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Giguere R, Balán IC, Kutner BA, Choi SK, Tingler R, Johnson S, Macagna N, Webster J, Liu A, Chariyalertsak S, Hoesley C, Gonzales P, Ho K, Kayange N, Palanee-Phillips T, Brown E, Zemanek J, Jacobson CE, Doncel GF, Piper J, Bauermeister JA. History of Rectal Product Use and Country of Residence Influence Preference for Rectal Microbicide Dosage Forms Among Young Sexual and Gender Minorities: A Multi-country Trial Comparing Placebo Douche, Suppository, and Insert Products. AIDS Behav 2024:10.1007/s10461-024-04360-9. [PMID: 38740628 DOI: 10.1007/s10461-024-04360-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
The DESIRE Study (MTN-035) explored product preference among three placebo rectal microbicide (RM) formulations, a rectal douche (RD), a suppository, and an insert, among 210 sexually active transgender people and men who have sex with men in five counties: the United States, Peru, Thailand, South Africa, and Malawi. Participants used each product prior to receptive anal sex (RAS) for 1 month, following a randomly assigned sequence, then selected their preferred product via computer assisted self-interview. In-depth interviews examined reasons for preference. We compared product preference and prior product use by country to explore whether geographic location and experience with the similar products impacted preference. A majority in the United States (56%) and Peru (58%) and nearly half in South Africa (48%) preferred the douche. Most in Malawi (59%) preferred the suppository, while half in Thailand (50%) and nearly half in South Africa (47%) preferred the insert. Participants who preferred the douche described it as quick and easy, already routinized, and serving a dual purpose of cleansing and protecting. Those who preferred the insert found it small, portable, discreet, with quick dissolution. Those who preferred the suppository found the size and shape acceptable and liked the added lubrication it provided. Experience with product use varied by country. Participants with RD experience were significantly more likely to prefer the douche (p = 0.03). Diversifying availability of multiple RM dosage forms can increase uptake and improve HIV prevention efforts globally.
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Affiliation(s)
- Rebecca Giguere
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Research, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | - Iván C Balán
- Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Bryan A Kutner
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Research, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Psychiatry Research Institute at Montefiore Einstein (PRIME), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seul Ki Choi
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Tingler
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Al Liu
- Bridge HIV at the San Francisco Department of Public Health, San Francisco, CA, USA
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Craig Hoesley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pedro Gonzales
- IMPACTA Asociación Civil, Impacta Salud y Educación, San Miguel CES, Lima, Peru
| | - Ken Ho
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noel Kayange
- Blanytre CRS, Johns Hopkins University Research Project, Blantyre, Malawi
| | - Thesla Palanee-Phillips
- Wits RHI, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth Brown
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jillian Zemanek
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Jeanna Piper
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Riddler SA, Kelly CW, Hoesley CJ, Ho KS, Piper JM, Edick S, Heard F, Doncel GF, Johnson S, Anderson PL, Brand RM, Kunjara Na Ayudhya RP, Bauermeister JA, Hillier SL, Hendrix CW. A Phase 1 Clinical Trial to Assess the Safety and Pharmacokinetics of a Tenofovir Alafenamide/Elvitegravir Insert Administered Rectally for HIV Prevention. J Infect Dis 2024:jiae211. [PMID: 38655842 DOI: 10.1093/infdis/jiae211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On-demand topical products could be an important tool for HIV prevention. We evaluated the safety, pharmacokinetics, and ex vivo pharmacodynamics of a tenofovir alafenamide/elvitegravir (TAF/EVG; 16 mg/20 mg) insert administered rectally. METHODS MTN-039 was a Phase 1, open-label, single-arm, 2-dose study. Blood, rectal fluid (RF), and rectal tissue (RT) were collected over 72 hours (hr) following rectal administration of one and two TAF/EVG inserts for each participant. ClinicalTrials.gov Identifier: NCT04047420. RESULTS TAF/EVG inserts were safe and well tolerated. EVG and tenofovir (TFV) were detected in blood plasma at low concentrations: median peak concentrations after 2 inserts were EVG 2.4 ng/mL and TFV 4.4 ng/mL. RT EVG peaked at 2-hr (median 2 inserts= 9 ng/mg) but declined to BLQ in the majority of samples at 24-hr, whereas TFV-DP remained high >2,000 fmol/million cells for 72-hr with 2 inserts. Compared to baseline, median cumulative log10 HIV p24 antigen of ex vivo rectal tissue HIV infection was reduced at each timepoint for both 1 and 2 inserts (p<0.065 and p<0.039, respectively). DISCUSSION Rectal administration of TAF/EVG inserts achieved high rectal tissue concentrations of EVG and TFV-DP with low systemic drug exposure and demonstrable ex vivo inhibition of HIV infection for 72 hours.
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Affiliation(s)
- Sharon A Riddler
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Clifton W Kelly
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA
| | - Craig J Hoesley
- Departments of Medicine and Medical Education, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Ken S Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Jeanna M Piper
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892 USA
| | - Stacey Edick
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Faye Heard
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | | | | | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Rhonda M Brand
- Department of Medicine, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, PA 15213 USA
| | | | - José A Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104 USA
| | - Sharon L Hillier
- Department of Obstetrics and Gynecology, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, PA 15213 USA
| | - Craig W Hendrix
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, MD 21287 USA
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Bauermeister JA, Horvath KJ, Lin WY, Golinkoff JM, Claude KF, Dowshen N, Castillo M, Sullivan PS, Paul M, Hightow-Weidman L, Stephenson R. Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139). BMC Public Health 2024; 24:1072. [PMID: 38632603 PMCID: PMC11025185 DOI: 10.1186/s12889-024-18522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing. METHODS Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups. RESULTS Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed. CONCLUSIONS Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov (NCT03132415).
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Affiliation(s)
- J A Bauermeister
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA.
| | - K J Horvath
- San Diego State University, San Diego, CA, USA
| | - W Y Lin
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - J M Golinkoff
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
| | - K F Claude
- Florida State University, Tallahassee, FL, USA
| | - N Dowshen
- University of Pennsylvania, 418 Curie Blvd, Room 222L, 19104, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Castillo
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - M Paul
- Baylor College of Medicine, Houston, TX, USA
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Wang Y, O'Connor K, Flores I, Berdahl CT, Urbanowicz RJ, Stevens R, Bauermeister JA, Gonzalez-Hernandez G. Health activism, vaccine, and mpox discourse: BERTopic based mixed-method analyses of tweets from sexual minority men and gender diverse (SMMGD) individuals in the U.S. medRxiv 2024:2024.03.19.24304519. [PMID: 38562836 PMCID: PMC10984054 DOI: 10.1101/2024.03.19.24304519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objectives To synthesize discussions among sexual minority men and gender diverse (SMMGD) individuals on mpox, given limited representation of SMMGD voices in existing mpox literature. Methods BERTopic (a topic modeling technique) was employed with human validations to analyze mpox-related tweets (n = 8,688; October 2020-September 2022) from 2,326 self-identified SMMGD individuals in the U.S.; followed by content analysis and geographic analysis. Results BERTopic identified 11 topics: health activism (29.81%); mpox vaccination (25.81%) and adverse events (0.98%); sarcasm, jokes, emotional expressions (14.04%); COVID-19 and mpox (7.32%); government/public health response (6.12%); mpox symptoms (2.74%); case reports (2.21%); puns on the virus' naming (i.e., monkeypox; 0.86%); media publicity (0.68%); mpox in children (0.67%). Mpox health activism negatively correlated with LGB social climate index at U.S. state level, ρ = -0.322, p = 0.031. Conclusions SMMGD discussions on mpox encompassed utilitarian (e.g., vaccine access, case reports, mpox symptoms) and emotionally-charged themes-advocating against homophobia, misinformation, and stigma. Mpox health activism was more prevalent in states with lower LGB social acceptance. Public Health Implications Findings illuminate SMMGD engagement with mpox discourse, underscoring the need for more inclusive health communication strategies in infectious disease outbreaks to control associated stigma.
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Affiliation(s)
- Yunwen Wang
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ivan Flores
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Carl T Berdahl
- Departments of Medicine and Emergency Medicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Ryan J Urbanowicz
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Robin Stevens
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Yu H, Bauermeister JA, Oyiborhoro U, Aryal S, Lipman TH, Tan ASL, Glanz K, Villarruel AM, Bonett S. Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study. BMC Public Health 2024; 24:830. [PMID: 38493101 PMCID: PMC10943829 DOI: 10.1186/s12889-024-18342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19. METHODS This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status. RESULTS Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76). CONCLUSIONS Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA.
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Ufuoma Oyiborhoro
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, Pennsylvania, 19104, USA
| | - Karen Glanz
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Antonia M Villarruel
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
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Cordova D, Bauermeister JA, Warner S, Wells P, MacLeod J, Neilands TB, Mendoza Lua F, Delva J, Fessler KB, Smith V, Khreizat S, Boyer C. Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e47216. [PMID: 38373025 PMCID: PMC10912993 DOI: 10.2196/47216] [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] [Received: 03/16/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. OBJECTIVE To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. METHODS In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. RESULTS This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. CONCLUSIONS This study has the potential to improve public health by preventing HIV/STI and substance use disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47216.
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Affiliation(s)
- David Cordova
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sydni Warner
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer MacLeod
- Livingston Physician Organization, Livingston, MI, United States
| | - Torsten B Neilands
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Frania Mendoza Lua
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Jorge Delva
- School of Social Work, Boston University, Boston, MA, United States
| | | | | | - Sarah Khreizat
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Cherrie Boyer
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
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Watson DL, Listerud L, Drab RA, Lin WY, Momplaisir FM, Bauermeister JA. HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis. J Int AIDS Soc 2024; 27:e26211. [PMID: 38332521 PMCID: PMC10853582 DOI: 10.1002/jia2.26211] [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: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. METHODS Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. RESULTS The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). CONCLUSIONS Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Louis Listerud
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan A. Drab
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Willey Y. Lin
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Florence Marie Momplaisir
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Choi SK, Muessig KE, Hightow-Weidman LB, Bauermeister JA. Paradata: Measuring Engagement in Digital HIV Interventions for Sexual and Gender Minorities. Curr HIV/AIDS Rep 2023; 20:487-501. [PMID: 37930613 DOI: 10.1007/s11904-023-00679-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this review was to examine online engagement using paradata (i.e., intervention usage metrics) as part of the reporting of online behavioral HIV prevention and care interventions' findings. We underscore the importance of these data in examining intervention engagement and effectiveness. RECENT FINDINGS We focused on studies indexed in PubMed and published between April 1, 2017, and June 30, 2023, that reported the development and testing of online behavioral interventions for HIV prevention and/or care. Of the 689 extracted citations, 19 met the study criteria and provided engagement data - only six studies tested the association between engagement and intervention outcomes. Of these, four studies found a positive association between participants' engagement and improvements in HIV-related outcomes. Increasing attention is being paid to the collection and reporting of paradata within HIV online behavioral interventions. While the current evidence suggests a dose-response relationship due to user engagement on HIV outcomes, greater efforts to systematically collect, report, and analyze paradata are warranted.
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Affiliation(s)
- Seul Ki Choi
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Suite 402, Philadelphia, PA, USA
| | - Kathryn E Muessig
- Institute On Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Lisa B Hightow-Weidman
- Institute On Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Suite 402, Philadelphia, PA, USA.
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Brown LA, Webster JL, Tran JT, Wolfe JR, Golinkoff J, Patel E, Arcomano AC, Ben Nathan J, Azat O'Connor A, Zhu Y, Oquendo M, Brown GK, Mandell D, Mowery D, Bauermeister JA. A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48177. [PMID: 37773618 PMCID: PMC10576233 DOI: 10.2196/48177] [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] [Received: 04/14/2023] [Revised: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. OBJECTIVE We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. METHODS Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program. RESULTS Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. CONCLUSIONS This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. TRIAL REGISTRATION ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48177.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica L Webster
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer T Tran
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - James R Wolfe
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jesse Golinkoff
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Esha Patel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amanda C Arcomano
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Ben Nathan
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Alexander Azat O'Connor
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Yiqin Zhu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Maria Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gregory K Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle Mowery
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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10
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Bonett S, Mahajan A, Williams J, Watson DL, Wood SM, Meanley S, Brady KA, Bauermeister JA. Perspectives From Community-Based HIV Service Organization Leaders on Priorities in Serving Sexual and Gender Minority Populations. AIDS Educ Prev 2023; 35:277-289. [PMID: 37535325 PMCID: PMC10461513 DOI: 10.1521/aeap.2023.35.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Sexual and gender minority (SGM) populations experience discrimination and care-related barriers when seeking appropriate sexual health services. Using rapid assessment procedures we conducted site visits with 11 community-based HIV service agencies to identify priorities, assets, and needs related to serving SGM clients and assessed the alignment of these services with the city's local Ending the HIV Epidemic plan. We identified and mapped themes across agencies into the Consolidated Framework for Implementation Research domains of inner and outer settings: client-facing materials; priorities in serving SGM communities; SGM policies and protocols; collecting sexual orientation and gender identity data; training and education; and funding and scope of programs. Rapid assessment procedures can accelerate the collection and interpretation of data to help public health institutions and community partners make timely adaptations when implementing comprehensive and culturally humble sexual health services for SGM communities.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Javontae Williams
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Dovie L Watson
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, and Adolescent HIV Services, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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11
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Phillips VL, Xue A, Castillo M, Santiago D, Wimbly T, Hightow-Weidman LB, Stephenson R, Bauermeister JA. Correction: Cost of peer mystery shopping to increase cultural competency in community clinics offering HIV/STI testing to young men who have sex with men: results from the get connected trial. Health Econ Rev 2023; 13:40. [PMID: 37493883 PMCID: PMC10373357 DOI: 10.1186/s13561-023-00453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Victoria L Phillips
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA.
| | - Ashley Xue
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA
| | - Marné Castillo
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Dalia Santiago
- Department of Pediatrics-Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Dallas, USA
| | - Taylor Wimbly
- Prevention Research Center, Morehouse School of Medicine, Atlanta, USA
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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12
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Biello KB, Valente PK, da Silva DT, Lin W, Drab R, Hightow-Weidman L, Mayer KH, Bauermeister JA. Who prefers what? Correlates of preferences for next-generation HIV prevention products among a national U.S. sample of young men who have sex with men. J Int AIDS Soc 2023; 26 Suppl 2:e26096. [PMID: 37439061 DOI: 10.1002/jia2.26096] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) has been available for young people for over a decade, yet only ∼15% of young people in the United States with indications for PrEP have a prescription for it. Next-generation PrEP modalities may address some of the challenges of daily oral PrEP. However, preferences for these products are unknown. METHODS From October 2020 to June 2021, we conducted an online survey of 737 cisgender, young men who have sex with men (age 15-24 years) without HIV across the United States who reported same-sex attraction or consensual sex with another man in the past 6 months. Participants completed a conjoint experiment comparing daily oral pills, event-driven oral pills, event-driven rectal douches, intramuscular injections, intravenous broadly neutralizing antibody (bnAb) infusions and subcutaneous implants. Participants ranked the products from most to least preferred. Exploded logit models examined the association between ranked preferences of PrEP modalities and socio-demographic and behavioural characteristics. RESULTS Participants' mean age was 21 years (SD = 2.3), and 56% identified as White. Nineteen percent were currently taking daily oral PrEP, and another 9% had previously taken it. Participants prioritized efficacy, absence of side effects and costs in the conjoint analyses. Daily oral PrEP had the highest preference ranking, followed by event-driven oral (OR = 0.89, p = 0.058), injectable (OR = 0.83, p = 0.005), implant (OR = 0.48, p < 0.0001), bnAb infusions (OR = 0.38, p < 0.0001) and rectal douches (OR = 0.24, p < 0.0001). There were differences in PrEP preferences across age, insurance status, sexual behaviour, PrEP use history, HIV and sexually transmitted infection (STI) testing history, and STI diagnoses (omnibus tests: p < 0.05). Participants also provided reasons for selecting their top product choice: ease of use for those who chose daily oral (99%) and daily event-driven (98.5%); feel more protected against HIV for those who chose injectable (95.4%) and implants (100%); not worrying about forgetting to take it for those who chose bnAbs (93.8%); and being able to stop taking it when they want for those who chose rectal douche (90.9%). CONCLUSIONS Next-generation modalities were less likely to be preferred over daily oral PrEP, with differences in the magnitude by socio-demographic and behavioural characteristics. Given the low uptake of daily oral PrEP, end-users' preferences for and concerns about PrEP products must be understood to ensure high acceptability and penetration.
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Affiliation(s)
- Katie B Biello
- Departments of Behavioral & Social Sciences and Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Pablo K Valente
- Departments of Behavioral & Social Sciences and Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut, USA
| | - Daniel Teixeira da Silva
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Willey Lin
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Ryan Drab
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - José A Bauermeister
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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13
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Delany‐Moretlwe S, Flexner C, Bauermeister JA. Advancing use of long-acting and extended delivery HIV prevention and treatment regimens. J Int AIDS Soc 2023; 26 Suppl 2:e26126. [PMID: 37439079 PMCID: PMC10338994 DOI: 10.1002/jia2.26126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Sinéad Delany‐Moretlwe
- Wits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Charles Flexner
- Divisions of Clinical Pharmacology and Infectious DiseasesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - José A. Bauermeister
- Department of Family & Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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14
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Florimbio AR, Walton MA, Duval ER, Bauermeister JA, Young SD, McAfee J, Bonar EE. Direct and Indirect Effects of Cannabis Risk Perceptions on Cannabis Use Frequency. Addict Res Theory 2023; 32:68-73. [PMID: 38268741 PMCID: PMC10805454 DOI: 10.1080/16066359.2023.2221029] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/24/2023] [Indexed: 01/26/2024]
Abstract
Background Perceived risk of harm associated with cannabis use has decreased in recent decades, particularly among emerging adults who show the highest prevalence of use. Cannabis-related protective behavioral strategies (PBS) are associated with lower cannabis use and fewer consequences; however, individuals who perceive using cannabis as low risk may use cannabis PBS less often. Therefore, using cross-sectional data, we examined the associations between perceived risk of harm associated with cannabis use, cannabis PBS, and cannabis use frequency. Method Participants were 146 emerging adults between the ages of 18-25 (56.2% female) who reported consuming cannabis at least 3 times/week and completed measures of past-month cannabis use, past three-month use of cannabis PBS, and perceived risk of harm associated with cannabis use. Path analyses examined direct and indirect effects of perceived risk of cannabis-related harm on cannabis frequency through cannabis PBS. Results Most (66.4%) participants reported no perceived risk of harm associated with occasional cannabis use, whereas 30.1% reported no perceived risk of harm associated with regular cannabis use. Findings indicated a significant indirect effect between perceived risk of harm and cannabis use frequency through cannabis PBS, b = -10.23, SE = 3.80, 95% CI [-17.67, -2.80], p = .007. Conclusions Among emerging adults who consume cannabis regularly, findings suggest that a greater perceived risk of cannabis-related harm is associated with decreased cannabis use frequency via increased use of cannabis PBS. Although future analyses evaluating causal mechanisms are needed, these findings have clinical implications for harm reduction interventions focused on cannabis use.
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Affiliation(s)
- Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Elizabeth R. Duval
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109
| | - José A. Bauermeister
- Department of Family & Community Health, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697
- Department of Emergency Medicine, University of California Irvine, CA 92697
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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15
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Phillips VL, Xue A, Castillo M, Santiago D, Wimbly T, Hightow-Wideman LB, Stephenson R, Bauermeister JA. Cost of peer mystery shopping to increase cultural competency in community clinics offering HIV/STI testing to young men who have sex with men: results from the get connected trial. Health Econ Rev 2023; 13:34. [PMID: 37266871 PMCID: PMC10236762 DOI: 10.1186/s13561-023-00447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Cultural competency has been identified as a barrier to lesbian, gay, bisexual and transgender (LGBT) populations seeking care. Mystery shopping has been widely employed in the formal health care sector as a quality improvement (QI) tool to address specific client needs. The approach has had limited use in community-based organizations due in part to lack of knowledge and resource requirement concerns. Several mystery shopping initiatives are now being implemented which focus on the LGBT population with the goal of reducing barriers to accessing care. One subset targets men who have sex with men (MSM) to increase uptake of human immunodeficiency virus (HIV) testing. No study investigates the costs of these initiatives. Get Connected was a randomized control trial with the objective of increasing uptake of HIV-prevention services among young men who have sex with men (YMSM) through use of a resource-locator application (App). The initial phase of the trial employed peer-led mystery shopping to identify culturally competent HIV testing sites for inclusion in the App. The second phase of the trial randomized YMSM to test the efficacy of the App. Our objective was to determine the resource inputs and costs of peer-led mystery shopping to identify clinics for inclusion in the App as costs would be critical in informing possible adoption by organizations and sustainability of this model. METHODS Through consultation with study staff, we created a resource inventory for undertaking the community-based, peer-led mystery shopping program. We used activity-based costing to price each of the inputs. We classified inputs as start-up and those for on-going implementation. We calculated costs for each category, total costs and cost per mystery shopper visit for the four-month trial and annually to reflect standard budgeting periods for data collected from September of 2019 through September of 2020. RESULTS Recruitment and training of peer mystery shoppers were the most expensive tasks. Average start-up costs were $10,001 (SD $39.8). Four-month average implementation costs per visit were $228 (SD $1.97). Average annual implementation costs per visit were 33% lower at $151 (SD $5.60). CONCLUSIONS Peer-led, mystery shopping of HIV-testing sites is feasible, and is likely affordable for medium to large public health departments.
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Affiliation(s)
- Victoria L Phillips
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA.
| | - Ashley Xue
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA
| | - Marné Castillo
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Dalia Santiago
- Department of Pediatrics-Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Dallas, USA
| | - Taylor Wimbly
- Prevention Research Center, Morehouse School of Medicine, Atlanta, USA
| | - Lisa B Hightow-Wideman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Reiter PL, Gower AL, Kiss DE, Shoben AB, Katz ML, Bauermeister JA, Paskett ED, McRee AL. Efficacy of the Outsmart HPV Intervention: A Randomized Controlled Trial to Increase HPV Vaccination among Young Gay, Bisexual, and Other Men Who Have Sex with Men. Cancer Epidemiol Biomarkers Prev 2023; 32:760-767. [PMID: 36958851 PMCID: PMC10239352 DOI: 10.1158/1055-9965.epi-23-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Routine human papillomavirus (HPV) vaccination is recommended for young adults, yet many young gay, bisexual, and other men who have sex with men (YGBMSM) remain unvaccinated. We report the efficacy of Outsmart HPV, a web-based HPV vaccination intervention for YGBMSM. METHODS From 2019 to 2021, we recruited YGBMSM in the United States who were ages 18-25 and unvaccinated against HPV (n = 1,227). Participants were randomized to receive either: (i) Outsmart HPV content online and monthly interactive text reminders (interactive group); (ii) Outsmart HPV content online and monthly unidirectional text reminders (unidirectional group); or (iii) standard information online about HPV vaccine (control group). Regression models compared study groups on HPV vaccination outcomes. RESULTS Overall, 33% of participants reported initiating the HPV vaccine series and 7% reported series completion. Initiation was more common among participants in the interactive group compared with the control group [odds ratio (OR) = 1.47, 98.3% confidence interval (CI): 1.03-2.11]. Completion was more common among participants in both the interactive group (OR = 3.70, 98.3% CI: 1.75-7.83) and unidirectional group (OR = 2.26, 98.3% CI: 1.02-5.00) compared with the control group. Participants who received Outsmart HPV content reported higher levels of satisfaction with online content compared with the control group. CONCLUSIONS Outsmart HPV is an efficacious and acceptable HPV vaccination intervention for YGBMSM. Future efforts are needed to determine how to optimize the intervention and disseminate it to settings that provide services to YGBMSM. IMPACT Outsmart HPV is a promising tool for increasing HPV vaccination among YGBMSM with the potential for wide dissemination.
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Affiliation(s)
- Paul L. Reiter
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Dale E. Kiss
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Abigail B. Shoben
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Mira L. Katz
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Electra D. Paskett
- College of Public Health, The Ohio State University, Columbus, OH
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Scientific Review, National Institutes of Health, Bethesda, MD
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Teixeira da Silva D, Makeneni S, Wall H, Bauermeister JA, Wood S. Measuring quality STI care among adolescent female primary care patients in Philadelphia. Sex Transm Infect 2023; 99:272-275. [PMID: 36868813 DOI: 10.1136/sextrans-2022-055623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Engagement in guideline-recommended sexually transmitted infection (STI) care is fundamental to ending the STI epidemic in the USA. However, the US 2021-2025 STI National Strategic Plan and STI surveillance reports do not include a framework to measure quality STI care delivery. This study developed and applied an STI Care Continuum that can be used across settings to improve STI care quality, assess adherence to guideline-recommended care and standardise the measurement of progress towards National Strategic goals. METHODS Review of the Centers for Disease Control and Prevention STI Treatment guidelines identified seven distinct steps of STI care for gonorrhoea, chlamydia and syphilis: (1) STI testing indication, (2) STI test completion, (3) HIV testing, (4) STI diagnosis, (5) partner services, (6) STI treatment and (7) STI retesting. Steps 1-4, 6 and 7 for gonorrhoea and/or chlamydia (GC/CT) were measured among females aged 16-17 years with a clinic visit at an academic paediatric primary care network in 2019. We used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7. RESULTS Among 5484 female patients aged 16-17 years, an estimated 44% had an STI testing indication. Among those patients, 17% were tested for HIV, of whom none tested positive, and 43% were tested for GC/CT, 19% of whom were diagnosed with GC/CT. Of these patients, 91% received treatment within 2 weeks and 67% were retested within 6 weeks to 1 year after diagnosis. On retesting, 40% were diagnosed with recurrent GC/CT. CONCLUSIONS Local application of an STI Care Continuum identified STI testing, retesting and HIV testing as areas for improvement. The development of an STI Care Continuum identified novel measures for monitoring progress towards National Strategic indicators. Similar methods can be applied across jurisdictions to target resources, standardise data collection and reporting and improve STI care quality.
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Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Spandana Makeneni
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Wall
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - José A Bauermeister
- Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Sarah Wood
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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18
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Valente PK, Operario D, Rusley J, Bauermeister JA, Biello KB. The need for a health equity framework in next-generation pre-exposure prophylaxis implementation. Lancet HIV 2023; 10:e266-e268. [PMID: 36848924 DOI: 10.1016/s2352-3018(23)00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 03/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective for prevention of HIV transmission and plays an important role in efforts to end the HIV epidemic within the next decade. However, disparities in access to PrEP might be fuelling disparities in the burden of HIV in the USA. The advent of next-generation PrEP formulations that do not involve daily regimens (eg, long-acting cabotegravir) holds potential to facilitate medication adherence, but if the roll-out of these formulations does not consider disparities in access, HIV disparities might be further widened. On the basis of US epidemiological data and informed by the Theory of Fundamental Causes of Health Disparities, we propose an equity-promoting framework to guide the implementation of daily oral and next-generation PrEP. Multilevel efforts to bolster equity in PrEP care include generating demand for next-generation PrEP formulations among marginalised groups, expanding the availability of health services providing oral and next-generation PrEP, and addressing structural and financial barriers to HIV prevention care. The aim of these strategies is to realise the potential of next-generation PrEP to provide people at high risk with effective options to prevent HIV acquisition, thereby helping to reduce both overall HIV transmission and health disparities in the USA.
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Affiliation(s)
- Pablo K Valente
- Department of Allied Health Sciences, University of Connecticut, Waterbury, CT, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jack Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - José A Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, 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
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19
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Florimbio AR, Coughlin LN, Bauermeister JA, Young SD, Zimmerman MA, Walton MA, Bonar EE. Risky Drinking in Adolescents and Emerging Adults: Differences between Individuals Using Alcohol Only versus Polysubstances. Subst Use Misuse 2022; 58:211-220. [PMID: 36537360 PMCID: PMC9877190 DOI: 10.1080/10826084.2022.2152192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups. METHODS Participants (N = 955; ages 16-24; 54.5% female) who reported recent risky drinking completed measures of alcohol/substance use, alcohol-related consequences, drinking motives, alcohol PBS, mental health symptoms, and emotion dysregulation. Participants were in the polysubstance group if they reported using at least one other substance (e.g., cannabis, stimulants) in addition to alcohol in the past three months. Chi-square and t-tests examined differences between the two groups and multiple regression analyses examined correlates of risky drinking. RESULTS Most participants (70.4%, n = 672) reported polysubstance use; these individuals engaged in riskier patterns of drinking, experienced more alcohol-related consequences, used fewer PBS, had stronger drinking motives (enhancement, social, coping), endorsed more mental health symptoms, and reported more emotion dysregulation. Regression models showed that emotion dysregulation significantly associated with risky drinking in the alcohol-only group; conformity and coping motives, alcohol PBS, and anxiety symptoms significantly associated with risky drinking in the polysubstance group. CONCLUSIONS Among risky drinking youth, results indicated youth engaging in polysubstance use have greater comorbidities and individual-level factors associated with risky drinking than youth who consume alcohol only. These findings may inform the tailoring of interventions for individuals who engage in risky drinking and polysubstance use.
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Affiliation(s)
- Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean D. Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Informatics, University of California, Irvine, Irvine, CA, USA
| | - Marc A. Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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20
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Sallabank G, Blackburn NA, Threats M, Pulley DV, Barry MC, LeGrand S, Harper GW, Bauermeister JA, Hightow-Weidman LB, Muessig KE. Media representation, perception and stigmatisation of race, sexuality and HIV among young black gay and bisexual men. Cult Health Sex 2022; 24:1729-1743. [PMID: 34895082 PMCID: PMC9188628 DOI: 10.1080/13691058.2021.2008506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Young Black gay and bisexual men who have sex with men experience stigma related to race, gender expression, sexuality and HIV status. Stigma impacts access to HIV care and prevention as well as interactions with healthcare providers. The amplification of stigma through popular media is under-researched in the health sciences. HealthMpowerment is a mobile phone optimised intervention to reduce sexual risk and support community-building for young Black gay and bisexual men (age 18-30). We analysed Forum conversations from 48 participants, 45.8% living with HIV. Of 322 stigma-relevant conversations, 18.9% referenced the media (e.g. television, news, social media) as a source of stigma. Forum conversations covered media representations of Black gay and bisexual men, media's influence on identity, and the creation of stigma by association with media representations. Cultural messages embedded in the media may accentuate stereotypes that influence perceptions of Black gay and bisexual men and disregard intersectional identities. HealthMpowerment provided a space to challenge stigmatising representations. Participants used HealthMpowerment to garner social support and celebrate positive media representations. Interventions for young Black gay and bisexual men should consider the influential role of media and include spaces for participants to process and address stigma.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Natalie A. Blackburn
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Threats
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deren V. Pulley
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan C. Barry
- Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gary W. Harper
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kathryn E. Muessig
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Reiter PL, Gower AL, Kiss DE, Shoben AB, Katz ML, Bauermeister JA, Paskett ED, McRee AL. Effects of a web-based HPV vaccination intervention on cognitive outcomes among young gay, bisexual, and other men who have sex with men. Hum Vaccin Immunother 2022; 18:2114261. [PMID: 36069662 DOI: 10.1080/21645515.2022.2114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Knowledge, attitudes, and beliefs are important antecedents to HPV vaccination, yet remain suboptimal among young gay, bisexual, and other men who have sex with men (YGBMSM). We report the effects of a theoretically-informed, web-based HPV vaccination intervention on these cognitive outcomes. From 2019-2021, we recruited a national sample of YGBMSM ages 18-25 in the United States who were unvaccinated against HPV (n = 1,227). Participants received either standard HPV vaccination information online (control) or population-targeted, individually-tailored content online (Outsmart HPV intervention). Mixed effects models determined if pre-post changes in cognitive outcomes differed between study groups. For five of seven knowledge items about HPV, there were larger pre-post increases among the intervention group than the control group in the percentage of participants who provided correct responses (all statistically significant at p = .05 after Holm's correction). There were also larger pre-post improvements among the intervention group than the control group for most attitudes and beliefs examined, including response efficacy of HPV vaccine (pre-post increases in means: 0.57 vs. 0.38); self-efficacy for the HPV vaccination process (pre-post increases in means: 0.23 vs. 0.10); and intention to get HPV vaccine (pre-post increases in means: 0.70 vs. 0.28) (all statistically significant at p = .05 after Holm's correction). Outsmart HPV is a promising tool for improving key cognitive antecedents to HPV vaccination among YGBMSM, supporting the use of theoretically-informed interventions to affect such outcomes. If efficacious in increasing HPV vaccine uptake in future analyses, this intervention could be utilized in clinical and other healthcare settings that provide services to YGBMSM.
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Affiliation(s)
- Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amy L Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dale E Kiss
- College of Public Health, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Abigail B Shoben
- College of Public Health, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - José A Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.,Center for Scientific Review, National Institutes of Health, Bethesda, MD, USA
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22
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Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, Mayer KH, Operario D, Rusley J, Biello KB. Preferences Across Pre-Exposure Prophylaxis Modalities Among Young Men Who Have Sex with Men in the United States: A Latent Class Analysis Study. AIDS Patient Care STDS 2022; 36:431-442. [PMID: 36367995 PMCID: PMC9910107 DOI: 10.1089/apc.2022.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Access to daily oral pre-exposure prophylaxis (PrEP) is suboptimal among young cisgender men who have sex with men (YMSM) in the United States. Next-generation modalities that do not involve daily oral regimens may mitigate some of the barriers to PrEP use. We identified latent classes of YMSM based on health care decision-making patterns and examined associations between latent classes and access to health care and PrEP modality preferences (i.e., daily and event-driven oral, rectal douches, broadly neutralizing antibodies, subcutaneous implants, and an injectable). Between October 2020 and June 2021, we administered an online survey to 737 YMSM. Latent class analysis (LCA) identified groups of YMSM based on communication with providers, stigma and mistrust in health care, and autonomy in sexual health decisions. Logistic regression examined associations between class membership and health care access, and exploded logit regression examined associations between class membership and ranked PrEP modality preferences. LCA identified three classes: shared decision-making (high communication with providers and high autonomy); provider-led decision-making (high communication and low autonomy); and patient-driven decision-making (low communication and high autonomy). Shared decision-making was associated with higher access to health care in comparison with the other classes. Across all classes, YMSM preferred daily oral PrEP over all next-generation PrEP modalities. Preferences for daily oral PrEP over next-generation PrEP modalities were particularly marked among the patient-driven decision-making class. Shared decision-making is associated with access to health care and HIV prevention and higher acceptability of next-generation PrEP modalities, and should be considered as part of future interventions to promote use of daily oral and next-generation PrEP.
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Affiliation(s)
- Pablo K. Valente
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Willey Y. Lin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Teixeira Da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jack Rusley
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katie B. Biello
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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23
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Meanley S, Sexton Topper P, Listerud L, Bonett SK, Watson D, Choi SK, Teixeira Da Silva D, Flores DD, James R, Bauermeister JA. Leveraging Resilience-supportive Strategies to Enhance Protective Factors in Young Sexual Minority Men: A Scoping Review of HIV Behavioral Interventions Implemented in High-income Countries. J Sex Res 2022; 59:957-983. [PMID: 35080999 DOI: 10.1080/00224499.2021.2024789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Behavioral HIV interventions focused on strengthening young sexual minority men's (SMM) internal (assets) and external (resources) protective factors are promising, yet their evaluation as resilience-supportive strategies to minimize or negate HIV-related risks remain understudied. The objective of this scoping review was to describe resilience-supportive intervention strategies that have been used to achieve desired HIV behavioral outcomes and to identify how these strategies have been evaluated using a resilience analytic framework. Our scoping review uncovered 271 peer-reviewed articles, of which 38 were eligible for inclusion based on our review criteria. The majority of interventions relied on social support strategies as their primary resilience-supportive strategy. A third of interventions reviewed analyzed their findings from a deficits-focused model, another third used compensatory resilience models, and the remaining interventions employed a hybrid (i.e., deficit and compensatory model) strategy. None of the interventions evaluated their intervention effects using a risk-protective model. From our synthesis regarding the current state of research around resilience-informed interventions, we propose strategies to inform the design of resilience-supportive approaches and make recommendations to move the field forward on how to develop, implement, and measure young SMM's resiliency processes.
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Affiliation(s)
- Steven Meanley
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
| | - Patrina Sexton Topper
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
| | - Louis Listerud
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
| | - Stephen K Bonett
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
- University of Pennsylvania Leonard Davis Institute of Health Economics
| | - Dovie Watson
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
- School of Medicine, Division of Infectious Diseases, University of Pennsylvania Perelman
| | - Seul Ki Choi
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
| | - Daniel Teixeira Da Silva
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
- University of Pennsylvania Leonard Davis Institute of Health Economics
- School of Medicine National Clinician Scholar, University of Pennsylvania Perelman
| | - Dalmacio D Flores
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
| | | | - José A Bauermeister
- School of Nursing, Department of Family and Community Health, University of Pennsylvania
- School of Nursing, Program on Sexuality, Technology, and Action Research, University of Pennsylvania
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24
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Bonar EE, Bauermeister JA, Blow FC, Bohnert ASB, Bourque C, Coughlin LN, Davis AK, Florimbio AR, Goldstick JE, Wisnieski DM, Young SD, Walton MA. A randomized controlled trial of social media interventions for risky drinking among adolescents and emerging adults. Drug Alcohol Depend 2022; 237:109532. [PMID: 35759874 PMCID: PMC9745675 DOI: 10.1016/j.drugalcdep.2022.109532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. PROCEDURES Using social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability. RESULTS The interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition. CONCLUSIONS Among this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA
| | - Amy S. B. Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210 USA,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | - Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Jason E. Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA,Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105
| | - Diane M. Wisnieski
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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25
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Bauermeister JA, Tingler RC, Ho K, Scheckter R, McClure T, Davis J, Piper J, Friedland BA, Edick S, Song M, Jiao Y, Hendrix CW, Hoesley C. Acceptability of PC-1005 Gel Administered Rectally to HIV-1 Seronegative Adults at Three Different Volume Levels (MTN-037). AIDS Educ Prev 2022; 34:257-271. [PMID: 35994578 PMCID: PMC9924357 DOI: 10.1521/aeap.2022.34.4.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multipurpose prevention technologies (MPT) have been increasingly researched for their dual-purpose preventative properties against HIV and other STIs. The acceptability of PC-1005, a topical MPT candidate, was explored among men and women participating in the MTN-037 Phase I trial at two U.S. sites (Pittsburgh, PA, and Birmingham, AL). We triangulated quantitative and qualitative assessments of the acceptability of three volumes (4 mL, 16 mL, 32 mL) of PC-1005 administered rectally (N = 12; 6 males, 6 females). Participants rated overall gel acceptability on a scale of 1-10, with a median of 7.17 (SD = 2.04) and had positive feelings about all three dose volumes, citing them to be very comfortable or comfortable (dose 1 = 91.7%; dose 2 = 91.7%; dose 3 = 83.3%). High acceptability of and comfort with all three dose volumes shows promise for PC-1005 as an MPT to prevent HIV and STIs, warranting future clinical development.
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Affiliation(s)
| | | | - Ken Ho
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | - Stacey Edick
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mei Song
- Microbicide Trials Network, Pittsburgh, Pennsylvania
| | - Yuqing Jiao
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Craig W Hendrix
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Craig Hoesley
- University of Alabama at Birmingham, Birmingham, Alabama
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26
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Wood SM, Meanley S, Bonett S, Torres ME, Watson DL, Williams JL, Brady KA, Bauermeister JA. Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia. J Acquir Immune Defic Syndr 2022; 90:S90-S97. [PMID: 35703760 PMCID: PMC9204788 DOI: 10.1097/qai.0000000000002969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Strengthening HIV prevention services is a key priority of the Ending the HIV Epidemic plan. Informed by the Consolidated Framework for Implementation Research, we examined HIV testers' perceived barriers and facilitators to implementing HIV prevention services, including testers' strengths and weaknesses; enabling factors within the inner and outer settings; and willingness to adopt potential implementation strategies. METHODS In 2019, the Penn Center for AIDS Research (CFAR) partnered with the Philadelphia Department of Public Health (PDPH) to examine system-level challenges and opportunities experienced by PDPH-funded HIV testers (individuals conducting HIV testing) in Philadelphia. We recruited HIV testers to complete 2 web surveys (n ≈ 40 each) and in-depth interviews (n = 11). RESULTS Testers self-reported high HIV testing self-efficacy and competence, despite identifying gaps in their knowledge of STI testing, reporting moderate willingness to recommend pre-exposure prophylaxis, and having insufficient cultural competency when working with priority populations. Testers indicated that educational materials and policies within their agencies might require realignment to affirm sexual and gender minority clients. In qualitative interviews, testers noted challenges to implementing PDPH priorities because limited funding fueled competition between local agencies, deterred interagency partnerships, and limited their ability to serve key populations locally. DISCUSSION HIV testers are critical partners in addressing agency-level barriers to HIV prevention service provision through multilevel implementation strategies. In partnership with PDPH, we will create and implement a train-the-trainers program consisting of skill-building activities, technical assistance, and capacity-building for all agency personnel to address missed opportunities in HIV prevention. These activities will reinforce scalability and sustainability of PDPH-supported HIV prevention programs.
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Affiliation(s)
- Sarah M Wood
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Mary E Torres
- Philadelphia Department of Public Health, Philadelphia, PA; and
| | - Dovie L Watson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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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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Biello KB, Valente PK, Lin WY, Lodge Ii W, Drab R, Hightow-Weidman L, da Silva DT, Mayer K, Bauermeister JA. PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men. AIDS Behav 2022; 26:1956-1965. [PMID: 34860304 PMCID: PMC9050851 DOI: 10.1007/s10461-021-03545-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Next generation PrEP formulations may circumvent factors that impede daily oral pre-exposure prophylaxis (PrEP) use among young men who have sex with men (YMSM). We conducted video-based cognitive interviews with 20 YMSM (age 16-24) recruited in the US Northeast to assess participants' attitudes and comprehension of written descriptions of next generation PrEP modalities. Participants were predominately racial/ethnic minorities and half used daily oral PrEP. We identified four main areas for improvement of descriptions: defining scientific terms and balancing medical jargon and casual language; referencing more established products to contextualize PrEP formulations (e.g., hormonal implants); ensuring clarity and reducing redundancy; and including imagery (e.g., rectal douche applicator). The refined descriptions serve as exemplar text that may be used in future studies examining YMSM's preferences across next generation PrEP modalities. Accurate descriptions of next generation PrEP products strengthen measurement accuracy and can help roll-out products that become approved for clinical use.
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Affiliation(s)
- Katie B Biello
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
- Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Pablo K Valente
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Willey Y Lin
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - William Lodge Ii
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel Teixeira da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, USA
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Klein AZ, Meanley S, O'Connor K, Bauermeister JA, Gonzalez-Hernandez G. Toward Using Twitter for PrEP-Related Interventions: An Automated Natural Language Processing Pipeline for Identifying Gay or Bisexual Men in the United States. JMIR Public Health Surveill 2022; 8:e32405. [PMID: 35468092 PMCID: PMC9086871 DOI: 10.2196/32405] [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: 07/26/2021] [Revised: 11/19/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly effective at preventing the acquisition of HIV. There is a substantial gap, however, between the number of people in the United States who have indications for PrEP and the number of them who are prescribed PrEP. Although Twitter content has been analyzed as a source of PrEP-related data (eg, barriers), methods have not been developed to enable the use of Twitter as a platform for implementing PrEP-related interventions. OBJECTIVE Men who have sex with men (MSM) are the population most affected by HIV in the United States. Therefore, the objectives of this study were to (1) develop an automated natural language processing (NLP) pipeline for identifying men in the United States who have reported on Twitter that they are gay, bisexual, or MSM and (2) assess the extent to which they demographically represent MSM in the United States with new HIV diagnoses. METHODS Between September 2020 and January 2021, we used the Twitter Streaming Application Programming Interface (API) to collect more than 3 million tweets containing keywords that men may include in posts reporting that they are gay, bisexual, or MSM. We deployed handwritten, high-precision regular expressions-designed to filter out noise and identify actual self-reports-on the tweets and their user profile metadata. We identified 10,043 unique users geolocated in the United States and drew upon a validated NLP tool to automatically identify their ages. RESULTS By manually distinguishing true- and false-positive self-reports in the tweets or profiles of 1000 (10%) of the 10,043 users identified by our automated pipeline, we established that our pipeline has a precision of 0.85. Among the 8756 users for which a US state-level geolocation was detected, 5096 (58.2%) were in the 10 states with the highest numbers of new HIV diagnoses. Among the 6240 users for which a county-level geolocation was detected, 4252 (68.1%) were in counties or states considered priority jurisdictions by the Ending the HIV Epidemic initiative. Furthermore, the age distribution of the users reflected that of MSM in the United States with new HIV diagnoses. CONCLUSIONS Our automated NLP pipeline can be used to identify MSM in the United States who may be at risk of acquiring HIV, laying the groundwork for using Twitter on a large scale to directly target PrEP-related interventions at this population.
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Affiliation(s)
- Ari Z Klein
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Graciela Gonzalez-Hernandez
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Iott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, Bauermeister JA, Veinot TC. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health 2022; 22:471. [PMID: 35264132 PMCID: PMC8908600 DOI: 10.1186/s12889-022-12761-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stigmatization may prompt gay, bisexual, queer and other men who have sex with men (GBQMSM) to avoid or delay HIV testing. There has been little attention to GBQMSMs’ perspectives about how stigma may influence their decisions about whether, where, and how often to get tested for HIV. Methods We conducted nine focus groups with 64 adult GBQMSM in Metropolitan Detroit, including HIV-negative men and people living with HIV (PLWH). Data were thematically analyzed deductively and inductively in three rounds. Results Three themes emerged regarding whether to get tested: (1) Perceived promiscuity, risk perceptions and HIV testing; (2) Fearing sexual rejection; and (3) Fearing friend and family member distancing and rejection. Themes concerning where to get tested included: (4) Conflating HIV testing and diagnosis; and (5) Seeking privacy and safety at specialized services. As for how often to get tested, themes included: (6) Reducing contact with healthcare providers due to intersectional stigma; (7) Responsibility and regular testing; and (8) HIV stigma and testing as routine care. Black participants articulated themes (3), (4), and (6) with greater frequency than other participants. Framing HIV testing as a personal responsibility may have created a “new stigma,” with unintended consequences not observed with “routine healthcare” messaging. Conclusions GBQMSMs’ perspectives indicate the potential for new foci for HIV testing promotion interventions based on stigma-related issues that they deem important. There is a need for interventions to challenge the “promiscuity” stereotype, and to reduce the sexual stigmatization of GBQMSM living with HIV/AIDS—especially online. Provider stigma requires both intervention and continued availability of specialized services. Future stigma-reduction interventions for Black GBQMSM could focus on building family support/acceptance, awareness of multiple testing options, and integrating LGBTQ-related issues into initiatives for racial justice in health care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12761-5.
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Affiliation(s)
- Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Akilah Benton
- Detroit Health Department, City of Detroit, Detroit, MI, USA
| | - Leon Golson
- Unified - HIV Health and Beyond, Ypsilanti, MI, USA
| | - Erin Kahle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jason Lam
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | | | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, USA. .,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Bonar EE, Goldstick JE, Chapman L, Bauermeister JA, Young SD, McAfee J, Walton MA. A social media intervention for cannabis use among emerging adults: Randomized controlled trial. Drug Alcohol Depend 2022; 232:109345. [PMID: 35144238 PMCID: PMC9549699 DOI: 10.1016/j.drugalcdep.2022.109345] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Cannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform - social media - we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial. PROCEDURES For NCT04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months. RESULTS The intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40). CONCLUSIONS This social media intervention for emerging adults' cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.
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Affiliation(s)
- Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA
| | - Jason E. Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Lyndsay Chapman
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Watson DL, Shaw PA, Petsis DT, Pickel J, Bauermeister JA, Frank I, Wood SM, Gross R. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014-2019. J Int AIDS Soc 2022; 25:e25867. [PMID: 35192740 PMCID: PMC8863354 DOI: 10.1002/jia2.25867] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Youth account for a disproportionate number of new HIV infections; however, pre-exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non-Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. METHODS We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient- and healthcare-level factors. RESULTS Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. CONCLUSIONS PrEP counselling and uptake among U.S. non-Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP-inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Pamela A. Shaw
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Danielle T. Petsis
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julia Pickel
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family & Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ian Frank
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Sarah M. Wood
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Robert Gross
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Resnick D, Schapira MM, Andrews ME, Essoka-Lasenberry A, Davis-Voge A, Bauermeister JA, Wood SM. "I Think That I Have a Good Understanding of How to Protect Myself": A Qualitative Study About HIV Risk Perceptions Among Men and Gender Diverse Individuals Who Have Sex With Men. AIDS Educ Prev 2022; 34:82-S5. [PMID: 35192391 PMCID: PMC8992390 DOI: 10.1521/aeap.2022.34.1.82] [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: 06/14/2023]
Abstract
This qualitative study aimed to determine how men and gender diverse individuals who have sex with men describe their perceived risk of HIV and what factors influence this risk assessment. We conducted in-depth, virtual interviews with 18 HIV-negative individuals from Philadelphia, eligible for or taking PrEP. The interviews assessed the participants' understanding of their HIV risk, using thematic analysis to deductively code and extract themes. Three themes emerged: (1) participants expressed both deliberative and affective risk perception before and after sexual encounters; (2) participants linked HIV knowledge to risk perception and stigma; (3) participants connected intrinsic and extrinsic factors to risk perception differently. Participants endorsed low overall risk perception, while also describing moments of high affective risk perception after sexual encounters in which they were not able to implement their preferred prevention strategies. Future research should explore helping individuals transform affective risk perception into empowerment around sexual health.
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Affiliation(s)
- Daniel Resnick
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
- Department of Medicine, Emory University School of Medicine, Atlanta GA
| | - Marilyn M Schapira
- The Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, Philadelphia PA
| | - Mary E. Andrews
- Annenberg School of Communication, the University of Pennsylvania, Philadelphia PA
| | - Amadi Essoka-Lasenberry
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
| | - Annet Davis-Voge
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia PA
| | - Sarah M Wood
- Craig Dalsimer Division of Adolescent Medicine, Children Hospital of Philadelphia, Philadelphia PA
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Bonar EE, Souweidane MA, Blow FC, Bohnert ASB, Bauermeister JA, Young SD, Walton MA. High-intensity drinking among adolescent and emerging adult risky drinkers. Subst Abus 2022; 43:713-721. [PMID: 35100097 PMCID: PMC9720995 DOI: 10.1080/08897077.2021.2007513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. Results: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation-seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. Conclusions: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Mariam A. Souweidane
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Bauermeister JA, Tingler RC, Johnson S, Macagna N, Lucas J, Dominguez-Islas C, Szydlo D, Ngo J, Jacobson CE, Kramzer L, Singh D, Dezzutti CS, Kunjara Na Ayudhya RP, Piper J, Devlin B, Hendrix CW, Ho K. Acceptability of a Dapivirine Gel Administered Rectally to HIV-1 Seronegative Adults (MTN-033 Study). AIDS Educ Prev 2021; 33:361-376. [PMID: 34596427 PMCID: PMC8637489 DOI: 10.1521/aeap.2021.33.5.361] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We triangulated quantitative and qualitative assessments to evaluate participants' acceptability of 0.05% dapivirine rectal microbicide (RM) gel administered via two separate modalities (a rectal applicator and an artificial phallus for use as a coital simulation device) as part of a Phase I trial (N = 14) among men who have sex with men (MSM) randomized using a 1:1 ratio. Overall, participants reported favorable acceptability of the gel (n = 11; 78.6%), the same or more at the end of the study compared to when they started the study. Additionally, when discussing their preferred administration modality, they noted that both methods had positive qualities but also potential areas of improvement. Our findings underscore the need to create multiple delivery methods for a future microbicide gel (i.e., with and without the need for an applicator) and highlight the importance of offering MSM choices in how biomedical HIV prevention strategies are delivered.
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Affiliation(s)
| | | | | | | | | | - Clara Dominguez-Islas
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington
| | - Daniel Szydlo
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie Ngo
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Devika Singh
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charlene S Dezzutti
- University of Pittsburgh, Pittsburgh, Pennsylvania
- Microbicide Trials Network, Pittsburgh, Pennsylvania
| | | | | | - Bríd Devlin
- International Partnership for Microbicides, Silver Spring, Maryland
| | - Craig W Hendrix
- Microbicide Trials Network, Pittsburgh, Pennsylvania
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ken Ho
- University of Pittsburgh, Pittsburgh, Pennsylvania
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36
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Sang JM, Egan JE, Meanley SP, Hawk ME, Markovic N, Bear TM, Matthews DD, Bauermeister JA. Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships. J Community Psychol 2021; 49:1732-1747. [PMID: 33608960 PMCID: PMC8316259 DOI: 10.1002/jcop.22522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 06/03/2023]
Abstract
We developed measures of relational beliefs and expectations among single young gay and bisexual men (YGBM). Data come from an online cross-sectional study YGBM, which ran from July 2012 until January 2013. There were 50 items on relational beliefs and 25 items on relational expectations. We used random split samples and a priori analysis to group items together and applied principal axis factoring with varimax orthogonal rotation. We had a total N = 1582 in our analytical sample and identified six constructs of relational expectations (restrictions, negative break up, masculine and gender norms, optimism, cheating, immediacy) and two constructs of relational beliefs (sex beliefs, equality). Our findings highlight specific relational cognitions among YGBM and offer insight into the beliefs and expectations that may inform their relationships. Findings may be useful for health professionals to help YGBM reflect and understand the health implications of their beliefs and expectations about same-sex relationships to promote healthy decision-making as they seek future partners.
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Affiliation(s)
- Jordan M. Sang
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven P. Meanley
- School of Nursing, University of Pennsylvania, Pittsburgh, Pennsylvania, USA
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary E. Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nina Markovic
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Dental Medicine, University of Pittsburgh, Philadelphia, Pennsylvania, USA
| | - Todd M. Bear
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derrick D. Matthews
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - José A. Bauermeister
- School of Nursing, University of Pennsylvania, Pittsburgh, Pennsylvania, USA
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bonar EE, Chapman L, McAfee J, Goldstick JE, Bauermeister JA, Carter PM, Young SD, Walton MA. Perceived impacts of the COVID-19 pandemic on cannabis-using emerging adults. Transl Behav Med 2021; 11:1299-1309. [PMID: 33904925 PMCID: PMC8135484 DOI: 10.1093/tbm/ibab025] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18-25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%-50%, across consumption methods) and negative emotions (e.g., loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) increased. They reported decreased in-person socialization (90.8%) and job losses (23.4%). Reports of increased cannabis smoking were associated with increased negative emotions. On an open-response item, employment/finances and social isolation were frequently named negative impacts (33.3% and 29.4%, respectively). Although cannabis-using emerging adults' reports of increases in cannabis use, coupled with mental health symptoms and social isolation, are concerning, the full impact of the pandemic on their health and well-being remains unknown. Future studies examining the relationship between social isolation, mental health, and cannabis use among young people are needed.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Lyndsay Chapman
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sean D Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, USA
- Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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Tapia GR, Glynn TR, Miller C, Manuzak JA, Broedlow CA, Mcgaugh A, Cherenack EM, Bauermeister JA, Grov C, Dilworth SE, Parisi R, Martinez D, Klatt NR, Carrico AW. Syndemics and preexposure prophylaxis are independently associated with rectal immune dysregulation in sexual minority men. AIDS 2021; 35:1295-1300. [PMID: 33710016 PMCID: PMC8603938 DOI: 10.1097/qad.0000000000002866] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Syndemic conditions have been linked to engagement in receptive condomless anal sex (CAS) and HIV seroconversion. However, little is known about the biological pathways whereby syndemics could amplify vulnerability to HIV and other sexually transmitted infections (STIs). DESIGN HIV-negative sexual minority men (i.e. gay, bisexual and other MSM) were recruited from four STI clinics in South Florida for a cross-sectional study. METHODS Participants completed assessments for four syndemic conditions: depression, posttraumatic stress disorder, hazardous alcohol use and any stimulant use (i.e. any self-reported use or reactive urine toxicology results). Cytokine and chemokine levels were measured using LEGENDplex from the rectal swabs of 92 participants reporting receptive CAS and no antibiotic use in the past three months. RESULTS After controlling for age, race/ethnicity, preexposure prophylaxis (PrEP) use and number of receptive CAS partners, a greater number of syndemic conditions was associated with higher levels of rectal cytokines/chemokines relevant to immune activation, inflammation and the expansion and maintenance of T-helper 17 target cells, including rectal interferon-gamma (β = 0.22; P = 0.047), CXCL-8 (β = 0.24; P = 0.025) and interleukin-23 (β = 0.22; P = 0.049). Elevations in rectal cytokine or chemokine levels were most pronounced among participants experiencing two or more syndemic conditions compared with those experiencing no syndemic conditions. PrEP use was independently associated with elevations in multiple rectal cytokines/chemokines. CONCLUSION Syndemic conditions could increase biological vulnerability to HIV and other STIs in sexual minority men by potentiating rectal immune dysregulation.
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Affiliation(s)
- Gregory R Tapia
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Tiffany R Glynn
- University of Miami, College of Arts and Sciences, Department of Psychology, Coral, Gables, Florida
| | - Charlene Miller
- University of Minnesota, School of Medicine, Department of Surgery; Minneapolis, Minnesota
| | - Jennifer A Manuzak
- Tulane National Primate Research Center, Tulane University; Division of Immunology, Covington, Los Angeles
| | - Courtney A Broedlow
- University of Minnesota, School of Medicine, Department of Surgery; Minneapolis, Minnesota
| | - Angela Mcgaugh
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, Florida
| | - Emily M Cherenack
- Duke University, Department of Psychology and Neuroscience, Durham, North Carolina
| | | | - Christian Grov
- City University of New York (CUNY), Graduate School of Public Health and Health, Policy, New York, New York
| | - Samantha E Dilworth
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, Florida
| | - Robert Parisi
- AIDS Healthcare Foundation, Ft. Lauderdale, Florida, USA
| | | | - Nichole R Klatt
- University of Minnesota, School of Medicine, Department of Surgery; Minneapolis, Minnesota
| | - Adam W Carrico
- University of Miami, Miller School of Medicine, Department of Public Health Sciences, Miami, Florida
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Coughlin LN, Bonar EE, Bohnert AS, Blow FC, Bauermeister JA, Cross Y, Cunningham R, Young SD, Walton MA. Patterns of same-day alcohol and cannabis use in adolescents and young adults with risky alcohol use. Addict Res Theory 2021; 30:89-95. [PMID: 36093415 PMCID: PMC9455920 DOI: 10.1080/16066359.2021.1936511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/16/2021] [Accepted: 05/26/2021] [Indexed: 06/14/2023]
Abstract
Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with a multilevel regression analysis in a sample of youth (16-24 years old) with risky alcohol use. Participants reported one or more days of alcohol and cannabis over the past month (N = 468). Quantity of cannabis use was highest on heavy drinking days [M = 0.91 grams, SD = 0.68] followed by moderate drinking days (M = 0.78 grams, SD = 0.63), and lowest on days without alcohol use (M = 0.74 grams, SD = 0.64, p < 0.001). In multilevel modeling analyses, adjusted for clustering within individuals, greater quantity of drinking on a given day was associated with greater cannabis use (estimate = 0.03, p < 0.001). When using alcohol and cannabis on the same day, greater alcohol use was associated with greater cannabis use. Preventing days of heavy use of multiple substances, particularly among at-risk drinkers, may complement interventions addressing co-use generally to prevent substance-related consequences.
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Affiliation(s)
- Lara N. Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Amy S.B Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, North Campus Research Complex, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Yazmyn Cross
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Rebecca Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, USA
- Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
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Muwanguzi PA, Bollinger RC, Ray SC, Nelson LE, Kiwanuka N, Bauermeister JA, Sewankambo NK. Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study. BMC Public Health 2021; 21:1002. [PMID: 34044799 PMCID: PMC8162015 DOI: 10.1186/s12889-021-11041-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, consequently, experience higher HIV-related mortality. Reaching men with HIV testing services is challenging, thus, increasing the need for innovative ways to engage men with low access and those at higher risk. In this study, we explore men's perceptions of drivers and barriers of workplace-based HIV self-testing in Uganda. METHODS An exploratory study involving men working in private security companies employing more than 50 men in two districts, in central and western Uganda. Focus group discussions and key informant interviews were conducted. Data were analyzed using inductive content analysis. RESULTS Forty-eight (48) men from eight private security companies participated in 5 focus group discussions and 17 key informant interviews. Of the 48 men, 14(29.2%) were ages 26-35 years. The majority 31(64.6%) were security guards. The drivers reported for workplace-based HIV self-testing included convenience, autonomy, positive influence from work colleagues, the need for alternative access for HIV testing services, incentives, and involvement of employers. The barriers reported were the prohibitive cost of HIV tests, stigma, lack of testing support, the fear of discrimination and isolation, and concerns around decreased work productivity in the event of a reactive self-test. CONCLUSIONS We recommend the involvement of employers in workplace-based HIV self-testing to encourage participation by employees. There is need for HIV self-testing support both during and after the testing process. Both employers and employees recommend the use of non-monetary incentives, and regular training about HIV self-testing to increase the uptake and acceptability of HIV testing services at the workplace.
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Affiliation(s)
- Patience A Muwanguzi
- School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Robert C Bollinger
- Johns Hopkins University School of Medicine, Phipps 540, 600 N. Wolfe St, Baltimore, MD, 21286, USA
| | - Stuart C Ray
- Johns Hopkins University School of Medicine, 855 N. Wolfe Street room 532, Baltimore, MD, 21205-1517, USA
| | - LaRon E Nelson
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Noah Kiwanuka
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - José A Bauermeister
- School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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41
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Bennett CL, Marks SJ, Rosenberger JG, Bauermeister JA, Clark MA, Liu T, Mayer KH, Merchant RC. Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2021; 19:2325958220919260. [PMID: 32314651 PMCID: PMC7175048 DOI: 10.1177/2325958220919260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Among HIV-uninfected, social media-using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as "unlikely" and 12% as "impossible." Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.
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Affiliation(s)
- Christopher L Bennett
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | | | - Melissa A Clark
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Kenneth H Mayer
- Fenway Health and Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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42
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Bauermeister JA, Bonett S, Rosengren AL, Choi SK, Watson D. Approaches to Promoting Linkage to and Retention in HIV Care in the United States: a Scoping Review. Curr HIV/AIDS Rep 2021; 18:339-350. [PMID: 33954910 DOI: 10.1007/s11904-021-00557-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Linkage to and retention in HIV care, as conceptualized in the HIV care continuum, remain critical steps towards achieving and maintaining viral suppression. We evaluated recently published (Jan 2018-Nov 2020) peer-reviewed clinical trials of linkage to and retention in care outcomes in the United States. RECENT FINDINGS We identified 12 trials evaluating linkage to and retention in care outcomes in the United States. Most trials did not adhere to standardized definitions or metrics for linkage to or retention in HIV care, hindering comparisons between studies. Four interventions indicated improvements on linkage to or retention in HIV care at follow-up, relying on behavioral incentives and/or case management as key intervention strategies. We recommend the adoption standardize metrics across linkage and retention trials, and the future use of implementation science frameworks to identify implementation facilitators and barriers, and evaluate key strategies associated with improvements in linkage to and retention in care.
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Affiliation(s)
- José A Bauermeister
- University of Pennsylvania, 418 Curie Blvd, Room 222L, Philadelphia, PA, 19104, USA.
| | - Stephen Bonett
- University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA
| | - A Lina Rosengren
- University of North Carolina - Chapel Hill, 130 Mason Farm Rd, CB 7215, Chapel Hill, NC, 27599, USA
| | - Seul Ki Choi
- University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA
| | - Dovie Watson
- University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA
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43
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Teixeira da Silva D, Biello K, Lin WY, Valente PK, Mayer KH, Hightow-Weidman L, Bauermeister JA. COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women. Vaccines (Basel) 2021; 9:204. [PMID: 33804530 PMCID: PMC7999863 DOI: 10.3390/vaccines9030204] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. Participants were recruited as part of an online cross-sectional study focused on an HIV biomedical prevention technology willingness in the United States at increased risk for HIV sero-conversion. Multivariate linear analysis was conducted to examine COVID-19 vaccine acceptance. The study sample included 1350 predominately gay (61.6%), Black (57.9%), cis-gender (95.7%) males with a mean age of 32.9 years. Medical mistrust and social concern regarding COVID-19 vaccine stigma were significantly associated with decreased COVID-19 vaccine acceptance, and altruism was significantly associated with increased vaccine acceptance. Black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers. As the planning of COVID-19 vaccine rollout efforts is conceptualized and designed, these data may inform equitable implementation strategies and prevent worsening health inequities among SGM populations.
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Affiliation(s)
- Daniel Teixeira da Silva
- Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Katie Biello
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912, USA; (K.B.); (P.K.V.)
- Fenway Health, Boston, MA 02215, USA;
| | - Willey Y. Lin
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Pablo K. Valente
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912, USA; (K.B.); (P.K.V.)
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA 02215, USA;
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Lisa Hightow-Weidman
- Department of Medicine, School of Medicine, University of North Carolina—Chapel Hill, Chapel Hill, NC 27517, USA;
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;
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44
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Zlotorzynska M, Bauermeister JA, Golinkoff JM, Lin W, Sanchez TH, Hightow-Weidman L. Online recruitment of youth for mHealth studies. Mhealth 2021; 7:27. [PMID: 33898596 PMCID: PMC8063013 DOI: 10.21037/mhealth-20-64] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/12/2020] [Accepted: 06/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Social networking sites and apps have emerged as an opportunity to engage in research young men who have sex with men (YMSM) at risk of HIV infection who may not be otherwise reached by in-person recruitment efforts. This paper highlights lessons learned, best practices and on-going recruitment challenges in the iTech network of the NIH Adolescent Trials Network for HIV Interventions. METHODS Recruitment was conducted for four randomized controlled trials (RCTs) of mHealth HIV prevention interventions for YMSM living in 10 US cities. Advertising was purchased on Facebook, Instagram, Snapchat, Twitter and Grindr. Users who clicked on banner ads were taken directly to a study-specific eligibility screener and if eligible, were asked to provide contact information for follow-up by respective study site staff. Ad and screening metrics (impressions, clicks, cost per click (CPC), click-through rate (CTR), number screened, number eligible, number who provided contact information and cost per eligible contact) were compared across platforms, studies and geographic areas (where available). Screening metrics were also calculated for in-person recruitment efforts. RESULTS Grindr and Snapchat ads produced the highest CTRs as compared to Facebook ads. However, these ads had the lowest proportions of users who initiated eligibility screeners and ultimately Facebook ads yielded the lowest cost per eligible contact across studies. Instagram ads yielded the highest proportions of eligible contacts who were racial/ethnic minorities and under the age of 18. Geographic variability in cost per eligible contact was observed for studies with identical eligibility criteria running concurrently in different regions, driven by both advertising costs and the screening and eligibility rates. Despite lower eligibility rates, the total numbers of eligible contacts were higher for online advertising campaigns, as compared to other recruitment efforts, for all studies except P3. Ads recruiting for P3 had the highest cost per eligible contact, likely due to this study having the most stringent eligibility criteria of the studies described. CONCLUSIONS We implemented a successful online advertising strategy to recruit YMSM at high risk for HIV infection into four RCTs of mHealth interventions. This report provides a framework for evaluation of data from future online recruitment efforts across platforms and geographic areas, regardless of inevitable changes in the digital marketing space.
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Affiliation(s)
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Willey Lin
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, USA
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45
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Meanley S, Chandler C, Jaiswal J, Flores DD, Stevens R, Connochie D, Bauermeister JA. Are Sexual Minority Stressors Associated with Young Men who Have Sex with Men's (YMSM) Level of Engagement in PrEP? Behav Med 2021; 47:225-235. [PMID: 32401184 PMCID: PMC7774673 DOI: 10.1080/08964289.2020.1731675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority stress. Adjusted for covariates, we developed two partial-proportional odds models examining the associations between PrEP continuum progression and minority stressors, as a composite, and community homophobia, sexuality-related discrimination, and internalized homonegativity, respectively. Our multivariable model demonstrated minority stress levels to be negatively associated with PrEP continuum location (AOR = 0.76, 95% CI: 0.58-0.99). Broken down, discrimination was positively associated with reporting being at an advanced location along the continuum (AOR = 1.39, 95% CI: 1.06-1.82). Internalized homonegativity was negatively associated with continuum location between PrEP-aware participants with no intention to initiate and participants who intended to initiate PrEP (AOR = 0.45, 95% CI: 0.27-0.77) and between those who intended to initiate and those who had ever used PrEP (AOR = 0.39, 95% CI: 0.22-0.69). Our findings suggest that minority stress, especially internalized homonegativity, remains a barrier to PrEP among PrEP-indicated YMSM. Sexuality-related discrimination was associated with PrEP continuum progression, suggesting potentially well-developed, adaptive coping skills (e.g., ability to locate sexuality-affirming providers). Coupled with stigma reduction efforts, HIV prevention services aiming to promote PrEP should incorporate internalized homonegativity screenings and referrals into sexuality-affirming resources for PrEP-indicated YMSM.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing,Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Cristian Chandler
- Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Jessica Jaiswal
- Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS,Department of Health Sciences, University of Alabama
| | - Dalmacio D. Flores
- Department of Family and Community Health, University of Pennsylvania School of Nursing,Research Education Institute for Diverse Scholars, Yale University School of Public Health Center for Interdisciplinary Research on AIDS
| | - Robin Stevens
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Daniel Connochie
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing
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46
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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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Siegler AJ, Knox J, Bauermeister JA, Golinkoff J, Hightow-Weidman L, Scott H. Mobile app development in health research: pitfalls and solutions. Mhealth 2021; 7:32. [PMID: 33898601 PMCID: PMC8063010 DOI: 10.21037/mhealth-19-263] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/31/2019] [Accepted: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Mobile app health research presents myriad opportunities to improve health, and simultaneously introduces a new set of challenges that are non-intuitive and extend beyond typical training received by researchers. Informed by our experiences with app development for health research, we discuss some of the most salient pitfalls when working with emerging technology as well as potential strategies to avoid or resolve these challenges. To address challenges at the project level, we suggest strategies that researchers can use to future-proof their research, such as using theory and involving those with app development expertise as part of a research team. At the structural level, we include a new model to characterize the relationship between technology- and research-timelines, and provide ideas regarding how to best address this challenge. Given that screen-based time now predominates our lived experiences, it is important that health researchers have the capacity and structural support to develop interventions that utilize these technologies, assess them rigorously, and ensure their timely and equitable dissemination.
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Affiliation(s)
- Aaron J. Siegler
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Justin Knox
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - José A. Bauermeister
- Department of Family & Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Golinkoff
- Department of Family & Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
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Abstract
PURPOSE OF REVIEW Advances in short- and long-acting pre-exposure prophylaxis (PrEP) technologies have incentivized the need to understand how individuals make trade-offs and competing decisions regarding PrEP modalities. The purpose of this review was to examine how researchers have conceptualized and measured attributes that are either intuitive and emotional (System 1) or deliberative and cognitive (System 2) in conjoint analysis or discrete choice experiments focused on diverse PrEP technologies among men who have sex with men (MSM). RECENT FINDINGS Across the 9 studies meeting inclusion criteria, 5 included oral PrEP, 3 included topical rectal microbicides, 4 included PrEP injectables, and 1 study focused on an HIV prevention vaccine. Studies have not used uniform metrics, making comparisons difficult. Researchers measured attributes linked to System 2 processing (e.g., cost, efficacy), yet none examined System 1 processing. There is not one product or attribute preferable to all groups. Prevention products will need to be developed and promoted to reflect that diversity. Given that PrEP technologies have been solely informed by System 2 attributes, efforts to integrate System 1 attributes into ongoing and future PrEP choice experiments are pivotal to advance PrEP acceptability research and interventions to support their implementation.
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Affiliation(s)
- José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Room 222L, Philadelphia, PA, 19104, USA.
| | - Julie S Downs
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Bien-Gund CH, Zhao P, Cao B, Tang W, Ong JJ, Baral SD, Bauermeister JA, Yang LG, Luo Z, Tucker JD. Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review. Sex Health 2020; 16:320-331. [PMID: 31213225 DOI: 10.1071/sh18191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.
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Affiliation(s)
- Cedric H Bien-Gund
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Peipei Zhao
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, 3688 Nanhai Avenue, Shenzhen 518060, China
| | - Weiming Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, 418 Curie Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li-Gang Yang
- Guangdong Provincial STD Control Center, No. 2 Lujing Road, Guangzhou 510095, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599, USA; and Corresponding author.
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50
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Sirdenis TK, Harper GW, Carrillo MD, Jadwin-Cakmak L, Loveluck J, Pingel ES, Benton A, Peterson A, Pollard R, Bauermeister JA. Toward Sexual Health Equity for Gay, Bisexual, and Transgender Youth: An Intergenerational, Collaborative, Multisector Partnerships Approach to Structural Change. Health Educ Behav 2020; 46:88S-99S. [PMID: 31549560 DOI: 10.1177/1090198119853607] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022]
Abstract
Background. Gay, bisexual, and transgender youth (GBTY) experience sexual health inequities and contend with intersectional oppression. The Michigan Forward in Enhancing Research and Community Equity (MFierce) Coalition formed as an intergenerational, collaborative, multisector partnership with a focus on implementing community-identified policy, systems, and environmental (PSE) change strategies to address inequities and injustices. Aims. We describe MFierce coalition development and structural change activities organized within Collaborating for Equity and Justice (CEJ) principles and provide empirical data supporting the utility of such principles. Method. We prioritized leadership by GBTY and created personal and professional capacity-building activities to support GBTY in being change agents. Our work was grounded in community-engaged scholarship and used a shared-power community development process. Our PSE change intervention, the Health Access Initiative (HAI), was a structural change program for health facilities aimed at improving the quality of and access to sexual health care for GBTY. Results. We evaluated coalition functioning and activities through multimethod assessments and evaluated PSE changes through HAI participant surveys. Data demonstrated positive and steady coalition dynamics, multiple benefits of participation for GBTY, and strategies for collaborative multigenerational community work. HAI outcome data revealed significant increases in PSE changes. Discussion. Centering life experiences of GBTY in collaborative partnerships and building opportunities for professional and personal development can support sustainable community change. We offer recommendations for developing future intergenerational, collaborative, multisector partnerships that prioritize youth leadership. Conclusion. Collaborative methods and careful consideration of adult-youth dynamics can inform future transformative efforts focused on health equity and justice for GBTY.
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Affiliation(s)
| | | | | | | | | | | | | | - Amy Peterson
- Michigan Department of Health and Human Services, Lansing, MI, USA
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