medication, yet Black and Hispanic/Latino sexual minority men's and gender diverse individuals' (SMMGD) PrEP use is limited due to factors such as PrEP barriers and anticipated PrEP stigma. Although most individuals who use PrEP take it as a daily regimen, there is evidence that many SMMGD are interested in using "on-demand" (also known as event-driven or intermittent or 2-1-1) PrEP. We used stepwise multinomial logistic regression to explore factors associated with on-demand, daily, and no PrEP use among 820 Black and Hispanic/Latino SMMGD ages 18-29 in the United States. We found that greater reported PrEP barriers were associated with higher odds of using PrEP on-demand or not using PrEP compared to daily PrEP use. More past 3-month sex partners and greater comfort telling others about PrEP use were associated with lower odds of on-demand compared to daily PrEP use. In addition, compared to daily PrEP use, more past 3-month sex partners, greater comfort telling others about PrEP use, and higher anticipated PrEP stigma were associated with lower odds of no current PrEP use compared to daily PrEP use. Findings may inform clinical practices and interventions to promote PrEP uptake and adherence.
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Affiliation(s)
- Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US.
| | - Taylor Rathus
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Esther Burson
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, US
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, US
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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Kalichman SC, Eaton LA, Kalichman MO. Perceived sensitivity to medicines and medication concerns beliefs predict intentional nonadherence to antiretroviral therapy among young people living with HIV. Psychol Health 2022:1-16. [PMID: 36111623 DOI: 10.1080/08870446.2022.2122462] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Objective: Among the sources of antiretroviral therapy (ART) nonadherence are patient decisions to skip or stop taking their medications, often stemming from medication beliefs and concerns about side- effects. While individuals who perceive greater sensitivity to medicines may be prone to medication concerns, understanding how these factors contribute to HIV treatment adherence requires further research. The current study tested the direct and indirect effects of perceived sensitivity to medicines on intentional nonadherence to ART, and whether medication concerns mediate this association.Methods: A sample of 418 younger (< 36 years of age) people living with HIV was recruited through community outreach to complete assessments of perceived sensitivity to medicines, medication concerns beliefs, adherence assessed by unannounced phone- based pill counts and HIV viral load, as well as monthly follow- up assessments of intentional nonadherence over a 15- month period.Results: Analyses at baseline and prospective Poisson regression models conducted over 15- months converged to show that perceived sensitivity to medicines significantly predicted intentional nonadherence to ART through medication concerns.Conclusions: These findings suggest that people who perceive greater sensitivity to medicines are prone to greater medication concerns that are related to intentional nonadherence. Cognitive behavioral interventions are needed to resolve medication concerns and reduce intentional nonadherence among people receiving ART.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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29
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Chandler CJ, Adams BJ, Eaton LA, Meunier É, Andrade E, Bukowski LA, Stall RD, Friedman MR. Intersectional Experienced Stigma and Psychosocial Syndemic Conditions in a Sample of Black Men Who Have Sex with Men Engaged in Sex Work (BMSM-SW) from Six US Cities. J Sex Res 2022; 59:920-930. [PMID: 35580257 PMCID: PMC9835797 DOI: 10.1080/00224499.2022.2072799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 06/15/2023]
Abstract
Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and "other" attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6-50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, USA 37203
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Brian J. Adams
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Leigh A. Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - Ronald D. Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261
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30
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Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.
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Affiliation(s)
- Christine M. Curley
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Aviana O. Rosen
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Colleen B. Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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31
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Watson RJ, Morgan E, Collibee C, Kalinowski J, Cunningham C, Edelman EJ, Chan P, Eaton LA. Substance Use and Healthcare Utilization Across the Pre-Exposure Prophylaxis (PrEP) Care Cascade among Black and Latino Men Who Have Sex with Men. Subst Use Misuse 2022; 57:1698-1707. [PMID: 35938746 PMCID: PMC9554788 DOI: 10.1080/10826084.2022.2108059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: Despite the documented efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, large disparities in uptake and adherence exist among Black and Latino/Hispanic men who have sex with men (BLMSM). Limited data exists among BLMSM on the impact of substance use at different stages of the PrEP Care Cascade. We examined the ways substance (alcohol, cannabis, other drug) use is related to PrEP experiences across the PrEP Care Cascade (PrEP aware/no use; PrEP use/discontinuation; PrEP use/adherent).Methods: We utilized data from a national sample of 908 BLMSM (Mage = 25.17, range: 18-29), collected between February and October 2020.Results: We found that heavier alcohol use, more other drug (e.g., cocaine) use, more participant healthcare utilization, and higher number of partners across all measures of substance use were separately associated with a lower likelihood of being aware of PrEP. These same factors were also associated with a higher likelihood of PrEP adherence. Conversely, only cannabis use was associated with discontinuation of PrEP use.Conclusions: While we confirm some earlier findings (i.e., alcohol use is associated with both PrEP discontinuation and PrEP use), we newly identify cannabis as a barrier to the adherence of PrEP. Our findings highlight the need for improved PrEP interventions to increase awareness among BLMSM with substance use who are among the most at-risk for HIV infection.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, Ohio, USA
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Casey Cunningham
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Wiginton JM, Eaton LA, Watson RJ, Maksut JL, Earnshaw VA, Berman M. Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia. Arch Sex Behav 2022; 51:2571-2581. [PMID: 34761347 PMCID: PMC9085967 DOI: 10.1007/s10508-021-02174-7] [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: 10/29/2020] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica L Maksut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Marcie Berman
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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Kalichman SC, Eaton LA, Kalichman MO. Believing That It Is Hazardous to Mix Alcohol With Medicines Predicts Intentional Nonadherence to Antiretrovirals. J Acquir Immune Defic Syndr 2022; 90:208-213. [PMID: 35125476 DOI: 10.1097/qai.0000000000002933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drinking alcohol is a robust predictor of medication nonadherence. In addition to the impact of intoxication on adherence, individuals who believe that it is hazardous to mix medications with alcohol (ie, interactive toxicity beliefs) may forgo taking their medications when drinking. Previous research suggests that alcohol-related intentional nonadherence is a direct result of interactive toxicity beliefs. This study prospectively tested the association between alcohol interactive toxicity beliefs and intentional nonadherence to HIV treatment [ie, antiretroviral therapy (ART)]. METHODS Four hundred eight people living with HIV completed comprehensive baseline assessments and 15-month attributions for ART nonadherence. RESULTS One in 5 participants reported foregoing taking their ART when drinking out of concern for hazardous mixing of alcohol and ART. Poisson regression models predicting the number of months that participants were intentionally nonadherent to ART because they were drinking was predicted by alcohol-ART interactive toxicity beliefs. CONCLUSIONS Beliefs that it is hazardous to drink alcohol when taking medications explains intentional nonadherence and should be directly addressed in adherence improvement interventions for people living with HIV who drink alcohol.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut
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34
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Kalinowski J, Layland EK, Eaton LA, Watson RJ. Strong Ethnic Identity Buffers the Association of Heterosexism with Substance Use Among Black Sexual Minority Men. J Racial Ethn Health Disparities 2022; 10:1270-1279. [PMID: 35556225 PMCID: PMC9936572 DOI: 10.1007/s40615-022-01312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/22/2021] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Heterosexist stigma, including microaggressions experienced in their own racial/ethnic communities, may partially explain disproportionate levels of substance use involvement among Black sexual minority men (BSMM). A strong sense of ethnic identity may provide BSMM with a protective resource. The purpose of this study was to explore associations between ethnic identity and substance use in BSMM. METHODS Data were from Black sexual minority men (n = 390 Mage = 25.28; SD = 2.81) in the PrEP and Substance Use National Survey collected from March 2020 to August 2020 that included self-reported cannabis, cocaine, methamphetamines, inhalants, hallucinogens, prescription drugs misuse, and overall substance use involvement. Using zero-inflated negative binomial regression, we assessed the association between heterosexist microaggressions within BSMM's racial/ethnic communities and substance use involvement, moderated by subjective sense of ethnic identity. RESULTS More than half of participants reported past 3-month substance use. Heterosexist microaggressions were associated with higher relative risk of cannabis use involvement (RR = 1.76; 95% CI 1.13-2.73) and overall substance use involvement (RR = 2.23; 95% CI 1.39-3.56). Stronger ethnic identity buffered the association of heterosexism on substance use involvement (cannabis: RR = 0.82; 95% CI 0.72-0.95; overall: RR = 0.77; 95% CI 0.66-0.89). CONCLUSION Nurturing ethnic identity development and reducing heterosexist stigma in Black communities may be a culturally responsive, two-pronged approach to reducing substance use involvement among BSMM. BSMM with strong ethnic identity demonstrated resilience to heterosexist stigma. Future research should examine the extent to which ethnic identity may be cultivated as a protective resource against substance use involvement.
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Affiliation(s)
- Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
| | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
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Watson RJ, Morgan E, Sherman J, Caba A, Wheldon CW, Chan PA, Eaton LA. Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample. Behav Med 2022:1-9. [PMID: 35465800 PMCID: PMC9592674 DOI: 10.1080/08964289.2022.2048249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/02/2022]
Abstract
Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.
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Affiliation(s)
- Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH,Infectious Disease Institute, The Ohio State University, Columbus, OH
| | | | - Antonia Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Christopher W. Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, US
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, RI, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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Watson RJ, Collibee C, Maksut JL, Earnshaw VA, Rucinski K, Eaton LA. High levels of undiagnosed rectal STIs suggest that screening remains inadequate among Black gay, bisexual and other men who have sex with men. Sex Transm Infect 2022; 98:125-127. [PMID: 33790050 PMCID: PMC8481425 DOI: 10.1136/sextrans-2020-054563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/25/2020] [Revised: 01/23/2021] [Accepted: 02/27/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To better understand rectal STI screening practices for Black gay, bisexual and other men who have sex with men (BGBMSM). FINDINGS Although 15% of BGBMSM lab tested positive for a rectal STI, the majority of these (94%) were asymptomatic. Though all participants reported their status as HIV negative/unknown, 31 of 331 (9.4%) tested positive on HIV rapid tests. Neither condomless anal intercourse nor the number of male sex partners was associated with rectal STI or HIV diagnosis, although rectal STI diagnosis was positively related to testing HIV positive. CONCLUSIONS Findings suggest that substantial numbers of BGBMSM have asymptomatic STIs but are not tested-an outcome that is likely a strong driver of onward HIV acquisition. Therefore, we must address the asymptomatic STI epidemic among GBMSM in order to reduce HIV transmission, as well as temper STI transmission, among this key population.
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Affiliation(s)
- Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Charlene Collibee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, US
| | - Jessica L. Maksut
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, US
| | - Valerie A. Earnshaw
- Department of Human Development & Family Sciences, University of Delaware, Newark, DE, US
| | - Katherine Rucinski
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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Abstract
Intersectionality has emerged as theoretically and practically important to advancing HIV stigma research. However, few psychometric measures capture the intricacies of intersectional stigma. Grounded in the HIV stigma framework and contemporary theories of intersectionality, this paper describes a novel approach to conceptualizing the measurement of intersectional stigma. Taking the notion of an intersection literally, that is the point at which two or more lines meet and form a union, we offer a geometric conceptualization for developing a psychometric instrument to measure intersectional stigma. Ratings of stigmatized attributes, such as stigma ascribed to gender, race, sexual orientation, and HIV status are assessed on independent scales to calculate their intersection using the Pythagorean Theorem, c = [Formula: see text] (a2 + b2) and its extension to multiple stigmatized attributes d = [Formula: see text] (a2 + b2 + c2). Data from a sample of Black /African American women living with HIV were used to test the concept of a geometric approach to measuring intersectional enacted stigma and intersectional anticipated stigma. Findings from the test of concept were encouraging and warrant further scale development research.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA.
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
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Kalichman SC, Eaton LA, Kalichman MO. Substance Use-Related Intentional Nonadherence to Antiretroviral Therapy Among Young Adults Living with HIV. AIDS Patient Care STDS 2022; 36:26-33. [PMID: 34905404 PMCID: PMC8905232 DOI: 10.1089/apc.2021.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/03/2023] Open
Abstract
Antiretroviral therapy (ART) reduces HIV disease burden, increases life expectancy, and prevents HIV transmission. Previous research suggests that believing that it is harmful to take ART when using substances (i.e., interactive toxicity beliefs) leads to intentional ART nonadherence; however, these associations have not been investigated among younger adults living with HIV and have not been linked to clinical outcomes. We examined the associations among interactive toxicity beliefs, intentional nonadherence, and HIV clinical outcomes in young adults living with HIV. People living with HIV younger than the age of 36 years who tested positive for at least one substance use biomarker (N = 406) completed a 1-month pretrial run-in study that included computerized interviews, substance use biomarkers, HIV viral load, and unannounced pill counts for ART adherence. Analyses compared three HIV clinical outcome groups: (1) HIV viral unsuppressed, (2) HIV viral suppressed and ART nonadherent, and (3) HIV viral suppressed and ART adherent, on substance use, interactive toxicity beliefs, and substance use-related intentional ART nonadherence. Results showed that a majority of participants reported intentional nonadherence. Participants with unsuppressed HIV reported greater interactive toxicity beliefs and intentional nonadherence. We conclude that intentional nonadherence adds to the detrimental impacts of substance use on ART adherence and interactive toxicity beliefs that foster these behaviors may be amenable to interventions.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA.,Address correspondence to: Seth C. Kalichman, PhD, Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
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39
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Driver R, Cortopassi AC, El-Krab R, Eaton LA, Kalichman SC. Examining Stigmatizing Beliefs about PrEP Use among Black Sexual Minority Men: A Test of Explanatory Mechanisms. Psychol Men Masc 2022; 23:26-34. [PMID: 36593763 PMCID: PMC9802639 DOI: 10.1037/men0000374] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Stigma often is cited as a barrier to the uptake and use of pre-exposure prophylaxis (PrEP) to prevent HIV among Black sexual minority men (SMM). Socialized gender norms (i.e., restrictive emotionality) are associated with experiences and manifestations of stigma in men. However, the association between restrictive emotionality and the stigma surrounding PrEP use has received little attention in previous research. The present study examines the association between restrictive emotionality and holding stigmatizing beliefs about PrEP use with a theoretically informed serial mediation model testing internalized homophobia and LGBT community connectedness as mediators among a sample of 455 Black SMM in the Southeastern US. Results indicate that restrictive emotionality is associated with stigmatizing beliefs about PrEP use. Further, internalized homophobia and LGBT community connectedness were found to partially mediate the proposed relationship serially. Internalized homophobia, but not LGBT community connectedness, also independently mediated the association between restrictive emotionality and stigmatizing beliefs of PrEP use. This study provides important insights into how aspects of masculinity influence the manifestation of stigmatizing beliefs about PrEP use among Black SMM. The present findings have implications for reducing these beliefs, which are known to negatively impact uptake and use of the HIV prevention tool among Black SMM at elevated risk for HIV.
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Affiliation(s)
- Redd Driver
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY.,Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Renee El-Krab
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs CT
| | - Seth C. Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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Kalichman SC, Eaton LA, Kalichman MO. Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention. Int J STD AIDS 2021; 33:73-80. [PMID: 34628983 DOI: 10.1177/09564624211046516] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
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Kalichman SC, Kalichman MO, Eaton LA. Undisclosed HIV Status to Sex Partners and Its Unintended Consequences in the Era of Undetectable = Untransmittable. J Acquir Immune Defic Syndr 2021; 88:149-156. [PMID: 34267054 DOI: 10.1097/qai.0000000000002762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) and sustained HIV suppression virtually eliminate HIV transmission, eg, having an undetectable viral load renders HIV untransmittable (U=U). Owing to the greatly reduced likelihood of HIV transmission when viral load is undetectable, we studied one behavioral ramification of adopting a U=U prevention strategy-not disclosing HIV status to sex partners. SETTING Cisgender men recruited through community outreach in the state of Georgia, USA. METHODS We examined HIV status disclosure to sex partners among 345 young (median age = 29 years) men receiving ART. Data were collected using computerized interviews, daily sexual behavior surveys over 28 days, unannounced pill counts for ART adherence, urine tests for drug use and urogenital health, and blood samples for HIV viral load. RESULTS One in 3 participants (34%) engaged in condomless anal/vaginal intercourse with an HIV-negative/unknown HIV status partner over 28 days. Average ART adherence was 76%, and one in 5 men had detectable HIV viral loads. Men who engaged in condomless sex with undisclosed partners demonstrated significantly less HIV disclosure to family and friends and had fewer enacted stigma experiences. Hierarchical regression models showed that endorsing U=U as a personal HIV prevention strategy predicted undisclosed condomless sex over and above substance use, HIV stigma experiences, disclosure to family and friends, ART adherence, and HIV viral load. CONCLUSIONS Interventions are needed to improve ART adherence and assist men living with HIV in their decisions to disclose HIV status to sex partners.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
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Simon KA, Hawthorne HM, Clark AN, Renley BM, Farr RH, Eaton LA, Watson RJ. Contextualizing the Well-being of Asexual Youth: Evidence of Differences in Family, Health, and School Outcomes. J Youth Adolesc 2021; 51:128-140. [PMID: 34550495 DOI: 10.1007/s10964-021-01500-5] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13-17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.
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Affiliation(s)
- Kay A Simon
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA.
| | - Heath M Hawthorne
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Alyssa N Clark
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Rachel H Farr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
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Kalichman SC, Katner H, Eaton LA, Hill M, Ewing W, Kalichman MO. Randomized Community Trial Comparing Telephone versus Clinic-Based Behavioral Health Counseling for People Living with HIV in a Rural Setting. J Rural Health 2021; 38:728-739. [PMID: 34494681 DOI: 10.1111/jrh.12618] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the efficacy of a theory-based behavioral intervention delivered via telephone versus clinic-based counseling to improve HIV outcomes and reduce alcohol consumption for people at-risk for treatment failure in a rural setting. METHODS Patients receiving HIV care (N = 240) were randomized using a computer-generated scheme to one of three conditions: (a) telephone behavioral health counseling, (b) clinic-based behavioral health counseling, or (c) attention control nutrition education. Behavioral counseling was delivered by either a community nurse or a paraprofessional patient navigator, with differences examined. Participants were followed for 12 months to assess medication adherence using unannounced pill counts and alcohol use measured by electronic daily text message assessments, and 18 months for HIV viral load and retention in care extracted from medical records. FINDINGS There was evidence for telephone and office-based counseling demonstrating greater medication adherence than the control condition but only in the short term. Clinic-based behavioral counseling significantly reduced alcohol use to a greater degree than telephone counseling and the control condition. There were no other differences between conditions. There were also no discernable differences between counseling delivered by the community nurse and the patient navigator. CONCLUSIONS Telephone and clinic-based counseling demonstrated improved medication adherence in the short term, while clinic-based counseling demonstrated reductions in alcohol use. The modest outcomes suggest that intensive intervention strategies are needed for patients that clinicians identify as at-risk for treatment discontinuation and treatment failure.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Wendy Ewing
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
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Chandler CJ, Creasy SL, Adams BJ, Eaton LA, Bukowski LA, Egan JE, Friedman MR, Stall RD, Whitfield DL. Characterizing Biomedical HIV Prevention Awareness and Use Among Black Transgender Women in the United States. AIDS Behav 2021; 25:2929-2940. [PMID: 33606134 DOI: 10.1007/s10461-021-03189-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
Black transgender women (BTW) in the United States experience disproportionate rates of HIV despite biomedical prevention interventions such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP). Using a sample of 490 BTW collected from 2014 to 2017, bivariate, multivariable, and multinomial analyses were conducted to determine factors associated with awareness and use of PrEP and nPEP. BTW living with HIV were more aware of PrEP than HIV-negative BTW. Structural, demographic, and trans-specific factors (e.g., experiences of homelessness, violence, and current hormone use) related to HIV risk were associated with PrEP and nPEP awareness. PrEP use was associated with behavioral HIV risks (e.g., STI diagnosis, having an HIV-positive partner, and needle-sharing) and may demonstrate risk recognition among BTW. Knowing someone using PrEP was significantly positively associated with PrEP use. Development of guidelines for PrEP and nPEP use for BTW should leverage the strengths of guidelines for other populations, while also acknowledging the unique risks for this population.
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Kalichman SC, El-Krab R, Shkembi B, Kalichman MO, Eaton LA. Prejudicial beliefs and COVID-19 disruptions among sexual minority men living with and not living with HIV in a high SARS-CoV-2 prevalence area. Transl Behav Med 2021; 11:1310-1317. [PMID: 33956159 PMCID: PMC8135944 DOI: 10.1093/tbm/ibab050] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic has had profound health and social impacts. COVID-19 also affords opportunities to study the emergence of prejudice as a factor in taking protective actions. This study investigated the association of COVID-19 concerns, prejudicial beliefs, and personal actions that involve life disruptions among people not living with and people living with HIV. 338 Black/African American men not living with HIV who reported male sex partners and 148 Black/African American men living with HIV who reported male sex partners completed a confidential survey that measured COVID-19 concern, COVID-19 prejudice, and personal action and institutionally imposed COVID-19 disruptions. Participants reported having experienced multiple social and healthcare disruptions stemming from COVID-19, including reductions in social contacts, canceling medical appointments, and inability to access medications. Mediation analyses demonstrated that COVID-19 concerns and COVID-19 prejudice were associated with personal action disruptions, indicating that these social processes are important for understanding how individuals modified their lives in response to COVID-19. It is imperative that public health efforts combat COVID-19 prejudice as these beliefs undermine investments in developing healthcare infrastructure to address COVID-19 prevention.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Renee El-Krab
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
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Pitpitan EV, MacKinnon DP, Eaton LA, Smith LR, Wagman J, Patterson TL. Using Novel Approaches to Evaluate Behavioral Interventions: Overlooked Significant HIV Prevention Effects in the HPTN 015 Project EXPLORE. J Acquir Immune Defic Syndr 2021; 87:1128-1135. [PMID: 33901103 PMCID: PMC8496973 DOI: 10.1097/qai.0000000000002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mediated and moderated processes that lead to intervention efficacy may underlie results of trials ruled as nonefficacious. The overall purpose of this study was to examine such processes to explain the findings of one of the largest, rigorously conducted behavioral intervention randomized controlled trials, EXPLORE. METHODS Four thousand two hundred ninety-five HIV-negative men who have sex with men (MSM) in the United States were randomized in a 2-armed trial. Participants completed follow-up and an HIV test every 6 months up to 48 months. We used multiple and causal mediation analyses to test 5 mediators, including safer sex self-efficacy and condomless receptive anal sex with HIV-positive or status-unknown partners on our primary outcome (HIV seroconversion). We also examined whether intervention effects on the mediators would be moderated by robust correlates of HIV among MSM, including stimulant use. RESULTS There were significant effects of the intervention on all hypothesized mediators. Stimulant use moderated the effect on condomless receptive anal sex In stratified multiple mediation models, we found that among MSM with low stimulant use, the intervention significantly prevented HIV by reducing condomless receptive anal sex with HIV-positive or status-unknown partners. Among MSM with higher stimulant use, there were no indirect effects of the intervention on HIV through any of the hypothesized mediators. CONCLUSION The results suggest that the null effect found in the original EXPLORE trial might have occurred as a function of previously unexplored mediated and moderated processes. This study illustrates the value of testing mediated and moderated pathways in randomized trials, even in trials ruled out as nonefficacious.
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Eaton LA, Watson RJ, Maksut JL, Rucinski KB, Earnshaw VA, Berman M. Elevated Perceived Risk for HIV as a Barrier to Accessing Health Care Among Black Men Who Have Sex with Men. Prev Sci 2021; 21:917-925. [PMID: 32504393 DOI: 10.1007/s11121-020-01135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)-the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being "extremely concerned about getting HIV"; and 17% reported worrying about HIV "all the time". Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.
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Affiliation(s)
- Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA.
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine B Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, 240 Academy St, Newark, DE, 19716, USA
| | - Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1248, USA
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Kalichman SC, Katner H, Eaton LA, Banas E, Hill M, Kalichman MO. Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting. Transl Behav Med 2021; 11:852-862. [PMID: 33200772 DOI: 10.1093/tbm/ibaa109] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. Arch Sex Behav 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
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Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Kalichman SC, Shkembi B, Kalichman MO, Eaton LA. Trust in health information sources and its associations with COVID-19 disruptions to social relationships and health services among people living with HIV. BMC Public Health 2021; 21:817. [PMID: 33910548 PMCID: PMC8080999 DOI: 10.1186/s12889-021-10856-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 10/12/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection (COVID-19) is potentially severe for individuals with compromised immune systems, including people living with HIV. Along with the direct health threats of COVID-19, there are disruptions to social relationships and health services resulting from mitigation efforts instituted by public health authorities. This study examined the relationship between trust in the government and trust in COVID-19 health information from the US CDC, state health departments, and social media on the experience of COVID-19 social and health services-related disruptions. METHODS People living with HIV (N = 459) recruited through social media advertisements and chain referrals completed confidential surveys delivered through an online platform. RESULTS Participants experienced high-levels of disruptions to social relationships and health services attributable to COVID-19 mitigation efforts. We also observed high-rates of inaccurate information and low-levels of trust in government and sources of COVID-19 information. Greater disruptions to social relationships were predicted by more concern about oneself and others contracting COVID-19, whereas disruptions to health services were predicted by greater concern for oneself contracting COVID-19, greater general medical mistrust, and less trust in information from the CDC. CONCLUSIONS Findings have implications for the necessity of rebuilding public trust in credible sources of health information and stepping up efforts to counter sources of inaccurate information.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA.
| | - Bruno Shkembi
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
| | - Lisa A Eaton
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
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