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Ware D, Rueda S, Plankey M, Surkan PJ, Okafor CN, Teplin L, Friedman MR. Correction: The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study. PLoS One 2024; 19:e0303716. [PMID: 38722898 PMCID: PMC11081218 DOI: 10.1371/journal.pone.0303716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0239291.].
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Qian Y, Detels R, Comulada WS, Hidalgo MA, Lee SJ, Biello KB, Yonko EA, Friedman MR, Palella FJ, Plankey MW, Mimiaga MJ. Longitudinal Analysis of Overlapping Psychosocial Factors Predicting Incident Hospitalization Among Mixed HIV Serostatus Men who have Sex with Men in the Multicenter AIDS Cohort Study. AIDS Behav 2024:10.1007/s10461-024-04356-5. [PMID: 38703339 DOI: 10.1007/s10461-024-04356-5] [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: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Men who have sex with men (MSM) are at increased risk for certain types of chronic diseases and mental health problems. Despite having extended survival in the highly active antiretroviral therapy (HAART) era, MSM living with HIV contend with aging-related diseases and complications with treatment. Consequent hospitalizations incur high costs, fear, low quality of life, and frailty. Unlike heterosexual men, MSM experience more structural violence and "syndemics" of psychosocial factors that not only accelerate HIV acquisition and transmission risk but also may increase morbidity, leading to greater rates of hospitalization. We aim to examine the impact of "syndemic" psychosocial factors on the incidence of hospitalization among geographically diverse MSM in the US. Participants were 1760 MSM from the Multicenter AIDS Cohort Study (MACS) between 2004 and 2019. We examined the relationship between six psychosocial factors (depression, stimulant use, smoking, heroin use, childhood sexual abuse, and intimate partner violence) and incident hospitalization (admission to a hospital for treatment). We found a positive dose-response relationship between the number of syndemic factors and hospitalization. MSM reporting five or more syndemic factors had over twice the risk of hospitalization compared to MSM without syndemic factors [aRR = 2.14 (95% CI = 1.56, 2.94)]. Psychosocial factors synergistically increased hospitalizations over time. The positive dose-response relationship between the number of syndemic factors and hospitalization and the synergistic effects of these factors underscore the need for interventions that disentangle the syndemics to reduce hospitalization and related costs and improve the quality of life among MSM.
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Affiliation(s)
- Yuhang Qian
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA.
| | - Roger Detels
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Marco A Hidalgo
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Sung-Jae Lee
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Katie B Biello
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Elizabeth A Yonko
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
| | - M Reuel Friedman
- School of Public Health, Newark, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Frank J Palella
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [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] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Appleton AA, Kuniholm MH, Vásquez E, Cohen MH, Donohue J, Floris-Moore M, Friedman MR, Hanna DB, Mimiaga MJ, Moran CA, Plankey MW, Teplin LA, Shitole SG, Ware D, Jones DL, Wise J. Life course history of physical and sexual abuse is associated with cardiovascular disease risk among women living with and without HIV. AIDS 2024; 38:739-750. [PMID: 38126350 PMCID: PMC10939824 DOI: 10.1097/qad.0000000000003822] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Sexual and physical abuse predict cardiovascular disease (CVD) among women in the general population. Women living with HIV (WLWH) report more abuse and have higher CVD risk compared with other women, yet associations between abuse history and CVD have not been considered among WLWH. This study fills this gap, and describes possible pathways linking abuse to CVD risk among WLWH and women living without HIV (WLWOH). METHODS Using 25 years of data from the Women's Interagency HIV Study (WIHS; n = 2734; WLWH n = 1963; WLWOH n = 771), we used longitudinal generalized estimating equations (GEE) to test associations between sexual and physical abuse with CVD risk. Framingham (FRS-H) and the American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores were examined. Analyses were stratified by HIV-serostatus. RESULTS Among WLWH, childhood sexual abuse was associated with higher CVD risk ( βFRS-H = 1.25, SE = 1.08, P = 0.005; βACC/AHA-PCE = 1.14, SE = 1.07, P = 0.04) compared with no abuse. Adulthood sexual abuse was associated with higher CVD risk for WLWH ( βFRS-H = 1.39, SE = 1.08, P < 0.0001) and WLWOH ( βFRS-H = 1.58, SE = 1.14, P = 0.0006). Childhood physical abuse was not associated with CVD risk for either group. Adulthood physical abuse was associated with CVD risk for WLWH ( βFRS-H = 1.44, SE = 1.07; P < 0.0001, βACC/AHA-PCE = 1.18, SE = 1.06, P = 0.002) and WLWOH ( βFRS-H = 1.68, SE = 1.12, P < 0.0001; βACC/AHA-PCE = 1.24, SE = 1.11, P = 0.03). Several pathway factors were significant, including depression, smoking, and hepatitis C infection. CONCLUSION Life course abuse may increase CVD risk among WLWH and women at high risk of acquiring HIV. Some comorbidities help explain the associations. Assessing abuse experiences in clinical encounters may help contextualize cardiovascular risk among this vulnerable population and inform intervention.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL
| | - Jessica Donohue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanyog G Shitole
- Cardiology Section, San Francisco Veterans Affairs Healthcare System
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Jenni Wise
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Siconolfi D, Thomas EG, Chen EK, Haberlen SA, Friedman MR, Ware D, Meanley S, Brennan-Ing M, Brown AL, Egan JE, Bolan R, Stosor V, Plankey M. Advance Care Planning Among Sexual Minority Men: Sociodemographic, Health Care, and Health Status Predictors. J Aging Health 2024; 36:147-160. [PMID: 37249419 PMCID: PMC10687306 DOI: 10.1177/08982643231177725] [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: 05/31/2023]
Abstract
Objectives: Advance care planning (ACP) specifies decision-making surrogates and preferences for serious illness or end-of-life medical care. ACP research has largely neglected sexual minority men (SMM), a population that experiences disparities in health care and health status. Methods: We examined formal and informal ACP among SMM ages 40+ in the Multicenter AIDS Cohort Study (N = 1,071). Results: For informal ACP (50%), younger SMM and men with past cardiovascular events had greater odds of planning; single men had lower odds of planning. For formal ACP (39%), SMM with greater socioeconomic status had greater odds of planning; SMM who were younger, of racial/ethnic minority identities, who were single or in a relationship without legal protections, and who lacked a primary care home had lower odds of planning. Discussion: Findings warrant further exploration of both informal and formal planning. More equitable, culturally-humble engagement of SMM may facilitate access, uptake, and person-centered planning.
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Affiliation(s)
| | | | | | | | - M Reuel Friedman
- Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
| | - Deanna Ware
- Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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6
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Barrett BW, Meanley S, Brennan-Ing M, Haberlen SA, Ware D, Detels R, Friedman MR, Plankey MW. The Relationship Between Posttraumatic Stress Disorder and Alcohol Misuse and Smoking Among Aging Men Who Have Sex With Men: No Evidence of Exercise or Volunteering Impact. J Aging Health 2023:8982643231215475. [PMID: 37976419 DOI: 10.1177/08982643231215475] [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: 11/19/2023]
Abstract
OBJECTIVES To determine if the association between posttraumatic stress disorder (PTSD) and substance use (alcohol misuse or smoking tobacco) is mediated/moderated by exercise or volunteering among aging (≥40 years) men who have sex with men (MSM), and if this mediation/moderation differs by HIV serostatus. METHODS Multicenter AIDS Cohort Study data were used. Three datasets with PTSD measured during different time periods (10/1/2017-3/31/2018, 898 men; 4/1/2018-9/30/2018, 890 men; 10/1/2018-3/31/2019, 895 men) were analyzed. Longitudinal mediation analyses estimated the mediation effect of exercise and volunteering on the outcomes. RESULTS Nine percent of MSM had evidence of PTSD. There was no statistically significant mediation effect of exercise or volunteering regardless of substance use outcome. The odds of smoking at a future visit among MSM with PTSD were approximately double those of MSM without PTSD. Results did not differ by HIV serostatus. DISCUSSION There is a particular need for effective smoking cessation interventions for aging MSM with PTSD.
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, The City University of New York, Hunter College, NY, New York, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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Meireles P, Ware D, Henriques A, Nieves-Lugo K, Stosor V, Brennan-Ing M, Meanley S, Haberlen S, Okafor CN, Shoptaw S, Friedman MR, Plankey M. Loneliness and Frailty Among Middle-Aged and Aging Sexual Minority Men Living With or Without HIV: A Longitudinal Cross-Lagged Panel Analysis. Innov Aging 2023; 7:igad113. [PMID: 38024328 PMCID: PMC10652703 DOI: 10.1093/geroni/igad113] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives Loneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study. Research Design and Methods We used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated. Results The estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23-3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI: .44-2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94-46) and loneliness (aOR = 13.94; 95% CI: 9.42-20.61) were large. Discussion and Implications Men who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV.
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Affiliation(s)
- Paula Meireles
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Deanna Ware
- Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ana Henriques
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Karen Nieves-Lugo
- Latino Health Research Center, Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging at Hunter College, City University of New York, New York, New York, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chukwuemeka N Okafor
- Department of Medicine, Division of Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Steve Shoptaw
- Departments of Family Medicine and Psychiatry and Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Michael Plankey
- Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
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López DJ, Yuan Y, Booth J, Wei K, Friedman MR. Discrimination and Rejection: The Effects of Ethnic and Sexuality-Based Discrimination Against Latino Gay and Bisexual Men. J Homosex 2023; 70:2828-2847. [PMID: 35801832 DOI: 10.1080/00918369.2022.2081105] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Latino gay and bisexual men (GBM) may experience discrimination attributed to their sexual orientation and ethnicity, necessitating an examination of their experiences from an intersectional lens. While relationships between discrimination and the internalization of those messages have been previously researched, less is known about experiencing discrimination attributed to different identities and its relationships with discrete attributions of internalized stigma. Understanding how different attributes of identity-based discrimination are related to different attributes of identity-based internalization of stigma among gay and bisexual men of color may be important in the design of interventions to help Latino GBM cope with discrimination and prevent negative mental health outcomes. In order to achieve this aim, the current study utilized data from the Latino MSM Community Involvement: HIV Protective Effects Study, which included 571 self-identified Latino GBM. Results demonstrate that experiences of external anti-Latino discrimination were significantly linked to both internalized ethnicity- and sexuality-based stigma, whereas experiences of external sexuality-based discrimination were not significantly linked with internalized ethnicity- or sexuality-based stigma. Results suggest a need for future research to further examine effects of external ethnic discrimination on the psychosocial health of Latino GBM.
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Affiliation(s)
- Daniel Jacobson López
- School of Social Work, Boston University, Boston, Massachusetts, USA
- Yale University, School of Public Health, New Haven, CT, USA
| | - Yan Yuan
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - Jamie Booth
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - Kai Wei
- School of Social Work, University of Pittsburgh, Pennsylvania, USA
| | - M Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Okafor CN, Ware D, Meanley S, Brennan-Ing M, Haberlen S, Teplin L, Mimiaga MJ, Reuel Friedman M, Plankey M. Individual-Level Psychosocial Resiliencies as Mediators of the Relationship Between Internalized Homophobia and Depressive Symptoms Among Middle-Aged and Older Men Living With and Without HIV. AIDS Behav 2023; 27:3171-3182. [PMID: 36943601 DOI: 10.1007/s10461-023-04037-9] [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: 03/05/2023] [Indexed: 03/23/2023]
Abstract
Among sexual minority men (SMM), internalized homophobia (IH) has been consistently associated with increased depression symptoms. However, some SMM experiencing IH demonstrate resilience to buffer against depression symptoms. In this analysis, we used the Stress Process Model (SPM) as a conceptual framework to explore individual-level psychosocial resilience (ILPR) factors serving as a buffer of the IH-depression relationship. To utilize the SPM to explore whether four ILPR factors, including volunteerism, optimism, religiosity/spirituality, and global resiliency measure mediate the relationship between IH and depression symptoms among middle-aged and older SMM living with and without HIV. We used exploratory and confirmatory factor analysis to construct measurement models for the four ILPR factors. We examined whether the four ILPR factors mediated the IH-depression relationship. IH was significantly and positively associated with depression symptoms. There was a partial mediation of the IH-depression association by the four ILPR. Specifically, we found statistically significant indirect effects of optimism and the global resilience measure and supporting buffering effects of the IH-depression association. Although, the indirect effects religiosity/spirituality on the IH-depression relationship was significant, it did not support a buffering of effect. The indirect effects of volunteerism were not statistically significant. Our findings highlight the potential role of ILPR factors in the development of resilience against the negative effects of IH. Implications of these results for future research and practice are discussed.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging at Hunter College, City University of New York, New York City, USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Linda Teplin
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers School of Public Health, Piscataway, USA
| | - Michael Plankey
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA
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10
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Jacobsen AP, Polanka BM, Ware D, Haberlen SA, Brennan-Ing M, Meanley S, Okafor CN, Palella FJ, Bolan RK, Friedman MR, Plankey M. Self-Perception of Aging and Hypertension in a Cohort of Sexual Minority. Cureus 2023; 15:e43127. [PMID: 37692714 PMCID: PMC10483890 DOI: 10.7759/cureus.43127] [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: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives To determine whether self-perception of aging is an important marker of health and hypertension among older sexual minority men. Methods We evaluated associations between self-perception of aging (chronologic-subjective age discrepancy and aging satisfaction) and hypertension among 1,180 sexual minority men (51.6% with HIV/48.4% without HIV) from the Multicenter AIDS Cohort Study using a manifest Markov chain model adjusted for HIV status, age, race/ethnicity, education, smoking status, inhaled nitrite use, diabetes, dyslipidemia, kidney and liver disease. Results The overall prevalence of hypertension increased from 73.1% to 82.6% over three years of follow-up. Older age discrepancy (aOR (adjusted odds ratio): 1.13 95% CI: 0.35-3.69) and low aging satisfaction (aOR: 0.88; 95% CI: 0.31-2.52) were not associated with an increased prevalence of hypertension, regardless of HIV status. Discussion More than 80% of sexual minority men had a diagnosis of hypertension but self-perception of aging was not predictive of incident hypertension.
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Affiliation(s)
- Alan P Jacobsen
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Brittanny M Polanka
- Division of Epidemiology and Community, University of Minnesota School of Public Health, Minneapolis, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Mark Brennan-Ing
- Department of Geriatrics, Brookdale Center for Healthy Aging, City University of New York, New York, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, USA
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Robert K Bolan
- Department of Family Medicine, Los Angeles LGBT Center, Los Angeles, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers, the State University of New Jersey, Rutgers, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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11
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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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12
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Perry N, Goldenberg T, Huebner D, Brown AL, Ware D, Meanley S, Haberlen S, Brennan-Ing M, Egan JE, Teplin L, Ho K, Detels R, Friedman MR, Plankey M. Longitudinal associations of relationship support and strain and internalized homophobia with mental health among middle-aged and older gay and bisexual men. Aging Ment Health 2023; 27:1609-1618. [PMID: 36415908 PMCID: PMC10200824 DOI: 10.1080/13607863.2022.2146656] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022]
Abstract
Objectives: Mental health concerns (e.g. depression, anxiety) that negatively impact gay, bisexual, and other men who have sex with men (GBMSM) persist over the life course and into old age, but less is known about potential contributors to GBMSM's mental health. Close relationships can be a source of risk or resilience from stress, exerting direct relationships on mental health, and may mediate well-established associations between minority stress and mental health. This study examined whether primary partner relationship support and strain were uniquely associated with, and mediated the association between internalized homophobia, and mental health among older GBMSM.Methods: GBMSM (N = 517, M age = 60) from the Multicenter AIDS Cohort Study, who were in primary relationships with men, provided self-report data at four timepoints. We used multilevel modeling to examine longitudinal associations among relationship support and strain and internalized homophobia with depression and anxiety.Results: Relationship strain, but not support, was positively associated with mental health concerns longitudinally. There was a significant, positive indirect effect of internalized homophobia on depression and anxiety through strain, but no support. Internalized homophobia was positively associated with relationship strain, which was positively associated with mental health symptoms longitudinally.Conclusions: Relationship strain was associated with depression and anxiety longitudinally among middle-aged and older GBMSM and mediated associations of internalized homophobia with mental health. The role of partner support warrants further investigation. Mental health interventions are critically needed for older GBMSM and, for partnered GBMSM, should include strategies for reducing relationship strain to foster well-being.
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Affiliation(s)
- Nicholas Perry
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Tamar Goldenberg
- Department of Public Health Education, School of Health and Human Sciences, UNC Greensboro, Greensboro, NC, USA
| | - David Huebner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, USA
| | | | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ken Ho
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
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13
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Henderson ER, Haberlen SA, Coulter RW, Weinstein AM, Meanley S, Brennan-Ing M, Mimiaga MJ, Turan JM, Turan B, Teplin LA, Egan JE, Plankey MW, Friedman MR. The role of social support on cognitive function among midlife and older adult MSM. AIDS 2023; 37:803-811. [PMID: 36728912 PMCID: PMC10157348 DOI: 10.1097/qad.0000000000003464] [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: 02/03/2023]
Abstract
OBJECTIVE This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV. DESIGN We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. METHODS We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. RESULTS Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. CONCLUSION Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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Affiliation(s)
- Emmett R. Henderson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea M. Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York City, New York
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Linda A. Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine, Infectious Diseases, Feinberg School of Medicine, Chicago, Illinois
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W. Plankey
- Department of Medicine, Division of General Internal Medicine, George town University Medical Center, Washington, District of Columbia
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Sumetsky N, Frankeberger J, Coulter RWS, Burke JG, Friedman MR, Mair C. Mental Health and Alcohol Use during and before the Early Phases of the COVID-19 Pandemic. Behav Med 2023; 49:195-203. [PMID: 35000570 PMCID: PMC9289939 DOI: 10.1080/08964289.2021.2015278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 06/10/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
The early phases of the coronavirus 19 disease (COVID-19) pandemic were associated with changes in psychological well-being and alcohol use. However, it is unclear whether these changes are artifacts of psychological well-being and alcohol use prior to the pandemic across different sociodemographic groups. We received surveys from 247 adult residents of Allegheny County, Pennsylvania (United States), with an oversampling of sexual- and gender-minority individuals. Responses included measures of psychological well-being, substance use, and sociodemographic characteristics. Unadjusted mean depression scores, anxiety scores, and number of drinking days increased for all age and income groups during COVID-19, while average number of drinks per drinking day and days intoxicated differentially increased or decreased by age and income groups. Using Bayesian seemingly unrelated regression, we assessed depression and anxiety symptoms and alcohol use during the early stages of the pandemic and one month before COVID-19 was first identified in Allegheny County concurrently. Those in the youngest (18-24) group drank on more days during (but not before) the pandemic than those in the 25-44 age group. Compared to cisgender women, gender-minority adults had higher depression scores during the early stages of the pandemic. Employed adults had lower anxiety scores during (but not before) the pandemic than adults who were unemployed. Those with past-year annual incomes above $80,000 had fewer drinks on average drinking occasions than those in the $40,000 or below group before (but not during) the pandemic. Patterns of psychological distress and alcohol use associated with the COVID-19 pandemic differ by subgroup compared to patterns prior to the pandemic. Interventions addressing worsening mental health outcomes and shifting alcohol use patterns must be sensitive to the needs of vulnerable groups, such as younger adults and those experiencing poverty or unemployment.
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Affiliation(s)
- Natalie Sumetsky
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
- Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health
| | - Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
- Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health
| | - Robert W. S. Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
- Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
- Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health
| | - M. Reuel Friedman
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
- Center for Social Dynamics and Community Health, University of Pittsburgh Graduate School of Public Health
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15
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Okafor CN, Brennan-Ing M, Ware D, Haberlen S, Egan JE, Brown AL, Meanley S, Stosor V, Shoptaw S, Friedman MR, Plankey M. Grit is associated with psychological health among older sexual minority men. Aging Ment Health 2023; 27:434-444. [PMID: 35138200 PMCID: PMC9360198 DOI: 10.1080/13607863.2022.2032594] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/17/2022] [Indexed: 01/21/2023]
Abstract
Objectives: Studies have shown that grit-defined as perseverance and passion for achieving one's long-term goals-is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress.Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress.Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1.Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594.
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Affiliation(s)
- Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, NY, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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16
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Leung T, Coulter RWS, Friedman MR, Thoma B, Switzer GE, Martina J, Egan JE, Primack B. The Influence of Social Media Interactions and Behaviors on Depressive Symptoms Among Sexual and Gender Minority Young Adults in the United States: Protocol for a Mixed Methods Longitudinal Study. JMIR Res Protoc 2023; 12:e43627. [PMID: 36692929 PMCID: PMC9906309 DOI: 10.2196/43627] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sexual and gender minority (SGM; ie, lesbian, gay, bisexual, transgender, and otherwise queer) young adults experience disparities in depression and other internalizing psychopathology. Although social media use is widespread and SGM people have more social media accounts and are more socially active on them than non-SGM individuals, few studies have examined the impact of social media on depression in this group. OBJECTIVE The PRIDE iM study will be the first longitudinal, mixed methods research conducted to determine the impact of social media interactions and behaviors as pathways to depressive symptoms among SGM young adults living in the United States. METHODS PRIDE iM uses a bookends variation of the longitudinal sequential mixed methods design. Participants will be recruited nationally from social media. First, between July 2019 and February 2020, we conducted a qualitative phase (T1) comprising web-based individual interviews (N=58) to inform the building and content of the quantitative survey. Second, from February 2022 to September 2022, we will conduct a series of web-based surveys (N=1000 at baseline) with 4 data points (T2-T5), each one collected every 6 to 8 weeks. Third, from October 2022 to December 2022, we will conduct a second qualitative phase (T6) of web-based interviews using outcome trajectories found in the longitudinal survey analyses to purposively sample survey participants and conduct web-based interviews to contextualize and explain survey findings. Qualitative data from T1 and T6 will be analyzed using a reflexive thematic analysis approach. As we sought to capture change over time in the association between the main predictors (ie, social media interactions and behaviors) and depressive symptoms, we propose analyzing T2 to T5 data using latent growth models with a structural equation modeling framework. Data integration at the method, interpretation, and reporting levels will be achieved through building and connecting and the use of a staged approach and joint displays, respectively. At all stages, we will assess the fit of data integration as recommended by the principles of best practice for mixed methods research in psychology. RESULTS Data collection will be completed by December 2022. Qualitative data analyses will be completed by March 2023, and quantitative analyses of the primary outcome of interest will be completed by June 2023. CONCLUSIONS PRIDE iM will confirm, reject, or uncover the presence of potential relationships between social media interactions and behaviors and depressive symptoms among SGM people. This study represents fundamental groundwork to develop social media-based interventions that target modifiable interactions and behaviors that are most likely to influence mental health outcomes, thus seizing the opportunity to merge the popularity of this medium among SGM people with evidence-based approaches. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43627.
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Affiliation(s)
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, NJ, United States
| | - Brian Thoma
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Galen E Switzer
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jamie Martina
- Department of Psychiatry, School of Medicine, University of Pittburgh Medical Center, Pittsburgh, PA, United States
| | - James Erin Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian Primack
- Department of Health Promotion and Health Behavior, College of Public Health and Human Sciences, Oregon State University, Corvalis, OR, United States
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17
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Arens Y, Bilker WB, Han X, Plankey M, Ware D, Friedman MR, D'Souza G, Stosor V, Shoptaw S, Schnoll RA, Tyndale RF, Ashare R, Gross R. Brief Report: HIV Infection Does Not Explain Higher Nicotine Metabolism in People Living With HIV. J Acquir Immune Defic Syndr 2022; 91:497-501. [PMID: 36083509 PMCID: PMC9649853 DOI: 10.1097/qai.0000000000003089] [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: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Smoking contributes to significant morbidity and mortality in people with HIV. People with HIV have relatively high nicotine metabolism rates, as measured by the nicotine metabolite ratio (NMR, 3-hydroxycotinine/cotinine). A higher NMR is associated with difficulty quitting smoking. We hypothesized that HIV infection might upregulate nicotine metabolism. SETTING A retrospective study of male current smokers in the Multicenter AIDS Cohort Study who HIV seroconverted between 1985 and 1993. METHODS Eligibility included having plasma stored before and after confirmed HIV seroconversion and current tobacco use. Samples were selected from the closest available visits before (median 3.3 months) and after (median 9.4 months) seroconversion. Antiretroviral therapy use was exclusionary. Cotinine and 3-hydroxycotinine were measured using liquid chromatography-tandem mass spectrometry. We compared NMR from plasma pre-HIV and post-HIV infection using signed-rank tests. We targeted a sample size of 71 pairs to achieve 80% power to detect a 0.1 unit increase in NMR with P = 0.05. RESULTS We analyzed paired samples from 78 participants; the median age was 34.5 years [interquartile range (IQR 29-40 years)]. The median NMR pre-HIV and post-HIV was 0.45 (IQR 0.32-0.54) and 0.46 (IQR 0.34-0.56), respectively. The median change in NMR postseroconversion was +0.01 (IQR -0.05, +0.09), P = 0.25. Stratification of median change in NMR by timing between samples or time since HIV seroconversion did not alter this finding. CONCLUSIONS Acquiring HIV had no measurable effect on NMR. We postulate that upregulation of the NMR may be due to direct pharmacologic effects of HIV medications or metabolic changes in response to HIV infection.
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Affiliation(s)
- Yotam Arens
- Division of Infectious Diseases, Departments of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Warren B Bilker
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Xiaoyan Han
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Gypsyamber D'Souza
- Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA
| | - Rachel F Tyndale
- Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; and
| | - Robert Gross
- Division of Infectious Diseases, Departments of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Departments of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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Chandran A, Haberlen S, Ware D, Meanley S, Brennan-Ing M, Brown AL, Teplin LA, Egan JE, Mimiaga MJ, Friedman MR, Plankey M. The relationship between serving as a mentor and depressive symptoms among sexual minority men in the MACS healthy aging study. Psychology of Sexual Orientation and Gender Diversity 2022. [DOI: 10.1037/sgd0000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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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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20
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Jones DL, Zhang Y, Rodriguez VJ, Haberlen S, Ramirez C, Adimora AA, Merenstein D, Aouizerat B, Sharma A, Wilson T, Mimiaga MJ, Sheth AN, Plankey M, Cohen MH, Stosor V, Kempf MC, Friedman MR. Association of PTSD With Longitudinal COVID-19 Burden in a Mixed-Serostatus Cohort of Men and Women: Weathering the Storm. J Acquir Immune Defic Syndr 2022; 90:567-575. [PMID: 35585664 PMCID: PMC9283230 DOI: 10.1097/qai.0000000000003006] [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: 09/23/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study of people with HIV (PWH) and those without HIV conducted during the COVID-19 pandemic in the United States in 2020 examines the impact of posttraumatic stress disorder (PTSD) on COVID-19 burden, defined as pandemic-related disruptions. METHODS Data consisted of survey responses on PTSD among participants (N = 2434) enrolled in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV (WIHS) cohorts. Unadjusted and adjusted regression models were used to examine the association of PTSD with COVID-19 burden (overall and domain-specific burdens). Quasi-Poisson regression models were used to assess associations with the COVID-19 burden score and 2 domain-specific burdens: (1) changes in resources and (2) interruptions in health care. Analyses was adjusted for age, race/ethnicity, HIV serostatus, current smoking status, number of comorbidities, education, and study regions. RESULTS Study participants were a median age of 58 (interquartile range, 52-65) years. In both bivariate and multivariable models, PTSD severity was associated with greater overall COVID-19 burden. PTSD severity was associated with the number of resource changes and number of interruptions in medical care. These findings were also consistent across cohorts (MACS/WIHS) and across HIV serostatus, suggesting a greater risk for COVID-19 burden with greater PTSD severity, which remained significant after controlling for covariates. CONCLUSIONS This study builds on emerging literature demonstrating the impact of mental health on the burden and disruption associated with the COVID-19 pandemic, providing context specific to PWH. The ongoing pandemic requires structural and social interventions to decrease disruption to resources and health resource needs among these vulnerable populations.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Psychology, University of Georgia, Athens, GA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Bradley Aouizerat
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York City, New York
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine
| | - Tracey Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago IL
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Evanston, IL
| | - Mirjam-Colette Kempf
- Department of Family, Community & Health Systems, Schools of Nursing, Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL; and
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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21
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Frankeberger J, Sumetsky N, Friedman MR, Burke JG, Coulter RWS, Mair C. Changes in activity locations during the COVID-19 pandemic and associations with depression, anxiety, loneliness, and alcohol use. Wellbeing Space Soc 2022; 3:100092. [PMID: 35860439 PMCID: PMC9281410 DOI: 10.1016/j.wss.2022.100092] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/29/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Restrictions and guidelines to limit the spread of COVID-19 caused considerable and rapid changes to individuals' daily routines. This study examines how activity locations changed during the COVID-19 pandemic and associated social distancing restrictions, and whether these changes were associated with depression, anxiety, loneliness, and alcohol use. METHODS A web-based survey was conducted early in the COVID-19 pandemic (May-June 2020) in Allegheny County (Pittsburgh), Pennsylvania. Participants (n = 265) reported visits to activity locations in the last 30 days and retrospectively for February 2020 (pre-pandemic). A principal components analysis was conducted to assess change in utilization of activity locations. Component scores of changes to activity locations were compared by sociodemographics. Poisson and zero-inflated negative binomial models were used to examine the relationship between component scores and pandemic depression symptoms, anxiety symptoms, loneliness, and drinking days. RESULTS Five distinct principal components of activity location changes were identified. The first component, characterizing broad reductions in activity locations during the early phases of the pandemic, was associated with increased depression and loneliness. CONCLUSIONS Results indicate non-uniform shifts in routine activities during the pandemic and highlight the importance of understanding how changes to the social environment affect individuals' psychological wellbeing and alcohol use.
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Affiliation(s)
- Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for Social Dynamics and Community Health, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Natalie Sumetsky
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for Social Dynamics and Community Health, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - M Reuel Friedman
- Center for LGBT Health Research, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for Social Dynamics and Community Health, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for Social Dynamics and Community Health, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for LGBT Health Research, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
- Center for Social Dynamics and Community Health, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
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22
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Friedman MR, Liu Q, Meanley S, Haberlen SA, Brown AL, Turan B, Turan JM, Brennan-Ing M, Stosor V, Mimiaga MJ, Ware D, Egan JE, Plankey MW. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health 2022; 112:S452-S462. [PMID: 35763737 PMCID: PMC9241468 DOI: 10.2105/ajph.2022.306735] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
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Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Qimin Liu
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Meanley
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Sabina A Haberlen
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Andre L Brown
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Bulent Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Janet M Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Mark Brennan-Ing
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Valentina Stosor
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J Mimiaga
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - James E Egan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Michael W Plankey
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
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Earnshaw VA, Jonathon Rendina H, Bauer GR, Bonett S, Bowleg L, Carter J, English D, Friedman MR, Hatzenbuehler ML, Johnson MO, McCree DH, Neilands TB, Quinn KG, Robles G, Scheim AI, Smith JC, Smith LR, Sprague L, Taggart T, Tsai AC, Turan B, Yang LH, Bauermeister JA, Kerrigan DL. Methods in HIV-Related Intersectional Stigma Research: Core Elements and Opportunities. Am J Public Health 2022; 112:S413-S419. [PMID: 35763749 PMCID: PMC9241464 DOI: 10.2105/ajph.2021.306710] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research. These core elements include multidimensional, multilevel, multidirectional, and action-oriented methods that sharpen focus on, and aim to transform, interlocking and reinforcing systems of oppression. We further identify opportunities for advancing HIV-related intersectional stigma research, including reducing barriers to and strengthening investments in resources, building capacity to engage in research and implementation of interventions, and creating meaningful pathways for HIV-related intersectional stigma research to produce structural change. Ultimately, the expected payoff for incorporating these core elements is a body of HIV-related intersectional stigma research that is both better aligned with the transformative potential of intersectionality and better positioned to achieve the goals of Ending the HIV Epidemic in the United States and globally. (Am J Public Health. 2022;112(S4):S413-S419. https://doi.org/10.2105/AJPH.2021.306710).
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Affiliation(s)
- Valerie A Earnshaw
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - H Jonathon Rendina
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Greta R Bauer
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Stephen Bonett
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Lisa Bowleg
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Joseph Carter
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Devin English
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - M Reuel Friedman
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Mark L Hatzenbuehler
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Mallory O Johnson
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Donna H McCree
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Torsten B Neilands
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Katherine G Quinn
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Gabriel Robles
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Ayden I Scheim
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Justin C Smith
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Laramie R Smith
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Laurel Sprague
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Tamara Taggart
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Alexander C Tsai
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Bulent Turan
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Lawrence H Yang
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - José A Bauermeister
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Deanna L Kerrigan
- Valerie A. Earnshaw is with the Department of Human Development and Family Sciences, College of Education and Human Development, University of Delaware, Newark. H. Jonathon Rendina is with the Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Stephen Bonett is with the School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is an AJPH Associate Editor and is with the Department of Psychological and Brain Sciences, George Washington University. Joseph Carter is with the Department of Psychology, Hunter College, New York, NY. Devin English is with the Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ. M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark L. Hatzenbuehler is with the Department of Psychology, Harvard University, Cambridge, MA. Mallory O. Johnson and Torsten B. Neilands are with the Department of Medicine, University of California, San Francisco. Donna H. McCree is with the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Katherine G. Quinn is with the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Gabriel Robles is with the School of Social Work, Rutgers University, New Brunswick. Ayden I. Scheim is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Justin C. Smith is with Positive Impact Health Centers, Atlanta. Laramie R. Smith is with the Division of Global Public Health and Infectious Diseases, School of Medicine, University of California, San Diego. Laurel Sprague is with the Department of Gender Equality, Human Rights, and Community Engagement, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. Tamara Taggart and Deanna L. Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Alexander C. Tsai is with the Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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Friedman MR, Kempf MC, Benning L, Adimora AA, Aouizerat B, Cohen MH, Hatfield Q, Merenstein D, Mimiaga MJ, Plankey MW, Sharma A, Sheth AN, Ramirez C, Stosor V, Wagner MCE, Wilson TE, D'Souza G, Weiss DJ. Prevalence of COVID-19-Related Social Disruptions and Effects on Psychosocial Health in a Mixed-Serostatus Cohort of Men and Women. J Acquir Immune Defic Syndr 2021; 88:426-438. [PMID: 34757972 PMCID: PMC8575096 DOI: 10.1097/qai.0000000000002799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/16/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study describes prevention behavior and psychosocial health among people living with HIV (PLHIV) and HIV-negative people during the early wave of the coronavirus disease 2019 (COVID-19) pandemic in the United States. We assessed differences by HIV status and associations between social disruption and psychosocial health. DESIGN A cross-sectional telephone/videoconference administered survey of 3411 PLHIV and HIV-negative participants in the Multicenter AIDS Cohort Study/WIHS Combined Cohort Study (MWCCS). METHODS An instrument combining new and validated measures was developed to assess COVID-19 prevention efforts, social disruptions (loss of employment, childcare, health insurance, and financial supports), experiences of abuse, and psychosocial health. Interviews were performed between April and June 2020. Associations between social disruptions and psychosocial health were explored using multivariable logistic regression, adjusting for sociodemographics and HIV status. RESULTS Almost all (97.4%) participants reported COVID-19 prevention behavior; 40.1% participants reported social disruptions, and 34.3% reported health care appointment disruption. Men living with HIV were more likely than HIV-negative men to experience social disruptions (40.6% vs. 32.9%; P < 0.01), whereas HIV-negative women were more likely than women with HIV to experience social disruptions (51.1% vs. 39.8%, P < 0.001). Participants who experienced ≥2 social disruptions had significantly higher odds of depression symptoms [aOR = 1.32; 95% confidence interval (CI): 1.12 to 1.56], anxiety (aOR = 1.63; 95% CI: 1.17 to 2.27), and social support dissatisfaction (aOR = 1.81; 95% CI: 1.26 to 2.60). CONCLUSIONS This study builds on emerging literature demonstrating the psychosocial health impact related to the COVID-19 pandemic by providing context specific to PLHIV. The ongoing pandemic requires structural and social interventions to decrease social disruption and address psychosocial health needs among the most vulnerable populations.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County Health and Hospitals System, Chicago IL
| | | | - Dan Merenstein
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Anandi N. Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Catalina Ramirez
- Department of Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Valentina Stosor
- Department of Medicine and Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Tracey E. Wilson
- Department of Community Health Sciences, SUNY Health Sciences University, Brooklyn, NY; and
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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25
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Henderson ER, Egan JE, Haberlen SA, Detels R, Teplin LA, Friedman MR, Plankey MW, Coulter RWS. Does Social Support Predict Depressive Symptoms? A Longitudinal Study of Midlife and Older Men Who Have Sex with Men from the Multicenter AIDS Cohort Study. Ann LGBTQ Public Popul Health 2021; 2:142-160. [PMID: 34778872 DOI: 10.1891/lgbtq-2020-0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study was designed to identify social support classes across time among midlife (40-64 years) and older (65+ years) gay, bisexual, and other men who have sex with men (MSM), and whether social support protects against depressive symptoms in this population. This study applied longitudinal latent class analysis across five visits on 1,329 individuals age 40 or older at baseline using data from the Multicenter AIDS Cohort Study (MACS) Healthy Aging substudy collected from April 2016 to October 2018. We identified four classes of social support across time: Partner-centered, that is, high levels of support from one's primary partner(s) and moderate support from friends and family; Friend-centered, that is, high levels of support from friends and chosen family; Low, that is, low levels of support from all sources; and Robust, that is, high levels of support from all sources. We found differences in class membership by age, race/ethnicity, employment status, sexual identity, education, relationship status, and HIV status. Finally, compared to MSM in the low support class, men in the other classes had lower odds of depressive symptoms at the final visit. The most common type of social support was partner-centered, while the least common type was robust. These findings suggest that the presence of any social support, regardless of the source, protects against depressive symptoms.
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Affiliation(s)
- Emmett R Henderson
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA.,University of Pittsburgh, Center for LGBT Health Research, Graduate School of Public Health, Pittsburgh, PA, USA
| | - James E Egan
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA.,University of Pittsburgh, Center for LGBT Health Research, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Sabina A Haberlen
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Roger Detels
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, USA
| | - Linda A Teplin
- Feinberg School of Medicine, Departments of Psychiatry and Behavioral Sciences and Medicine, Infectious Diseases, Chicago, IL, USA
| | - M Reuel Friedman
- University of Pittsburgh, Center for LGBT Health Research, Graduate School of Public Health, Pittsburgh, PA, USA.,University of Pittsburgh, Department of Infectious Diseases and Microbiology, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Michael W Plankey
- Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, Washington, DC, USA
| | - Robert W S Coulter
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA.,University of Pittsburgh, Center for LGBT Health Research, Graduate School of Public Health, Pittsburgh, PA, USA
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26
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Cheng W, Egan JE, Zhong F, Xu H, Stall R, Friedman MR. Effectiveness of HIV Self-testing on Regular HIV Testing Among Ever-Tested Men Who Have Sex Men in China: A Pragmatic Randomized Controlled Trial. AIDS Behav 2021; 25:3494-3502. [PMID: 33506306 DOI: 10.1007/s10461-021-03161-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to demonstrate the effectiveness of HIV self-testing (HIVST) on promoting regular HIV testing, which defined as having uptake HIV testing every three to 6 months, among men who have sex with men (MSM) in Guangzhou, China. 491 ever-tested MSM were recruited from a community-based HIV clinic and randomly assigned into either intervention arm that provided text message plus HIVST service (n = 250) or standard of care arm (n = 241) being a text message promoting HIV testing every 3 months. Overall, 73.7% (330/448) of the participants had uptake HIV testing, and 27.7% (124/448) of them reported ever used of an HIV self-test during study period. HIVST significantly increased regularly HIV testing among participants in the intervention arm compared with standard of care arm (77.4% vs 69.5%). HIVST as a supplement to the existing facility-based testing services is promising in promoting regular HIV testing among MSM in China. Trial registration number: ChiCTR1800016811.
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Affiliation(s)
- Weibin Cheng
- Guangdong Second Provincial General Hospital, No. 466 Xinguangzhong Road, Haizhu District, Guangzhou, 510317, Guangdong, China.
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fei Zhong
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Penukonda V, Utz T, Perry NS, Ware D, Brennan-Ing M, Meanley S, Brown A, Haberlen S, Egan J, Shoptaw S, Teplin LA, Friedman MR, Plankey M. Viral suppression among middle-aged and aging MSM living with HIV: Partnership type and quality. PLoS One 2021; 16:e0258032. [PMID: 34597316 PMCID: PMC8486120 DOI: 10.1371/journal.pone.0258032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Functional support—the availability of material aid, emotional support, or companionship—promotes general well-being. For men who have sex with men (MSM) living with HIV, having a person who supports you associates with viral suppression. This study examines the association between supportive partnerships and HIV viral suppression among middle-aged and aging MSM living with HIV. A total of 423 middle-aged and aging MSM (mean age, 58.2 years) from the Multicenter AIDS Cohort Study provided self-reported data about their partnerships. Separate Poisson regression models assessed how partnership type, support, strain, and duration from April 2017 were associated with repeated viral load measurements up to April 2019. Of the follow-up visits (N = 1289), 90.0% of participants were virally suppressed. Most participants reported being non-Hispanic White (61.0%) and college-educated (83.4%). Participants were asked about their primary partnerships (i.e., “someone they are committed to above anyone else”) and secondary partnerships (i.e., those who can also be intimate or supportive but not necessarily romantic or sexual). The participants reported: no partnerships (45.2%), only primary partnerships (31.0%), only secondary partnerships (11.1%), or both primary and secondary partnerships (12.8%). Primary and secondary partnerships had mean (SD) durations of 15.9 (11.3) and 25.2 (16.5) years, respectively. Participants reporting both primary and secondary partnerships (compared with no partnership) showed significantly higher odds of being virally suppressed (adjusted prevalence ratio [aPR], 1.04; 95% CI, 1.00–1.08; p = 0.043). Albeit not statistically significant, primary-only (aPR, 1.01; 95% CI, 0.97–1.06; p = 0.547) or secondary-only (aPR, 1.03; 95% CI, 0.98–1.08; p = 0.224) partnership types were positively associated with viral suppression. Partner support and strain were not associated with viral suppression in any partnership group. Being older and non-Hispanic Black were positively and negatively associated with viral suppression, respectively. Encouraging partnerships should be considered one of clinicians’ many tools to help middle-aged and aging MSM achieve long-term viral suppression.
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Grants
- U01 HL146205 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146193 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- R01 MD010680 NIMHD NIH HHS
- U01 HL146245 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- P30 AI050410 NIAID NIH HHS
- National Institute on Minority Health and Health Disparities
- The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Connie Wofsy Women’s HIV Study, Northern California CRS (Bradley Aouizerat, Phyllis Tien, and Jennifer Price), U01-HL146242; Los Angeles CRS (Roger Detels), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).
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Affiliation(s)
- Vaibhav Penukonda
- Georgetown University School of Medicine, Washington, District of Columbia, United States of America
- * E-mail:
| | - Timothy Utz
- Georgetown University School of Medicine, Washington, District of Columbia, United States of America
| | - Nicholas S. Perry
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States of America
- Center for Behavioral Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, New York, United States of America
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Andre Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, California, United States of America
| | - Linda A. Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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28
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Egan JE, Haberlen SA, Meanley S, Ware D, Brown AL, Siconolfi D, Brennan-Ing M, Stall R, Plankey MW, Friedman MR. Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men: Protocol for an Observational Cohort Study. JMIR Res Protoc 2021; 10:e25750. [PMID: 34554100 PMCID: PMC8498890 DOI: 10.2196/25750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. OBJECTIVE This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. METHODS This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. RESULTS Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. CONCLUSIONS Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/25750.
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Affiliation(s)
- James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, United States
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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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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D'Souza G, Bhondoekhan F, Benning L, Margolick JB, Adedimeji AA, Adimora AA, Alcaide ML, Cohen MH, Detels R, Friedman MR, Holman S, Konkle-Parker DJ, Merenstein D, Ofotokun I, Palella F, Altekruse S, Brown TT, Tien PC. Characteristics of the MACS/WIHS Combined Cohort Study: Opportunities for Research on Aging With HIV in the Longest US Observational Study of HIV. Am J Epidemiol 2021; 190:1457-1475. [PMID: 33675224 DOI: 10.1093/aje/kwab050] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018-September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48-63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research.
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Brennan-Ing M, Haberlen S, Ware D, Egan JE, Brown AL, Meanley S, Palella FJ, Bolan R, Cook JA, Okafor CN, Friedman MR, Plankey MW. Psychological Connection to the Gay Community and Negative Self-Appraisals in Middle-Aged and Older Men Who Have Sex With Men: The Mediating Effects of Fitness Engagement. J Gerontol B Psychol Sci Soc Sci 2021; 77:39-49. [PMID: 33945614 PMCID: PMC8755915 DOI: 10.1093/geronb/gbab076] [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: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. METHOD Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. RESULTS The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. DISCUSSION Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, USA,Address correspondence to: Mark Brennan-Ing, PhD, Brookdale Center for Healthy Aging, Hunter College, the City University of New York, 2180 Third Avenue, 8th Floor, New York, NY 10035, USA. E-mail:
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert Bolan
- Department of Family Medicine, University of Southern California, Los Angeles, USA
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, 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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Noor SW, Hart TA, Okafor CN, Ware D, Chew KW, D’Souza G, Ho K, Friedman MR, Plankey M. Staying or moving: Results of a latent transition analysis examining intra-individual stability of recreational substance use among MSM in the Multicenter AIDS Cohort Study from 2004 to 2016. Drug Alcohol Depend 2021; 220:108516. [PMID: 33485009 PMCID: PMC7901540 DOI: 10.1016/j.drugalcdep.2021.108516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/15/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies have examined patterns of substance use among Men who have Sex with Men (MSM), but few have examined factors predicting transitioning from one substance use pattern to another. We investigated transitioning from one substance use pattern to another over a 12-year period (2004-2016) among the Multicenter AIDS Cohort Study participants. METHOD Alcohol, marijuana, heroin, cocaine, poppers, uppers (e.g., methamphetamines) and erectile dysfunction(ED) medications use in the last 6 months from 3568 US MSM was dichotomized (no/yes) to classify participants into substance use classes at each follow up visit. We fit latent transition models to calculate transition probabilities of moving from one substance use class to another over a 3, 4 and 6-year time period. Then fit regression models to identify factors associated with the probability of each participant staying in or moving from the same substance use class. RESULTS Overall, cocaine and ED medication use declined but marijuana and heroin use increased over 2004-2016. We observed most participants (84.6 %-100 %) stayed in the same class. Increased age was associated with transition from the Minimal-use class to the Alcohol-only class (aOR = 1.06,95 %CI:1.01-1.13;p < 0.01) and non-White MSM reported lower odds of moving from the Alcohol-only class to the Alcohol-Popper class (aOR = 0.50,95 %CI:0.30-0.82;p <0.01). There were no difference in the transition probabilities by HIV-status. CONCLUSION Despite decline in substance use in general, participants are highly stable in their choice of substances. However, treating MSM as a homogeneous group can lead to an under-appreciation of the diversity of prevention needs and treatment of substance using MSM.
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Affiliation(s)
- Syed W. Noor
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada,Department of Kinesiology and Health Science, Louisiana State University Shreveport, One University Place, Shreveport, LA 71115, USA
| | - Trevor A. Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1311 S 5th St, Waco, TX 76706, USA
| | - Deanna Ware
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Suite 120 Washington, D.C. 20057, USA
| | - Kara W. Chew
- David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA 90025, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Ken Ho
- Division of Infectious Diseases, University of Pittsburgh, 3520 Fifth Avenue, Suite 533, Pittsburgh, PA 15213, USA
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Michael Plankey
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Suite 120 Washington, D.C. 20057, USA
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Statz M, Ware D, Perry N, Huebner D, Cox C, Brown A, Meanley S, Haberlen S, Egan J, Brennan M, Teplin LA, Bolan R, Friedman MR, Plankey M. Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men. PLoS One 2021; 16:e0245863. [PMID: 33596240 PMCID: PMC7888601 DOI: 10.1371/journal.pone.0245863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.
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Affiliation(s)
- Matthew Statz
- Georgetown University School of Medicine, Washington, DC, United States of America
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
- * E-mail:
| | - Nicholas Perry
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
- Rhode Island Hospital, Providence, RI, United States of America
| | - David Huebner
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC, United States of America
| | - Christopher Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Andre Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, United States of America
| | - Sabina Haberlen
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Mark Brennan
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, United States of America
| | - Linda A. Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Robert Bolan
- Los Angeles LGBT Center, Los Angeles, CA, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
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Barrett BW, Abraham AG, Dean LT, Plankey MW, Friedman MR, Jacobson LP, Teplin LA, Gorbach PM, Surkan PJ. Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men. Soc Psychiatry Psychiatr Epidemiol 2021; 56:259-272. [PMID: 32780176 PMCID: PMC7870462 DOI: 10.1007/s00127-020-01940-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 08/07/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors-such as social inequalities-contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM). METHODS Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity. RESULTS At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms. CONCLUSION Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.
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Grants
- U54 AG062334 NIA NIH HHS
- U01 HL146205 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01-HL146242-01 National Heart, Lung, and Blood Institute (US)
- P30-CA006973 Sidney Kimmel Comprehensive Cancer Center
- U01-HL146333-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146240 NHLBI NIH HHS
- U01-HL146192-01 National Heart, Lung, and Blood Institute (US)
- R25-MH083620 NIMH NIH HHS
- U01 HL146241 NHLBI NIH HHS
- U01 HL146333 NHLBI NIH HHS
- R38 AI140299 NIAID NIH HHS
- U01-HL146208-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146245 NHLBI NIH HHS
- U01-HL146241-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146240-01 National Heart, Lung, and Blood Institute (US)
- P30 CA006973 NCI NIH HHS
- P30 AI094189 NIAID NIH HHS
- R25 MH083620 NIMH NIH HHS
- U01-HL146204-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146245-01 National Heart, Lung, and Blood Institute (US)
- K01 CA184288 NCI NIH HHS
- U01-HL146202-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146192 NHLBI NIH HHS
- U01 AI035041 NIAID NIH HHS
- K01-CA184288 NCI NIH HHS
- U01-HL146193-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146242 NHLBI NIH HHS
- P30-AI094189 Johns Hopkins University Center for AIDS Research
- R03-MH103961 NIMH NIH HHS
- U01-HL146203-01 National Heart, Lung, and Blood Institute (US)
- R01 DA022936 NIDA NIH HHS
- R21 AG059505 NIA NIH HHS
- R01-DA022936 NIDA NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01-HL146194-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146193 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01-HL146205-01 National Heart, Lung, and Blood Institute (US)
- R03 MH103961 NIMH NIH HHS
- U01-HL146201-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146203 NHLBI NIH HHS
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Alison G Abraham
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael W Plankey
- Department of Medicine, Medical Center, Georgetown University, Washington, DC, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamela J Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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De Jesus M, Ware D, Brown AL, Egan JE, Haberlen SA, Palella FJ, Detels R, Friedman MR, Plankey MW. Social-environmental resiliencies protect against loneliness among HIV-Positive and HIV- negative older men who have sex with men: Results from the Multicenter AIDS Cohort Study (MACS). Soc Sci Med 2021; 272:113711. [PMID: 33550066 DOI: 10.1016/j.socscimed.2021.113711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Loneliness is associated with negative health outcomes, such as cardiovascular disease, cognitive impairment, dementia, physical functional decline, depression, and increased mortality risk, among HIV- positive and HIV-negative older men who have sex with men (MSM). Given these negative health outcomes, it is imperative to identify factors that minimize loneliness in these vulnerable groups. OBJECTIVE We sought to examine whether social-environmental resiliencies-defined as an individual's level of support, social bonding, and psychological sense of community among gay men-buffer against symptoms of loneliness. METHOD We analyzed longitudinal data from 1,255 older MSM with and without HIV infection, all of whom were enrolled in the Multicenter AIDS Cohort Study (MACS). Using longitudinal latent class analysis (LLCA), we identified three underlying classes (Social Connectors, Non-community Connectors, and Social Isolates) in the social environment of the sample. We assessed the prevalence of loneliness by these latent classes. By lagging social environmental factors over time, we were able to examine the temporal relationships between latent classes and subsequent loneliness. RESULTS Consistent with our hypothesis, multivariate associations revealed that compared to Social Connectors with high levels of social support and social bonding and a strong perceived sense of community among gay men, Social Isolates (Prevalence Ratio (PR): 1.42; 95% CI: 1.08-1.88; p = 0.0120) and Non-community Connectors (PR: 1.34; 95% CI: 1.03-1.75; p = 0.0322) were more likely to experience loneliness after adjustment for covariates and baseline loneliness. There were no differences by HIV status. CONCLUSIONS These longitudinal data allowed us to make causal inferences related to the social environmental resiliencies lowering the odds of loneliness among HIV-positive and HIV-negative older MSM. Developing individual- and community-level tailored interventions for these populations by leveraging social environmental resiliencies is key to reducing loneliness and promoting health.
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Affiliation(s)
- Maria De Jesus
- School of International Service, Center on Health, Risk, and Society, American University, Washington, DC, USA.
| | - Deanna Ware
- Georgetown University Department of Medicine, Washington, DC, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank Joseph Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roger Detels
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Friedman MR, Chandler CJ, Adams BJ, Hawk ME, Givens DL, Bauermeister JA, Bowleg L. Toward a New Framework for Equity in Epidemic Allocations: Implications of HIV-Prevention-Allocation Misalignment. Am J Public Health 2021; 111:12-14. [PMID: 33326270 PMCID: PMC7750601 DOI: 10.2105/ajph.2020.306032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - Cristian J Chandler
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - Brian J Adams
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - Mary E Hawk
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - David L Givens
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - José A Bauermeister
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
| | - Lisa Bowleg
- M. Reuel Friedman, Cristian J. Chandler, and David L. Givens are with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Brian J. Adams is a PhD candidate in and Mary E. Hawk is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. José A. Bauermeister is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Lisa Bowleg is with the Department of Psychology, George Washington University, Washington, DC
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Ware D, Rueda S, Plankey M, Surkan P, Okafor CN, Teplin L, Friedman MR. The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study. PLoS One 2020; 15:e0239291. [PMID: 33007781 PMCID: PMC7532049 DOI: 10.1371/journal.pone.0239291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023] Open
Abstract
Many persons living with HIV (PLWH) either reduced their employment capacity or stopped work completely due to disease progression. With the advent of effective antiretroviral therapy, some PLWH were able to return to the workforce and many are now transitioning into retirement. We examined the histories of employment, retirement and disability status on depression among 1,497 Participants living with HIV from 1997 to 2015 in the Multicenter AIDS Cohort Study. Data were collected on depressive symptoms, employment, retirement, disability status as well as HIV-related and sociodemographic characteristics. Employment, retirement and disability status were lagged 2 years to assess whether the risk of depression at a given observation were temporally predicted by each respective status, adjusting for prior depressive symptoms and covariates. Being employed (aOR: 0.76; 95% CI: 0.71-0.82) had lower odds of depression risk two years later compared to those unemployed. There were higher odds of depression risk associated with disability (aOR: 1.43; 95% CI: 1.32-1.54) versus those not on disability. Retirement status was not associated with the risk of depressive symptoms. These findings could help inform policies and employment programs to facilitate the return to work for PLWH who are willing and able to work.
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Affiliation(s)
- Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Sergio Rueda
- Department of Psychiatry, Institute of Medical Science, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Pamela Surkan
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
| | - Linda Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Abraham AG, Ervin A, Swenor B, Ramulu P, Channa R, Kong X, Stosor V, Friedman MR, Detels R, Plankey M. Prevalence and Consequences of Perceived Vision Difficulty in Aging Adults with HIV Infection. Am J Ophthalmol 2020; 218:268-278. [PMID: 32621897 PMCID: PMC9230650 DOI: 10.1016/j.ajo.2020.06.018] [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: 01/03/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite well-known ocular complications of HIV-related immune suppression, few studies have examined the prevalence and consequences of visual impairment among aging long-term survivors of HIV. DESIGN Retrospective cohort study. METHODS Aging HIV-infected (HIV+) men who have sex with men (MSM) and HIV-uninfected (HIV-) MSM controls reported their difficulty performing 6 vision-dependent tasks (difficulty defined as: no, a little, moderate, and extreme difficulty). Relationships were examined using logistic regression, regressing each outcome separately on categorical visual function responses, with missing data multiply imputed. RESULTS There were 634 age-matched pairs for a total sample of 1,268 MSM of 1,700 MSM with available data. The median age was 60 years old (interquartile range [IQR], 54, 66), and 23% were African American. Among HIV+ men, 95% were virally suppressed (viral load <400 copies/mL). HIV+ men were more likely to report moderate or extreme difficulty performing at least 1 task (21% for HIV+ compared to 13% for HIV-; P < .01). Participants reporting extreme vision-related difficulty performing at least 1 task had 11.2 times the odds of frailty (95% confidence interval [CI], 5.2-23.9), 2.6 times the odds of a slow gait speed (95% CI, 1.4-4.8), and 3.2 times the odds of impaired instrumental activities of daily living (95% CI: 1.6-6.3) compared to those reporting no vision-related difficulty on any task. CONCLUSIONS Perceived vision difficulty was more common among older HIV+ MSM than age-matched HIV- MSM controls and was associated with higher risk of depression and physical function loss among MSM.
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Affiliation(s)
- Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Ann Ervin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bonnie Swenor
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pradeep Ramulu
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Roomasa Channa
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Xiangrong Kong
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roger Detels
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University, Washington, DC, USA
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Matthews DD, Sang JM, Chandler CJ, Bukowski LA, Friedman MR, Eaton LA, Stall RD. Black Men Who Have Sex with Men and Lifetime HIV Testing: Characterizing the Reasons and Consequences of Having Never Tested for HIV. Prev Sci 2020; 20:1098-1102. [PMID: 31089952 DOI: 10.1007/s11121-019-01022-4] [Citation(s) in RCA: 10] [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] [Indexed: 01/24/2023]
Abstract
HIV testing remains a critical point of entry to HIV treatment services and now biomedical prevention as well. Yet despite the high HIV prevalence among Black men who have sex with men (MSM), insufficient attention has been given to factors associated with those Black MSM in the United States who have never received an HIV test in their lifetime. Promoting Our Worth, Equality, & Resilience (POWER) is a cross-sectional observational study that recruited Black MSM at Black Pride events across six cities in the United States from 2014 to 2017. Participants completed an anonymous questionnaire and were offered free, confidential HIV testing. Of the 4174 Black MSM without a prior HIV diagnosis, 404 (9.68%) had never tested for HIV (mean age = 31.03 years). Lower education and greater internalized homophobia were associated with never having tested for HIV. Higher age (AOR = 1.05, 95%, 1.02-1.07) and assumption of HIV-positivity (AOR = 3.24, 95% CI 1.53-6.84) were both associated with increased odds of an HIV-positive test result (n = 119; 36%). To compare, HIV prevalence among Black MSM who had received at least one HIV test before study participation was 23%. While a minority of Black MSM had never received an HIV test, this group had a significantly higher likelihood of HIV infection. Alternative HIV testing strategies are needed to facilitate HIV testing initiation among Black MSM for whom conventional HIV testing modalities are insufficient.
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Affiliation(s)
- Derrick D Matthews
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Jordan M Sang
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Cristian J Chandler
- Department of Epidemiology, Emory University Rollins School of Public Health, Druid Hills, GA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Mansfield, CT, USA
| | - Ron D Stall
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Coulter RWS, Jun HJ, Truong N, Mair C, Markovic N, Friedman MR, Silvestre AJ, Stall R, Corliss HL. Effects of familial and non-familial warmth during childhood and adolescence on sexual-orientation disparities in alcohol use trajectories and disorder during emerging adulthood. Drug Alcohol Depend 2019; 205:107643. [PMID: 31689643 PMCID: PMC6952075 DOI: 10.1016/j.drugalcdep.2019.107643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 11/20/2018] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated sexual-orientation differences in typologies of self-reported familial and non-familial warmth in childhood (before age 11) and adolescence (ages 11-17); and tested whether warmth explained sexual minority emerging adults' (ages 18-25) heightened odds of having heavier alcohol use trajectories (AUTs) and heightened risk for past-year alcohol use disorder (AUD) compared to completely heterosexuals. METHODS Using self-reported data from the U.S.-based Growing Up Today Study cohort, latent class analyses identified typologies of familial and non-familial warmth during childhood and adolescence. Multivariable regression models tested our objectives. RESULTS Six warmth classes emerged, including: High-High (i.e., high familial and high non-familial warmth, respectively); High-Moderate; Moderate-Moderate; Moderate-Occasional; Occasional-Occasional; and Low-Low. Among women, sexual minorities had higher odds than completely heterosexuals of being in the Moderate-Moderate, Moderate-Occasional, and Occasional-Occasional versus the High-High warmth class. There were not significant associations between sexual orientation and warmth classes for men. Lower warmth classes were generally associated with greater past-year AUD, and mediated heightened disparities in AUD for sexual minority women versus completely heterosexual women (4.3% mediated), but not among men. Warmth classes were generally unassociated with AUTs, and did not mediate sexual-orientation differences in AUTs. CONCLUSIONS Lower warmth was associated with greater alcohol-related problems, but not alcohol use itself. Warmth explained a small proportion of AUD disparities for sexual minority women-but not for men.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, 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, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, 3414 Fifth Ave, Pittsburgh, PA, 15213 USA; Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261 USA.
| | - Hee-Jin Jun
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA
| | - Nhan Truong
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA, 15261 USA
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Pittsburgh, PA, 15261 USA
| | - Anthony J Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Pittsburgh, PA, 15261 USA
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, 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, 130 DeSoto Street, Pittsburgh, PA, 15261 USA
| | - Heather L Corliss
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA; Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA
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Friedman MR, Sang JM, Bukowski LA, Chandler CJ, Egan JE, Eaton LA, Matthews DD, Ho K, Raymond HF, Stall R. Prevalence and Correlates of PrEP Awareness and Use Among Black Men Who Have Sex with Men and Women (MSMW) in the United States. AIDS Behav 2019; 23:2694-2705. [PMID: 30820849 PMCID: PMC6713621 DOI: 10.1007/s10461-019-02446-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/19/2022]
Abstract
Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014-2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p < 0.001). Among PrEP-aware MSM, MSMW were more likely than MSMO to report PrEP use (p < 0.05). MSMW receiving gay community support were more likely to be PrEP-aware (p < 0.01). MSMW reporting any past-year STI diagnoses were more likely to report PrEP use (p < 0.01). Findings suggest that PrEP awareness campaigns tailored for Black MSMW, concomitant with STI-to-PrEP interventions, will facilitate greater PrEP uptake in this population.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan M Sang
- 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
| | - Cristian J Chandler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James E Egan
- 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
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ken Ho
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ron 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
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Nieves-Lugo K, Ware D, Friedman MR, Haberlen S, Egan J, Brown AL, Dakwar O, Plankey M. Self-perception of aging among HIV-positive and HIV-negative participants in the Multicenter AIDS Cohort Study. AIDS Care 2019; 32:818-828. [PMID: 31547674 DOI: 10.1080/09540121.2019.1668536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Self-perception of aging is an important predictor of quality of life. Therefore, we sought to examine self-perceptions of aging (age discrepancy and aging satisfaction) between HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS). We included 835 HIV-negative and 784 HIV-positive men aged 50 years and older who had completed a survey about age discrepancy and aging satisfaction from the "Attitude toward own aging" subscale of the Philadelphia Geriatric Center Morale scale. Multinomial generalized logit models were generated to assess self-perception of aging by HIV-status. Most of the participants self-identified as white, former smokers, and had completed high school. HIV-positive individuals reported higher prevalence of comorbidities than HIV-negative individuals. After adjusting for covariates, positive age discrepancy (older subjective age) was positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. Low aging satisfaction was associated with being a current and former smoker and having depressive symptoms, diabetes, and no age and positive age discrepancy. Being black had decreased odds of low aging satisfaction. These findings should inform health care professionals to promote positive views of aging in the assessment and management of HIV, depression, and diabetes.
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Affiliation(s)
- Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, DC, USA
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Omar Dakwar
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
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Coulter RWS, Egan JE, Kinsky S, Friedman MR, Eckstrand KL, Frankeberger J, Folb BL, Mair C, Markovic N, Silvestre A, Stall R, Miller E. Mental Health, Drug, and Violence Interventions for Sexual/Gender Minorities: A Systematic Review. Pediatrics 2019; 144:e20183367. [PMID: 31427462 PMCID: PMC6855817 DOI: 10.1542/peds.2018-3367] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions. OBJECTIVE To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY. DATA SOURCES PubMed, PsycINFO, and Education Resources Information Center. STUDY SELECTION Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY. DATA EXTRACTION Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor. RESULTS With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality. LIMITATIONS There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY. CONCLUSIONS The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.
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Affiliation(s)
- Robert W S Coulter
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Medicine, School of Medicine, and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - James E Egan
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Suzanne Kinsky
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Center for High-Value Health Care, UPMC, Pittsburgh, Pennsylvania; and
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, and
- Infectious Diseases and Microbiology, and
| | | | | | - Barbara L Folb
- Departments of Behavioral and Community Health Sciences and
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Mair
- Departments of Behavioral and Community Health Sciences and
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Dental Public Health, School of Dental Medicine
| | - Anthony Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Ron Stall
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Elizabeth Miller
- Departments of Behavioral and Community Health Sciences and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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45
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Ware D, Palella FJ, Chew KW, Friedman MR, D'Souza G, Ho K, Plankey M. Examination of Polypharmacy Trajectories Among HIV-Positive and HIV-Negative Men in an Ongoing Longitudinal Cohort from 2004 to 2016. AIDS Patient Care STDS 2019; 33:354-365. [PMID: 31369298 PMCID: PMC6661916 DOI: 10.1089/apc.2019.0057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Polypharmacy is the concurrent use of five or more medications. We used group-based trajectory analysis to identify groups of non-HIV medication polypharmacy and investigate associated risk factors among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS) from 2004 to 2016. Each participant was assigned to mutually exclusive groups based on their observed patterns of polypharmacy over time. Risk factors associated with membership with resulting groups were investigated using a multinomial generalized logit model with repeated measures. There were 3160 participants (54.3% HIV positive) included in the study. The overall prevalence of polypharmacy was 33.1% and was higher in HIV-positive than HIV-negative participants (36.2% vs. 30.0%; p < 0.001). Four distinct groups of polypharmacy emerged over time among all participants and among HIV-positive participants only: (1) nonpolypharmacy, (2) slow increasing polypharmacy, (3) rapid increasing polypharmacy, and (4) sustained polypharmacy. Being HIV positive, being 50 years of age or older, having medication insurance coverage, and having increased health care use were positively associated with membership in groups with sustained or increasing polypharmacy. Half of participants in each analysis had membership in one of the three high polypharmacy groups. This study revealed that access to care, through medication insurance coverage and health care use, was a key driver of polypharmacy in this cohort. Further exploration of medically appropriate and inappropriate prescribing practices in the context of polypharmacy and its impact on health outcomes in this and other populations is warranted.
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Affiliation(s)
- Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kara W. Chew
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gypsyamber D'Souza
- Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
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46
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Friedman MR, Bukowski L, Eaton LA, Matthews DD, Dyer TV, Siconolfi D, Stall R. Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support. Arch Sex Behav 2019; 48:213-224. [PMID: 29623533 PMCID: PMC6173653 DOI: 10.1007/s10508-018-1162-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/02/2018] [Accepted: 01/25/2018] [Indexed: 05/04/2023]
Abstract
Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Leigh 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
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Ron 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
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47
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Beach L, Bartelt E, Dodge B, Bostwick W, Schick V, Fu TCJ, Friedman MR, Herbenick D. Meta-Perceptions of Others' Attitudes Toward Bisexual Men and Women Among a Nationally Representative Probability Sample. Arch Sex Behav 2019; 48:191-197. [PMID: 30446861 PMCID: PMC6467292 DOI: 10.1007/s10508-018-1347-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 05/12/2023]
Abstract
Researchers posit that negative attitudes, prejudice, and discrimination (i.e., binegativity) from heterosexual and gay/lesbian individuals may contribute to health disparities among bisexual individuals relative to heterosexual and gay/lesbian individuals. Recent studies have focused on gay, lesbian, and heterosexual people's (e.g., "others") attitudes toward bisexual people. No studies have investigated how bisexual individuals perceive others' attitudes toward bisexual people, which are generally known as "meta-perceptions." As part of the 2015 National Survey of Sexual Health and Behavior, we collected data from a nationally representative probability sample of 2999 adults, including from a subsample of 33 men and 61 women self-identified as bisexual. The Bisexualities: Indiana Attitudes Scale-bisexual (BIAS-b), a modified 5-item scale assessing bisexual people's perceptions of others' attitudes toward bisexual individuals, was included and was followed by an open-ended text box question. Quantitative scale data were analyzed using descriptive and gamma regression methods. Two coders thematically analyzed the open-ended text box data. The internal consistency of the BIAS-b was high (Cronbach's α = 0.85). An exploratory factor analysis supported a one-factor solution. Participants responded to statements regarding others' attitudes toward them as bisexual people, including the domains of confusion, HIV/STD risk, incapability of monogamy, promiscuity, and instability ("just a phase"). Participants' text box descriptions largely aligned with these five domains, with the exception of HIV/STD risk. Additionally, some participants reported others' positive perceptions of them as bisexual individuals. In sum, we observed a range of meta-perceptions, primarily neutral to negative, but also including some relatively positive. These results show the need for interventions to promote acceptance of bisexual individuals among heterosexual and gay/lesbian individuals.
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Affiliation(s)
- Lauren Beach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth Bartelt
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Wendy Bostwick
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, University of Texas Health Sciences Center, Houston, TX, USA
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
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48
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Blosnich JR, Cassese EC, Friedman MR, Coulter RWS, Sang JM, Matthews DD, Mair C. Religious freedom restoration acts and sexual minority population health in the United States. Am J Orthopsychiatry 2018; 89:675-681. [PMID: 30247051 DOI: 10.1037/ort0000349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Religious freedom restoration acts (RFRAs) in the United States potentially facilitate discrimination against lesbian, gay, and bisexual individuals (i.e., sexual minorities). In the current investigation, we explored whether a population health metric among sexual minority adults changed over time based on the presence, absence, or introduction of a state RFRA. Data are from 21 of the United States that gathered sexual orientation data from population-based samples of noninstitutionalized adults in the 2015 Behavioral Risk Factor Surveillance System (CDC, 2015, 2016). The analytic sample included 4,911 sexual minority individuals. Time was measured in 4 3-month quarters (i.e., Q1, Q2, Q3, Q4). For each state, the prevalence of sexual minority adults reporting ≥14 unhealthy days/30 days was calculated. Only Indiana (the only state in the sample that passed an RFRA in 2015) exhibited significant increasing proportions over time of sexual minority adults reporting ≥14 unhealthy days (Q1 = 24.5%, Q2 = 34.8%, Q3 = 41.2%, Q4 = 59.5%; β = 0.50, SE = 0.23, p = .037). Post hoc analyses revealed that unhealthy days did not increase for heterosexual adults in Indiana. Indiana's RFRA could have contributed to the increasing prevalence of unhealthy days among sexual minority adults in that state during 2015. Public health surveillance tools are needed to expedite analyses of the impact of laws on minority population health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- John R Blosnich
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh School of Medicine
| | - Erin C Cassese
- Department of Political Science, West Virginia University
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Robert W S Coulter
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
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49
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Ware D, Palella FJ, Chew KW, Friedman MR, D’Souza G, Ho K, Plankey M. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. PLoS One 2018; 13:e0203890. [PMID: 30204807 PMCID: PMC6133387 DOI: 10.1371/journal.pone.0203890] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/29/2018] [Indexed: 01/21/2023] Open
Abstract
Rates of aging-related comorbidities, which require targeted medications to treat, have been shown to be increased among persons living with HIV compared with uninfected counterparts. Polypharmacy is generally defined as the concurrent use of 5 or more medications. We investigated polypharmacy prevalence for non-HIV medications over a 12-year period among HIV-positive and -negative participants in the Multicenter AIDS Cohort Study. Information regarding non-HIV medication use, HIV status, age, race/ethnicity, enrollment period, and medication insurance was obtained on 3,160 participants from semiannual visits between 2004 and 2016. Polypharmacy was defined as taking 5 or more non-HIV medications since the last health care visit. Generalized estimating equation models with repeated measures were produced overall and by HIV status to examine polypharmacy. The unadjusted prevalence of polypharmacy across all study visits was 18.6% and was higher among HIV-positive participants (24.4%) compared with HIV-negative participants (11.6%) (P < .0001). Among the 50 years and older age group, HIV-positive and HIV-negative participants had increases in polypharmacy over the observation period, from 38.4% to 46.8% (P = .0081) and from 16.7% to 46.0% (P < .0001), respectively. Among participants younger than 50, polypharmacy among HIV-positive participants remained stable (18.9% in 2004 to 17.3% in 2016; P = .5374) but increased among HIV-negative men (5.6% to 20.4%; P < .0001). After adjusting for age, race/ethnicity, and medication insurance, HIV-positive participants had a higher prevalence of polypharmacy than HIV-negative participants (25.3% vs 18.7%; P < .0001). Older age, white race, and having medication insurance coverage were also associated with greater polypharmacy. A convergence of polypharmacy prevalence was observed between HIV-positive and -negative participants at the end of observation. HIV-positive status was associated with an increased likelihood of polypharmacy, after adjusting for age, race/ethnicity, enrollment period, medication insurance, and study visit. Over time, polypharmacy prevalence increased among all participants, with converging rates between HIV-positive and -negative participants by the end of the observation period.
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Affiliation(s)
- Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
- * E-mail:
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Kara W. Chew
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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50
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Adams B, Krier S, Netto J, Feliz N, Friedman MR. "All We Had Were the Streets": Lessons Learned From a Recreation-Based Community Health Space for Young Black MSM and Trans Women Across the HIV Prevention and Care Continuum. AIDS Educ Prev 2018; 30:309-321. [PMID: 30148667 DOI: 10.1521/aeap.2018.30.4.309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Young Black men who have sex with men (MSM) and transgender people experience disparities in HIV incidence and HIV outcomes. To effectively engage these communities in HIV-related programming, we developed a recreation-based community health space. We sought to examine the challenges and successes in implementing this program. Qualitative data were collected from federal progress reports and by a process evaluator who recorded interviews with staff, stakeholders, and participants. These data were coded for themes related to barriers and successes. We consolidated themes into four key domains: community engagement, service provision, stigma, and violence. Each of these domains was determined to significantly affect programmatic success during the implementation period. Young Black MSM and transgender people experience stigmas that pose challenges to effective engagement in HIV-related programming. These lessons learned offer strategies for community engagement and for addressing violence and stigma to maximize programmatic effectiveness.
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Affiliation(s)
- Brian Adams
- Department of Infectious Diseases and Microbiology and the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Krier
- Department of Infectious Diseases and Microbiology and the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jess Netto
- Community Human Services, Inc., Pittsburgh
| | - Nayck Feliz
- Division of Adolescent Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology and the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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