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Huang JL, Xin X, Ma MJ, Ning Z, Xiao ST, Chen PP. A qualitative study on the clinical safety and user experiences of female condoms for anal intercourse among men who have sex with men in Shanghai, China. Front Public Health 2023; 11:1243891. [PMID: 38074717 PMCID: PMC10701689 DOI: 10.3389/fpubh.2023.1243891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
Objective This qualitative study aimed to understand the clinical safety, efficacy, and receptiveness of using the female condom (FC) during anal intercourse among men who have sex with men (MSM). Methods Subjects for this study were recruited from a two-group crossover trial among MSM in Shanghai. The trial consisted of two phases, each including the use of condoms (FC vs. male condom), questionnaires, and in-depth one-on-one interviews. The two phases were separated by a washout period of 4 weeks. The minimum sample size for this study was determined in accordance with the principle of "information saturation." The qualitative data were organized and analyzed using ATLAS.ti version 7. Results A total of 26 participants from the MSM population were recruited for this study, with 10 assuming the insertive role (i.e., "1"), 8 assuming the receptive role (i.e., "0"), and 8 being versatile (i.e., "0.5"). Each participant completed the crossover trial comprising two phases. The cumulative usage of FCs and male condoms (MCs) amounted to 115 and 127 times, respectively. During the reported sexual encounters, no participants reported incidents of condom rupture, slippage, or other malfunctions. A few participants reported experiencing slight chafing pain, primarily put forward by "0" participants. Apart from those reports, no instances of bleeding, swelling, or allergic reactions were reported. The efficiency of FC in disease prevention, the sexual partner's willingness to use FC, the freshness of FC, and positive sexual experiences were the main reasons for the consistent use of FC for anal sex. Discomfort and pain during sexual activity, the loose design and thick material of FCs, and difficulties in placing FCs were the major obstacles to FC use among MSM. The elements referring to the forehead exhibited varied in importance among "1,", "0," and "0.5" participants. Regarding the willingness to use the FC in the future anal intercourse, 61.54% of participants expressed a positive inclination, 23.08% were uncertain, and 15.38% stated that they would not. "A better sense of security during anal sex" was the main factor affecting willingness among "0" participants and "the sexual pleasure that the FC brought" among "1" participants. Improving the design and technology of FCs and increasing the frequency of use and practice might improve the use skills, which will favor the willingness to use FCs among the MSM population. Conclusion FCs received positive user feedback from study participants, but distinctions were found in individuals in different sexual roles. Large-scale quantitative studies are needed to evaluate the clinical safety of the FC and its effectiveness in preventing the transmission of STDs during anal intercourse.
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Affiliation(s)
- Jia-Lu Huang
- School of Public Health, Dali University, Dali, China
| | - Xin Xin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Ming-Jun Ma
- School of Public Health, Dali University, Dali, China
| | - Zhen Ning
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shao-tan Xiao
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Pan-pan Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
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Malekinejad M, Jimsheleishvili S, Barker EK, Hutchinson AB, Shrestha RK, Volberding P, Kahn JG. Sexual Practice Changes Post-HIV Diagnosis Among Men Who Have Sex with Men in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:257-278. [PMID: 35829969 PMCID: PMC9834435 DOI: 10.1007/s10461-022-03761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Men who have sex with men (MSM) often change sexual behaviors following HIV diagnosis. This systematic review examined such changes, including sero-adaptive behaviors (i.e., deliberate safer-sex practices to reduce transmission risk) to better understand the magnitude of their association with HIV diagnosis. We searched four databases (1996-2017) and reviewed references from other systematic reviews. We included studies conducted in the United States that compared sexual behavior among HIV-infected "aware" versus "unaware" MSM. We meta-analytically pooled RRs and associated 95% confidence intervals (CI) using random-effects models, and assessed risk of bias and evidence quality. Twenty studies reported k = 131 effect sizes on sexual practices outcomes, most of which reported changes in unprotected sex (k = 85), and on sex with at-risk partners (k = 76); 11 reported sero-adaptive behaviors. Unprotected anal intercourse with an HIV-uninfected/unknown-status partner was less likely among aware MSM (insertive position: k = 2, RR 0.26, 95% CI 0.17, 0.41; receptive position: k = 2, RR 0.53, 95% CI 0.37, 0.77). Risk of not always serosorting among aware MSM (k = 3) was RR = 0.92 (0.83, 1.02). Existing evidence, although low-quality, suggests that HIV-infected MSM tend to adopt safer sexual practices once aware of their diagnosis. Variation in reporting of outcomes limits their comparability. Sero-adaptive behavior data are sparse.
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Affiliation(s)
- Mohsen Malekinejad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA ,550 16th Street, San Francisco, CA 94158 USA
| | - Sopiko Jimsheleishvili
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - Erin K. Barker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ram K. Shrestha
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Paul Volberding
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA
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Dirisu O, Adediran M, Omole A, Akinola A, Ebenso B, Shoyemi E, Eluwa G, Tun W, Adebajo S. The Syndemic of Substance Use, High-Risk Sexual Behavior, and Violence: A Qualitative Exploration of the Intersections and Implications for HIV/STI Prevention Among Key Populations in Lagos, Nigeria. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.822566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundKey populations (KP) are defined groups with an increased risk of HIV due to specific higher risk behaviours. KP who use substances engage in risky behaviors that may play a co-active role in HIV transmission and acquisition in Nigeria. This qualitative study explored the 'syndemics' of substance use, sexual risk behavior, violence and HIV infection among KP who use substances.MethodsNineteen sexually active men who have sex with men [MSM] and 18 female sex workers [FSW] aged 16 years and older who use substances were purposively selected to participate in sixteen in-depth interviews and two focus groups. We utilized a syndemic framework to explore the interaction of socio-economic factors, substance use and high-risk sexual practices. The interviews were audio-recorded, transcribed, organized in NVIVO 11 and analyzed using thematic analysis.ResultsMajority (95%) were non-injection substance users (primarily alcohol and marijuana); a few KP also used cocaine and heroin. Sixty percent of participants were between 16-24 years. Substance use utilities and trajectories were heavily influenced by KP social networks. They used substances as a coping strategy for both physical and emotional issues as well as to enhance sex work and sexual activities. Key HIV/STI risk drivers in the settings of substance use during sexual intercourse that emerged from this study include multiple sexual partnerships, condom-less sex, transactional sex, intergenerational sex, double penetration, rimming, and sexual violence. Poverty and adverse socio-economic conditions were identified as drivers of high-risk sexual practices as higher sexual risks attracted higher financial rewards.Conclusions and RecommendationsFindings indicate that KP were more inclined to engage in high-risk sexual practices after the use of substances, potentially increasing HIV risk. The syndemic of substance use, high-risk sexual behavior, adverse socio-economic situations, and violence intersect to limit HIV prevention efforts among KP. The behavioural disinhibition effects of substances as well as social and structural drivers should be considered in the design of targeted KP HIV prevention programs. HIV intervention programs in Nigeria may yield better outcomes if they address the nexus of sexual risk behavior and substance use as well as knowledge and appropriate use of HIV prophylaxis.
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Anker B, Jaffar S, Patani H, Bristow CC, Sukhija-Cohen AC. Clinical Factors Associated With Accurate Presumptive Treatment of Neisseria gonorrhoeae Infections in Men Who Have Sex with Men and Transgender Women. Clin Infect Dis 2021; 73:e3156-e3162. [PMID: 33625487 PMCID: PMC8563201 DOI: 10.1093/cid/ciaa1828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Neisseria gonorrhoeae (N. gonorrhoeae) infections have increased among men who have sex with men and are high among transgender women. Presumptive treatment guidelines may lead to inaccurate treatments and possible antibiotic resistance. Using patient data from AIDS Healthcare Foundation sexually transmitted infection (STI) testing clinics in California and Florida, we identified clinical factors associated with accurate presumptive N. gonorrhoeae treatment. Methods Multivariable logistic regression analyses were conducted using patient visit data from 2013 to 2017. A sample of 42 050 patient encounters were analyzed. The primary outcome variable included accurate versus inaccurate presumptive treatment. Risk ratios were generated for particular symptoms, high-risk sexual behavior, and history of N. gonorrhoeae. Results Twelve percent (5051/42 050) of patients received presumptive N. gonorrhoeae treatment, and 46% (2329/5051) of presumptively treated patients tested positive for N. gonorrhoeae infection. Patients presenting with discharge or patients presenting with dysuria were more likely to receive accurate presumptive treatment. Conclusions Providers should continue to follow the Centers for Disease Control and Prevention guidelines and consider presumptive N. gonorrhoeae treatment based on specific symptoms. As the STI epidemic continues to rise in the United States, along with increased antibiotic resistance, it is imperative to accurately test, diagnose, and treat populations at risk for N. gonorrhoeae and other STIs.
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Affiliation(s)
- Bryan Anker
- University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA
| | - Samia Jaffar
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Henna Patani
- AIDS Healthcare Foundation, Public Health Division, Los Angeles, California, USA
| | | | - Adam C Sukhija-Cohen
- AIDS Healthcare Foundation, Public Health Division, Los Angeles, California, USA
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Egan JE, Corey SL, Henderson ER, Abebe KZ, Louth-Marquez W, Espelage D, Hunter SC, DeLucas M, Miller E, Morrill BA, Hieftje K, Sang JM, Friedman MS, Coulter RWS. Feasibility of a Web-Accessible Game-Based Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Results From a Randomized Controlled Trial. J Adolesc Health 2021; 69:604-614. [PMID: 34140199 PMCID: PMC8494066 DOI: 10.1016/j.jadohealth.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/15/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being. METHODS We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability. RESULTS We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08). CONCLUSIONS We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.
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Affiliation(s)
- James E Egan
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Stephanie L Corey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emmett R Henderson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Louth-Marquez
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy Espelage
- School of Education, University of North Carolina, Chapel Hill, North Carolina
| | - Simon C Hunter
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jordan M Sang
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S Friedman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Freedman MS, Beer L, Mattson CL, Sullivan PS, Skarbinski J. Behavioral and Clinical Characteristics of Self-Identified Bisexual Men Living with HIV Receiving Medical Care in the United States-Medical Monitoring Project, 2009-2013. JOURNAL OF HOMOSEXUALITY 2021; 68:1223-1241. [PMID: 31173564 DOI: 10.1080/00918369.2019.1621553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nationally representative data comparing demographic, risk, and clinical information among bisexual men with other MSM or heterosexuals are lacking. We described differences in demographic characteristics, behaviors, and clinical outcomes among self-identified HIV-positive bisexual, gay, and heterosexual men receiving HIV medical care in the United States. We analyzed data from the 2009-2013 cycles of the Medical Monitoring Project (MMP), a surveillance system that provides nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in medical care. Altogether, 10% (95% confidence interval [CI] 9-11) of men self-identified as bisexual, 56% (CI 51-61) as gay, and 32% (CI 28-37) as heterosexual. We observed significant differences in demographic factors, clinical outcomes, drug use, and sexual behavior among bisexual men compared with gay and heterosexual men. Providers should consider sexual identities as well as sexual behaviors when developing and implementing prevention programs.
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Affiliation(s)
- Mark S Freedman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Beer
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine L Mattson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jacek Skarbinski
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Malekinejad M, Blodgett J, Horvath H, Parriott A, Hutchinson AB, Shrestha RK, McCabe D, Volberding P, Kahn JG. Change in Condom Use in Populations Newly Aware of HIV Diagnosis in the United States and Canada: A Systematic Review and Meta-Analysis. AIDS Behav 2021; 25:1839-1855. [PMID: 33389321 DOI: 10.1007/s10461-020-03113-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
HIV-infected individuals "aware" of their infection are more likely to use condoms, compared to HIV-infected "unaware" persons. To quantify this likelihood, we undertook a systematic review and meta-analysis of U.S. and Canadian studies. Twenty-one eligible studies included men who have sex with men (MSM; k = 15), persons who inject drugs (PWID; k = 2), and mixed populations of high-risk heterosexuals (HRH; k = 4). Risk ratios (RR) of "not always using condoms" with partners of any serostatus were lower among aware MSM (RR 0.44 [not significant]), PWID (RR 0.70) and HRH (RR 0.27); and, in aware MSM, with partners of HIV-uninfected or unknown status (RR 0.46). Aware individuals had lower "condomless sex likelihood" with HIV-uninfected or unknown status partners (MSM: RR 0.58; male PWID: RR 0.44; female PWID: RR 0.65; HRH: RR 0.35) and with partners of any serostatus (MSM only, RR 0.72). The association diminished over time. High risk of bias compromised evidence quality.
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Salazar-Vizcaya L, Kusejko K, Schmidt AJ, Carrillo-Montoya G, Nicca D, Wandeler G, Braun DL, Fehr J, Darling KEA, Bernasconi E, Schmid P, Günthard HF, Kouyos RD, Rauch A. Clusters of Sexual Behavior in Human Immunodeficiency Virus-positive Men Who Have Sex With Men Reveal Highly Dissimilar Time Trends. Clin Infect Dis 2021; 70:416-424. [PMID: 30874293 DOI: 10.1093/cid/ciz208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Separately addressing specific groups of people who share patterns of behavioral change might increase the impact of behavioral interventions to prevent transmission of sexually transmitted infections. We propose a method based on machine learning to assist the identification of such groups among men who have sex with men (MSM). METHODS By means of unsupervised learning, we inferred "behavioral clusters" based on the recognition of similarities and differences in longitudinal patterns of condomless anal intercourse with nonsteady partners (nsCAI) in the HIV Cohort Study over the last 18 years. We then used supervised learning to investigate whether sociodemographic variables could predict cluster membership. RESULTS We identified 4 behavioral clusters. The largest behavioral cluster (cluster 1) contained 53% of the study population and displayed the most stable behavior. Cluster 3 (17% of the study population) displayed consistently increasing nsCAI. Sociodemographic variables were predictive for both of these clusters. The other 2 clusters displayed more drastic changes: nsCAI frequency in cluster 2 (20% of the study population) was initially similar to that in cluster 3 but accelerated in 2010. Cluster 4 (10% of the study population) had significantly lower estimates of nsCAI than all other clusters until 2017, when it increased drastically, reaching 85% by the end of the study period. CONCLUSIONS We identified highly dissimilar behavioral patterns across behavioral clusters, including drastic, atypical changes. The patterns suggest that the overall increase in the frequency of nsCAI is largely attributable to 2 clusters, accounting for a third of the population.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Axel J Schmidt
- Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland.,Sigma Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Dunja Nicca
- Institute of Nursing Science, University of Basel, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Katharine E A Darling
- Infectious Diseases Service, Department of Medicine, University Hospital of Lausanne (CHUV), Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Lugano Regional Hospital, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Infection Control, Cantonal Hospital St. Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern, Switzerland
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Kelvin E, Patel V, Mirzayi C, Anastos K, Grov C. Lifetime prevalence and correlates of female condom use for anal sex in a geographically diverse sample of Men who have sex with men (MSM) in the United States. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 32:331-341. [PMID: 34141047 PMCID: PMC8205508 DOI: 10.1080/19317611.2020.1813860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Examine use of the female condom (FC) for anal sex among Men who have sex with men (MSM) in the United States (US). METHODS An online survey among 3,837 MSM. RESULTS 5.2% had used the FC for anal sex. Use was higher among those who had used the FC for vaginal sex (OR=14.39, p<0.001), those with multiple partners, (OR=2.68, p=0.004), and those who were HIV-positive (OR=2.07, p<0.001) or on PrEP (OR=2.66, p<0.001). CONCLUSIONS FC use for anal sex was associated with risk of HIV infection/transmission and may be a risk reduction strategy used by MSM in the US.
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Affiliation(s)
- Elizabeth Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
| | - Viraj Patel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York USA
| | - Chloe Mirzayi
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
- Department of Community Health and Social Science, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York USA
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10
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Trajectories of and disparities in HIV prevalence among Black, white, and Hispanic/Latino men who have sex with men in 86 large U.S. metropolitan statistical areas, 1992-2013. Ann Epidemiol 2020; 54:52-63. [PMID: 32950653 DOI: 10.1016/j.annepidem.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas. METHODS This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States. RESULTS Our estimates indicate that HIV prevalence among MSM increased, from an across-metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions. CONCLUSIONS The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.
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11
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Thoma BC, Huebner DM. Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior. Ann Behav Med 2019; 52:973-987. [PMID: 30346501 DOI: 10.1093/abm/kay002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM. Purpose The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM. Method YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling. Results Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior. Conclusions Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.
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Affiliation(s)
- Brian C Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David M Huebner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
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12
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Maitino EM, Shafir SC, Beymer MR, Shover CL, Cunningham NJ, Flynn RP, Bolan RK. Age at first HIV test for MSM at a community health clinic in Los Angeles. AIDS Care 2019; 32:186-192. [PMID: 31663365 DOI: 10.1080/09540121.2019.1683806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.
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Affiliation(s)
- Emily M Maitino
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Matt R Beymer
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Los Angles LBGT Center, Los Angeles, CA, USA
| | - Chelsea L Shover
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nicole J Cunningham
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Risa P Flynn
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert K Bolan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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13
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Fairchild AL, Bayer R, Green SH, Colgrove J, Kilgore E, Sweeney M, Varma JK. The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS. Am J Public Health 2019; 108:1180-1186. [PMID: 30088996 DOI: 10.2105/ajph.2018.304516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fear is now commonly used in public health campaigns, yet for years ethical and efficacy-centered concerns provided a challenge to using fear in such efforts. From the 1950s through the 1970s, the field of public health believed that using fear to influence individual behavior would virtually always backfire. Yet faced with the limited effectiveness of informational approaches to cessation, antitobacco campaigns featured fear in the 1960s. These provoked little protest outside the tobacco industry. At the outset of the AIDS epidemic, fear was also employed. However, activists denounced these messages as stigmatizing, halting use of fear for HIV/AIDS until the 21st century. Opposition began to fracture with growing concerns about complacency and the risks of HIV transmission, particularly among gay men. With AIDS, fear overcame opposition only when it was framed as fair warning with the potential to correct misperceptions.
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Affiliation(s)
- Amy Lauren Fairchild
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Ronald Bayer
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Sharon H Green
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - James Colgrove
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Elizabeth Kilgore
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Monica Sweeney
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Jay K Varma
- Amy Lauren Fairchild is with the Department of Health Policy and Management, Texas A&M School of Public Health, College Station. Ronald Bayer, Sharon H. Green, and James Colgrove are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of study, Elizabeth Kilgore, Monica Sweeney, and Jay K. Varma were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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14
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Kubicek K, Beyer WJ, Wong CF, Kipke MD. Engaging Young Men in the HIV Prevention and Care Continua: Experiences From Young Men of Color Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:325-343. [PMID: 31361519 DOI: 10.1521/aeap.2019.31.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual minority individuals experience barriers to receiving equitable health care. Research also indicates that young men who have sex with men (YMSM), particularly young men of color, have limited engagement in the HIV care continuum and there are significant disparities across the continuum. This study aims to uncover how providers can engage YMSM of color in all forms of care, including primary care and HIV prevention through an HIV prevention continuum. This qualitative study reports data from the Healthy Young Men's Cohort Study; a total of 49 YMSM participated in the eight focus groups. This study provides a description of YMSM's overall health concerns, experiences with health care, and under what circumstances YMSM seek care. We then present a model describing the salient characteristics of a HIV prevention continuum for YMSM of color and provide clear areas for education, intervention, and policy change to support better overall health for YMSM of color.
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Affiliation(s)
| | | | | | - Michele D Kipke
- Community, Health Outcomes, and Intervention Research Program, Children's Hospital Los Angeles
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15
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Parmenter JG, Crowell KA, Galliher RV. Subjective Importance of Masculinity as a Factor in Understanding Risky Sexual Attitudes and Behaviors among Sexual Minority Men. SEX ROLES 2019. [DOI: 10.1007/s11199-019-01067-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Stahlman S, Lyons C, Sullivan PS, Mayer KH, Hosein S, Beyrer C, Baral SD. HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading? Sex Health 2019; 14:5-17. [PMID: 27491699 DOI: 10.1071/sh16070] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
Abstract
The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.
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Affiliation(s)
- Shauna Stahlman
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Carrie Lyons
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Kenneth H Mayer
- Fenway Health, The Fenway Institute, 1340 Boylston Street, 8th floor, Boston, MA 02215, USA
| | - Sean Hosein
- CATIE (Canada's AIDS Treatment Information Exchange), 555 Richmond Street West, Suite 505, Box 1104, Toronto, ON M5V 3B1, Canada
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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17
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Díaz YMS, Orlando-Narváez SA, Ballester-Arnal R. Risk behaviors for HIV infection. A review of emerging trends. CIENCIA & SAUDE COLETIVA 2019; 24:1417-1426. [PMID: 31066843 DOI: 10.1590/1413-81232018244.02322017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/29/2017] [Indexed: 11/22/2022] Open
Abstract
HIV infection, acquired with the conscious participation of the recipient, is a complex problem of international concern, especially among men who have sex with men. Behaviors emerge such as bareback (intentionally unprotected anal sex between men) and bugchasing (bareback sex when one participant is HIV+ and the other is not). A group of emerging risk behaviors for HIV infection was characterized. A review of the literature in the MEDLINE, Web of Science and regional SciELO databases was performed. HIV-related search terms such as unprotected sex, barebacking/bareback and bug chasing, were used. Bareback and bug chaser behaviors occur, among other factors, through social homonegativity, ART positive coverage, insufficient prevention campaigns, search for new sensations and attempts to strengthen the relationship with the HIV+ member. Unprotected sex is primarily associated with having HIV/AIDS diagnoses, physical violence due to sexual orientation, viewing homosexual sex sites, and having bought or sold sex. It is necessary to work with individual behaviors that draw individuals close to infection.
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18
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Coulter RW, Sang JM, Louth-Marquez W, Henderson ER, Espelage D, Hunter SC, DeLucas M, Abebe KZ, Miller E, Morrill BA, Hieftje K, Friedman MS, Egan JE. Pilot Testing the Feasibility of a Game Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12164. [PMID: 30767903 PMCID: PMC6416896 DOI: 10.2196/12164] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023] Open
Abstract
Background Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (nontransgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via a Web-accessible game intervention. Nevertheless, little research has examined the feasibility of using a Web-accessible game intervention with SGMY. Objective This study aimed to describe the protocol for a randomized controlled trial (RCT) pilot, testing the feasibility and limited efficacy of a game-based intervention for increasing help-seeking–related knowledge, intentions, self-efficacy, behaviors, productive coping skills use, and coping flexibility and reducing health risk factors and behaviors among SGMY. Methods We enrolled 240 SGMY aged 14 to 18 years residing in the United States into a 2-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with 3 primary components: encouraging help-seeking behaviors, encouraging use of productive coping, and raising awareness of Web-based resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources, covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted via the internet. We conveniently sampled SGMY using Web-based advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of Web-based resources. Tertiary outcomes include bullying and cyberbullying victimization, loneliness, mental health issues, substance use, and internalized sexual and gender minority stigma. Results From April to July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition and half (n=120) into the control condition. At baseline, 52.1% (125/240) of the participants identified as gay or lesbian, 26.7% (64/240) as bisexual, 24.2% (58/240) as queer, and 11.7% (28/240) as another nonheterosexual identity. Nearly half (113/240) of participants were a gender minority: 36.7% (88/240) were cisgender boys, and 16.3% (39/240) were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants. Conclusions Web-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited efficacy that can inform future Web-based studies and a larger RCT aimed at improving health equity for SGMY. Trial Registration ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW) International Registered Report Identifier (IRRID) DERR1-10.2196/12164
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Affiliation(s)
| | - Jordan M Sang
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Dorothy Espelage
- College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Simon C Hunter
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | | | | | | | | | | | - James E Egan
- University of Pittsburgh, Pittsburgh, PA, United States
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19
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Murrill CS, Bingham T, Lauby J, Liu KL, Wheeler D, Carballo-Diéguez A, Marks G, Millett GA. Respondent-Driven Sampling in a Multi-Site Study of Black and Latino Men Who Have Sex with Men. J Natl Med Assoc 2018; 108:69-76. [PMID: 26928490 DOI: 10.1016/j.jnma.2015.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Respondent-driven sampling (RDS) was used to recruit four samples of Black and Latino men who have sex with men (MSM) in three metropolitan areas to measure HIV prevalence and sexual and drug use behaviors. We compared demographic and behavioral risk characteristics of participants across sites, assessed the extent to which the RDS statistical adjustment procedure provides estimates that differ from the crude results, and summarized our experiences using RDS. METHODS From June 2005 to March 2006 a total of 2,235 MSM were recruited and interviewed: 614 Black MSM and 516 Latino MSM in New York City, 540 Black MSM in Philadelphia, and 565 Latino MSM in Los Angeles County. Crude point estimates for demographic characteristics, behavioral risk factors and HIV prevalence were calculated for each of the four samples. RDS Analysis Tool was used to obtain population-based estimates of each sampled population's characteristics. RESULTS RDS adjusted estimates were similar to the crude estimates for each study sample on demographic characteristics such as age, income, education and employment status. Adjusted estimates of the prevalence of risk behaviors were lower than the crude estimates, and for three of the study samples, the adjusted HIV prevalence estimates were lower than the crude estimates. However, even the adjusted HIV prevalence estimates were higher than what has been previously estimated for these groups of MSM in these cities. Each site faced unique circumstances in implementing RDS. CONCLUSIONS Our experience in using RDS among Black and Latino MSM resulted in diverse recruitment patterns and uncertainties in the estimated HIV prevalence and risk behaviors by study site.
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Affiliation(s)
| | - Trista Bingham
- Division of HIV and STD Programs, Los Angeles County Department of Public Health
| | | | | | | | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University
| | - Gary Marks
- Centers for Disease Control and Prevention
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20
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Hirschtritt ME, Dauria EF, Marshall BDL, Tolou-Shams M. Sexual Minority, Justice-Involved Youth: A Hidden Population in Need of Integrated Mental Health, Substance Use, and Sexual Health Services. J Adolesc Health 2018; 63:421-428. [PMID: 30077548 PMCID: PMC6642258 DOI: 10.1016/j.jadohealth.2018.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE We sought to compare the demographic characteristics, drug and alcohol use, sexual behaviors, delinquency, and mental health indicators of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents. METHODS Using adolescent- and caregiver-reported baseline data from the Epidemiologic Study Involving Children in the Court, a prospective cohort study of 423 adolescent-caregiver dyads recruited from a Northeastern family court system, we compared demographic and behavioral health characteristics of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents. RESULTS Nearly one-third of the adolescents (31.4%, n = 133) were classified as a sexual minority; 19.6% (n = 81) self-identified with a nonheterosexual sexual orientation. Sexual minority adolescents were more likely than their nonsexual minority peers to identify as female, to have used psychiatric services or psychotropic medications, to have used an illicit drug or alcohol or to know peers who use these substances, to report alcohol/drug use during sex, to endorse more severe mental health problems, to have more recent post-traumatic symptoms, and to have engaged in self-harm behaviors. However, sexual minority adolescents did not differ from nonsexual minority adolescents in other demographic characteristics (including school performance) or delinquent behavior. CONCLUSIONS One-third of court-involved, nonincarcerated adolescents may be sexual minorities. Specificscreening methods are necessary to identify these adolescents and to address their unique risk characteristics, which include more severe mental health difficulties and higher rates of high-risk sexual behavior and drug/alcohol use compared with their nonsexual minority peers.
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Affiliation(s)
- Matthew E Hirschtritt
- University of California, Department of Psychiatry, Weill Institute for Neurosciences; San Francisco, California
| | - Emily F Dauria
- University of California, Department of Psychiatry, Weill Institute for Neurosciences; San Francisco, California; Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry; San Francisco, California
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health; Providence, Rhode Island
| | - Marina Tolou-Shams
- University of California, Department of Psychiatry, Weill Institute for Neurosciences; San Francisco, California; Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry; San Francisco, California.
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21
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A Gold-Standard for Entity Resolution within Sexually Transmitted Infection Networks. Sci Rep 2018; 8:8776. [PMID: 29884882 PMCID: PMC5993735 DOI: 10.1038/s41598-018-26794-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/17/2018] [Indexed: 11/24/2022] Open
Abstract
Contact tracing for venereal disease control has been widespread since 1936 and relies on reported information about contacts’ attributes to determine whether two contacts may represent the same individual. We developed and implemented a gold-standard for determining overlap between contacts reported by different individuals using cell phone numbers as unique identifiers. This method was then used to evaluate the performance of using reported names and demographic characteristics to infer overlap. Cell-phone numbers, names and demographic data for a sample of high-risk men in India and their contacts were collected using a novel, hybrid instrument involving both cell-phone data extraction and Computer-Assisted Personal Interviewing (CAPI). Logistic regression was used to model the probability that a pair of contacts reported by different respondents were identical, based on the correspondence between their reported names and attributes. A discrete mixture model is proposed which provides predictions nearly as good as the logistic model but may be used in a new population without re-calibration. Despite achieving AUCs of 0.83–0.86, the low rate of true overlap among a very large number of contact pairs still results in a high rate of false positives. Next generation contact tracing calls for more archived or digital matching processes.
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22
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Ristuccia A, LoSchiavo C, Halkitis PN, Kapadia F. Sexualised drug use among sexual minority young adults in the United States: The P18 cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:207-214. [PMID: 29610012 DOI: 10.1016/j.drugpo.2018.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Substance use and condomless sexual behaviours are both well studied in sexual minority men, but few researchers have used event-level data collection to examine sexualised drug use in sexual and gender minority young adults. The aim of this study is to describe the co-occurrence of sex under the influence of substances and condomless sexual behaviours, using nuanced event-level data, in a racially/ethnically and socioeconomically diverse sample in New York City. METHODS Data from one wave of a cohort of sexual and gender minority young adults who were assigned male at birth (n = 500) were used to characterise co-occurrence of sex under the influence of drugs and condomless sexual behaviours (oral receptive, anal insertive, and anal receptive sex), in the last 30 days. Logistic regression models were constructed to assess associations between sex while high and condomless sexual behaviours, controlling for sociodemographic factors. RESULTS Preliminary analyses indicated significant associations between engaging in sex while high and condomless sexual behaviours. In unadjusted regression models, sexualised and non-sexualised drug use were both significantly associated with increased odds of condomless sexual behaviours. In adjusted models, sexualised drug use remained significantly associated with condomless anal insertive sex (AOR = 3.57) and condomless anal receptive sex (AOR = 4.98). Having multiple sexual partners was also significantly associated with greater odds of condomless sexual activity in all three adjusted models. CONCLUSION Multivariable analyses indicated that engaging in sex while high on any drug was associated with increased condomless sexual behaviour, but that sexualised drug use was associated with particularly elevated condomless anal sex. These findings provide insight for understanding the co-occurrence of substance use and condomless sex, and suggest a need for HIV/STI risk reduction strategies that address the role of sexualised drug use.
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Affiliation(s)
- Annie Ristuccia
- Center for Health, Identity, Behavior and Prevention Studies, 665 Broadway #800, New York, NY 10012, USA.
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies, 665 Broadway #800, New York, NY 10012, USA; Department of Biostatistics and Social and Behavioral Sciences, School of Public Health, Rutgers University, 684 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies, 665 Broadway #800, New York, NY 10012, USA; Department of Biostatistics and Social and Behavioral Sciences, School of Public Health, Rutgers University, 684 Hoes Lane West, Piscataway, NJ 08854, USA; Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Rd, Piscataway Township, NJ 08854, USA; Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Lane West, Piscataway Township, NJ 08854, USA; School of Public Affairs and Administration, Rutgers University, 111 Washington Street, Newark, NJ 07102, USA.
| | - Farzana Kapadia
- Center for Health, Identity, Behavior and Prevention Studies, 665 Broadway #800, New York, NY 10012, USA; Department of Epidemiology, College of Global Public Health, New York University, 715 Broadway, New York, NY 10003, USA; Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY 10016, USA.
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23
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Frequent implementation of interventions may increase HIV infections among MSM in China. Sci Rep 2018; 8:451. [PMID: 29323225 PMCID: PMC5765000 DOI: 10.1038/s41598-017-18743-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022] Open
Abstract
Intervention measures among men who have sex with men (MSM) are usually designed to reduce the frequency of high risk behaviors (within-community level), but unfortunately may change the contact network and consequently increase the opportunity for them to have sex with new partners (between-community level). A multi-community periodic model on complex network is proposed to study the two-side effects of interventions on HIV transmission among MSM in China, in which the wanning process of the impacts of interventions are modelled. The basic reproduction number for the multi-community periodic system is defined and calculated numerically. Based on the number of annual reported HIV/AIDS cases among MSM in China, the unknown parameters are estimated by using MCMC method and the basic reproduction number is estimated as 3.56 (95%CI [3.556, 3.568]). Our results show that strong randomness of the community-connection networks leads to more new infections and more HIV/AIDS cases. Moreover, main conclusion indicates that implementation of interventions may induce more new infections, depending on relative level of between- and within-community impacts, and the frequency of implementation of interventions. The findings can help to guide the policy maker to choose the appropriate intervention measures, and to implement the interventions with proper frequency.
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Loeliger KB, Biggs ML, Young R, Seal DW, Beckwith CG, Kuo I, Gordon MS, Altice FL, Ouellet LJ, Cunningham WE, Young JD, Springer SA. Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium. AIDS Behav 2017; 21:2945-2957. [PMID: 28188460 DOI: 10.1007/s10461-017-1722-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.
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Lam CR, Holtz TH, Leelawiwat W, Mock PA, Chonwattana W, Wimonsate W, Varangrat A, Thienkrua W, Rose C, Chitwarakorn A, Curlin ME. Subtypes and Risk Behaviors Among Incident HIV Cases in the Bangkok Men Who Have Sex with Men Cohort Study, Thailand, 2006-2014. AIDS Res Hum Retroviruses 2017; 33:1004-1012. [PMID: 28019101 DOI: 10.1089/aid.2016.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 incidence and prevalence remain high among men who have sex with men (MSM), and transgender women (TGW), in Thailand. To examine the link between epidemiologic factors and HIV-1 subtype transmission among Thai MSM, we compared covariates of infection with HIV CRF01_AE and other HIV strains among participants in the Bangkok MSM Cohort Study (BMCS). The BMCS was an observational cohort study of Thai MSM and TGW with up to 60 months of follow-up at 4 monthly intervals. Participants underwent HIV/sexually transmitted infections testing and provided behavioral data at each visit. Infecting viral strain was characterized by gene sequencing and/or multiregion hybridization assay. We correlated behavioral/clinical variables with infecting strain using Cox proportional hazards. Among a total of 1372 HIV seronegative enrolled participants with 4,192 person-years of follow-up, we identified 215 seroconverters between April 2006 and December 2014, with 177 infected with CRF01_AE and 38 with non-CRF01_AE subtype. Age 18-21 years (adjusted hazard ratio [AHR] 2.2, 95% confidence interval [CI]: 1.4-3.5), age 22-29 (AHR 1.6, 95% CI: 1.1-2.3), living alone (AHR 1.5, 95% CI: 1.1-2.1), drug use (AHR 2.2, 95% CI: 1.4-3.5), intermittent condom use (AHR 1.7, 95% CI: 1.3-2.3), any receptive anal intercourse (AHR 1.7, 95% CI: 1.2-2.4), group sex (AHR 1.5, 95% CI: 1.1-2.2), anti-herpes simplex virus type 1 (AHR 1.5, 95% CI: 1.1-2.1), and Treponema pallidum antibody positivity (AHR 2.5, 95% CI: 1.4-4.4) were associated with CRF01_AE infection. Age 18-21 years (AHR 5.1, 95% CI: 1.6-16.5), age 22-29 (AHR 3.6, 95% CI: 1.3-10.4), drug use (AHR 3.1, 95% CI: 1.3-7.5), group sex (AHR 2.4, 95% CI: 1.1-5.0), and hepatitis B virus surface antigen (AHR 3.6, 95% CI: 1.3-10.2) were associated with non-CRF01_AE infection. We observed several significant biological and behavioral correlates of infection with CRF01_AE and other HIV strains among Thai MSM. Divergence in correlates by strain may indicate differences in HIV transmission epidemiology between CRF01_AE and other strains. These differences could reflect founder effects, transmission within networks distinguished by specific risk factors, and possibly biological differences between HIV strains.
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Affiliation(s)
- Caitlin R. Lam
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Timothy H. Holtz
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanna Leelawiwat
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Philip A. Mock
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wannee Chonwattana
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wipas Wimonsate
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Varangrat
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Warunee Thienkrua
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Charles Rose
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anupong Chitwarakorn
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Marcel E. Curlin
- Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Schneider JA, Lancki N, Schumm P. At the intersection of criminal justice involvement and sexual orientation: Dynamic networks and health among a population-based sample of young Black men who have sex with men. SOCIAL NETWORKS 2017; 51:73-87. [PMID: 29062165 PMCID: PMC5650246 DOI: 10.1016/j.socnet.2017.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mass incarceration of young Black men has a significant impact on their network composition and stability that, in turn, may have major implications for health and well-being. A sub-group of young Black men with criminal justice involvement (CJI) identify as gay, bisexual or are non-identified men who have sex with men (hereafter MSM). This paper focuses on the potential effects of CJI on the composition of Black MSM social and sexual networks, their stability over time, and concomitant health and social outcomes. We use data from the UConnect study, a population-based cohort of young Black MSM 16-29 years of age (n=618) selected using respondent-driven sampling in Chicago from 2013-2016. Both confidant and sexual network name generators and interpreters were administered at 9-month intervals over three waves of data collection. Ego and dyadic-level data were collected on behaviors prevalent among MSM and including factors associated with network CJI, network stability, and health outcomes. Generalized Structural Equation Models (GSEM) were utilized to determine the relationship between CJI network composition, network stability and behaviors prevalent among young Black MSM and their networks. In the UConnect cohort, 46% had at least once been detained, arrested or spent time in jail or prison. In addition, 20% of participants reported incident CJI over the study period. Respondents with a history of CJI were significantly more likely to have CJI homophily in their confidant and sexual networks. Multivariate analyses demonstrate that the association between one's history of CJI, housing instability and drug use is partially explained by one's network CJI. In addition, a higher prevalence of network CJI is associated with increased turnover in the confidant network, and this network instability is also related to important health and social outcomes. This analysis describes the networks of criminal justice involved men among a representative sample of young Black MSM and demonstrates the relationship between CJI network homophily, network stability and their impact on several key health and social outcomes relevant to this population.
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Affiliation(s)
- J A Schneider
- Department of Medicine, University of Chicago
- Department of Public Health Sciences, University of Chicago
- Chicago Center for HIV Elimination, University of Chicago
| | - N Lancki
- Department of Medicine, University of Chicago
- Chicago Center for HIV Elimination, University of Chicago
| | - P Schumm
- Department of Public Health Sciences, University of Chicago
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Thoma BC. Parental Monitoring Among Young Men Who Have Sex With Men: Associations With Sexual Activity and HIV-Related Sexual Risk Behaviors. J Adolesc Health 2017; 61:348-354. [PMID: 28528209 PMCID: PMC5785918 DOI: 10.1016/j.jadohealth.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parental monitoring is protective against adolescent sexual risk behavior among heterosexual adolescents, yet it is unclear whether these findings generalize to YMSM. YMSM experience unique family dynamics during adolescence, including coming out to parents and parental rejection of sexual orientation. The present study examined how theoretically derived parental monitoring constructs were associated with sexual activity and sexual risk behaviors among YMSM. METHODS YMSM aged 14-18 years completed a cross-sectional online survey (n = 646). Factor analysis was completed to determine factor structure of monitoring measure. Sexual behaviors were predicted from monitoring constructs and covariates within regression models. RESULTS Parental knowledge and adolescent disclosure, parental solicitation, parental control, and adolescent secret-keeping emerged as four distinct monitoring constructs among YMSM. Higher knowledge and disclosure (b = -.32, p = .022), higher control (b = -.28, p = .006), lower solicitation (b = .31, p = .008), and lower secret-keeping (b = .25, p = .015) were associated with lower odds of sexual activity with males in the past 6 months. Higher knowledge and disclosure (b = -.12, p = .016), higher control (b = -.08, p = .039), and lower secret-keeping (b = .11, p = .005) were associated with having fewer recent sexual partners. Monitoring constructs were unassociated with condomless anal intercourse instances among sexually active YMSM. CONCLUSIONS YMSM disclosure is closely tied with parental knowledge, and parents should foster relationships and home environments where YMSM are comfortable disclosing information freely. Effective parental monitoring could limit YMSM's opportunities for sexual activity, but monitoring is not sufficient to protect against HIV-related sexual risk behaviors among sexually active YMSM.
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Affiliation(s)
- Brian C. Thoma
- Address correspondence to: Brian C. Thoma, Ph.D., Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213.
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28
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Logie CH, Kenny KS, Lacombe-Duncan A, Levermore K, Jones N, Neil A, Ellis T, Marshall A, Newman PA. Social-ecological factors associated with HIV infection among men who have sex with men in Jamaica. Int J STD AIDS 2017; 29:80-88. [PMID: 28669320 DOI: 10.1177/0956462417717652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Jamaica, where homosexuality is criminalized, scant research has examined associations between sexual stigma and HIV infection. The study objective was to examine correlates of HIV infection among men who have sex with men (MSM) in Jamaica. We conducted a cross-sectional tablet-based survey with MSM in Jamaica using chain referral sampling. We assessed socio-demographic, individual, social, and structural factors associated with HIV infection. A logit-link model, fit using backwards-stepwise regression, was used to estimate a final multivariable model. Among 498 participants (median age: 24, interquartile range: 22-28), 67 (13.5%) were HIV-positive. In the multivariable model, HIV infection was associated with increased odds of socio-demographic (older age, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.00-1.10]; residing in Kingston versus Ocho Rios [OR: 6.99, 95% CI 2.54-19.26]), individual (poor/fair versus excellent/good self-rated health [OR: 4.55, 95% CI: 1.81-11.42], sexually transmitted infection [STI] history [OR: 3.67, 95% CI: 1.61-8.38]), and structural (enacted sexual stigma [OR: 1.08, 95% CI: 1.01-1.15], having a health care provider [OR: 2.23, 95% CI: 1.06-4.66]) factors. This is among the first studies to demonstrate associations between sexual stigma and HIV infection in Jamaica. Findings underscore the need to integrate STI testing in the HIV care continuum and to address stigma and regional differences among MSM in Jamaica.
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Affiliation(s)
- Carmen H Logie
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada.,2 Women's College Research Institute, Women's College Hospital, 7938 University of Toronto , Toronto, Canada
| | - Kathleen S Kenny
- 3 Gillings School of Global Public Health, 2331 University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Ashley Lacombe-Duncan
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada
| | | | | | - Ava Neil
- 4 Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Tyrone Ellis
- 4 Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Annecka Marshall
- 5 Institute for Gender and Development Studies, 62707 University of the West Indies , Mona Campus, Jamaica
| | - Peter A Newman
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada
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Miller RL, Boyer CB, Chiaramonte D, Lindeman P, Chutuape K, Cooper-Walker B, Kapogiannis BG, Wilson CM, Fortenberry JD. Evaluating Testing Strategies for Identifying Youths With HIV Infection and Linking Youths to Biomedical and Other Prevention Services. JAMA Pediatr 2017; 171:532-537. [PMID: 28418524 PMCID: PMC5540008 DOI: 10.1001/jamapediatrics.2017.0105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS Testing strategies were evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS A total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]). CONCLUSIONS AND RELEVANCE The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing
| | - Cherrie B. Boyer
- Department of Pediatrics, University of California, San Francisco
| | | | - Peter Lindeman
- Department of Psychology, Michigan State University, East Lansing
| | - Kate Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | | | - Bill G. Kapogiannis
- Maternal and Pediatric Infectious Disease, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Craig M. Wilson
- Department of Epidemiology, University of Alabama, Birmingham
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Sharma A, Wang LY, Dunville R, Valencia RK, Rosenberg ES, Sullivan PS. HIV and Sexually Transmitted Disease Testing Behavior Among Adolescent Sexual Minority Males: Analysis of Pooled Youth Risk Behavior Survey Data, 2005-2013. LGBT Health 2017; 4:130-140. [PMID: 28145800 PMCID: PMC10671379 DOI: 10.1089/lgbt.2016.0134] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Adolescent sexual minority males (ASMM) comprise a high-risk group that may benefit from expanded human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention services. The purpose of this study was to estimate the prevalence of HIV and STD testing among ASMM from pooled high school Youth Risk Behavior Surveys (YRBSs). METHODS Data came from 26 YRBSs from 2005 to 2013, which included questions on sexual identity and/or sex of sexual contacts and questions on ever being tested for HIV and/or STDs. Multivariable logistic regression was used to identify factors independently associated with lifetime HIV testing among sexually experienced ASMM. RESULTS Overall, 3027 of 43,037 (6.3%, 95% confidence interval [CI]: 5.8%-6.8%) males were categorized as ASMM. Among 1229 sexually experienced ASMM, 413 (26.6%, 95% CI: 21.8%-31.4%) reported ever being tested for HIV, and among 571 ASMM who reported not using a condom during last intercourse, 192 (29.4%, 95% CI: 21.3%-37.6%) reported testing. A longer duration since first intercourse (≥3 vs. ≤1 year: adjusted prevalence ratio [aPR]: 1.6, 95% CI: 1.0-2.6) and recent intercourse (within the past 3 months vs. earlier: aPR: 2.2, 95% CI: 1.4-3.4) was associated with a higher adjusted prevalence of HIV testing. Sixty-four of 252 (30.2%, 95% CI: 20.0%-40.4%) sexually experienced ASMM reported ever being tested for STDs. CONCLUSION Low levels of testing among sexually experienced ASMM, particularly those who reported sex without a condom at last intercourse, highlight the exigency of improving age-appropriate HIV and STD prevention services. Educating healthcare providers to better assess adolescent sexual histories is essential to increasing testing.
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Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Dunville
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel K. Valencia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eli S. Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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31
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Dadasovich R, Auerswald C, Wilson EC, Minnis AM, Raymond HF, McFarland W. Testosterone and sexual risk among transmen: a mixed methods exploratory study. CULTURE, HEALTH & SEXUALITY 2017; 19:256-266. [PMID: 27552941 PMCID: PMC5569315 DOI: 10.1080/13691058.2016.1216605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Little research has explored the link between the behavioural effects of testosterone use among transmen and HIV risk. We conducted a mixed methods study to explore testosterone use among transmen and the behavioural effects on HIV risk. A sample of 122 transmen from San Francisco participated in a cross-sectional quantitative survey and 14 transmen participated in 2 focus group discussions. Most participants (81.9%) were currently taking hormones. Participants attributed testosterone use to new sexual behaviours among 69% of transmen, changes in sexual attraction (49%), and increased frequency of sexual activity (72%). Among current testosterone users, 3.3% had cisgender men as partners before starting testosterone, whereas after starting testosterone, 25.4% did. Similarly, 4.1% had a transgender woman as a sexual partner before starting testosterone and 13.9% after starting testosterone. Findings suggest that testosterone's side effects were associated with transmen's desires for sex with cisgender men who have sex with men. The reported increase in attraction to and sex with partners from populations with a high HIV prevalence may have important implications for HIV risk among transmen, especially as the availability of transgender health services may draw transmen to a context in which HIV prevalence is high.
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Affiliation(s)
- Rand Dadasovich
- UC Berkeley-UC San Francisco Joint Medical Program, California, USA
| | - Coco Auerswald
- UC Berkeley-UC San Francisco Joint Medical Program, California, USA
- UC Berkeley School of Public Health, California, USA
| | - Erin C. Wilson
- San Francisco Department of Public Health, Center for Public Health Research, California, USA
- Corresponding author. Erin C. Wilson.
| | | | - H. Fisher Raymond
- UC San Francisco, Epidemiology and Biostatistics, California, USA
- San Francisco Department of Public Health, Center for Public Health Research, California, USA
| | - Willi McFarland
- UC San Francisco, Epidemiology and Biostatistics, California, USA
- San Francisco Department of Public Health, Center for Public Health Research, California, USA
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32
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Rebchook G, Keatley J, Contreras R, Perloff J, Molano LF, Reback CJ, Ducheny K, Nemoto T, Lin R, Birnbaum J, Woods T, Xavier J. The Transgender Women of Color Initiative: Implementing and Evaluating Innovative Interventions to Enhance Engagement and Retention in HIV Care. Am J Public Health 2017; 107:224-229. [PMID: 28075641 PMCID: PMC5227951 DOI: 10.2105/ajph.2016.303582] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/04/2022]
Abstract
To improve health outcomes among transgender women of color living with HIV, the Health Resources and Services Administration's Special Programs of National Significance program funded the Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative in 2012. Nine demonstration projects in four US urban areas implemented innovative, theory-based interventions specifically targeting transgender women of color in their jurisdictions. An evaluation and technical assistance center was funded to evaluate the outcomes of the access to care interventions, and these findings will yield best practices and lessons learned to improve the care and treatment of transgender women of color living with HIV infection.
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Affiliation(s)
- Gregory Rebchook
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - JoAnne Keatley
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Robert Contreras
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Judy Perloff
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Luis Freddy Molano
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Cathy J Reback
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Kelly Ducheny
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Tooru Nemoto
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Royce Lin
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Jeffrey Birnbaum
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Tiffany Woods
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
| | - Jessica Xavier
- Gregory Rebchook is with the Center for AIDS Prevention Studies, University of California, San Francisco (UCSF). JoAnne Keatley is with the Center of Excellence for Transgender Health, UCSF. Robert Contreras is with BIENESTAR Human Services, Los Angeles, CA. Judith Perloff is with Chicago House & Social Services, Chicago, IL. Luis Freddy Molano is with the Community Healthcare Network, New York, NY. Cathy J. Reback is with the Friends Research Institute, Los Angeles. Kelly Ducheny is with Howard Brown Health, Chicago. Tooru Nemoto is with the Public Health Institute, Oakland, CA. Royce Lin is with the San Francisco Department of Public Health, San Francisco. Jeffrey Birnbaum is with the Downstate Medical Center, State University of New York, Brooklyn. Tiffany Woods is with the Tri-City Health Center, Fremont, CA. Jessica Xavier is with the Health Resources and Services Administration, Rockville, MD
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Lindong I, Edwards L, Dennis S, Fajobi O. Similarities and Differences Matter: Considering the Influence of Gender on HIV Prevention Programs for Young Adults in an Urban HBCU. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020133. [PMID: 28146047 PMCID: PMC5334687 DOI: 10.3390/ijerph14020133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) disproportionately burdens African American youth and young adults. In studies conducted in Historically Black Colleges and Universities (HBCU) settings, African American youth generally perceive themselves as having a low risk of contracting HIV and sexually transmitted diseases (STDs) despite having higher rates of unprotected sexual encounters, multiple sex partners, and particularly low rates of HIV testing and awareness of HIV status. These findings position HBCUs in a pivotal role for theory-based research and practice to modify behaviors in order to decrease HIV acquisition risk. Get Students Mobilized and Retooled to Transform (SMART) is an interventional research project in an urban HBCU in a northeastern metropolitan area in the US. The project is designed to assess and then address irresponsible behavior among students on college campuses that leads to illicit drug use, excessive alcohol consumption and underage drinking, and risky sexual behaviors that increase the likelihood of acquiring HIV and STDs. As gender plays a critical role in interventions, this article explores gender similarities and differences to inform the planning and implementation of Get SMART and any subsequent projects that address substance and alcohol use and HIV in an HBCU setting. Survey research was conducted to find similar and different factors that may be valuable in implementing and tailoring evidence-based interventions in a predominantly African American campus setting. Survey results revealed that more young adult women consume alcohol and use marijuana than young adult men. Young adult men were also more likely to be tested for HIV when compared to young adult women.
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Affiliation(s)
- Ian Lindong
- School of Community Health and Policy, Morgan State University, 1700 E Cold Spring Ln, Baltimore, MD 21251, USA.
| | - Lorece Edwards
- School of Community Health and Policy, Morgan State University, 1700 E Cold Spring Ln, Baltimore, MD 21251, USA.
| | - Sabriya Dennis
- School of Community Health and Policy, Morgan State University, 1700 E Cold Spring Ln, Baltimore, MD 21251, USA.
| | - Olaoluwa Fajobi
- School of Community Health and Policy, Morgan State University, 1700 E Cold Spring Ln, Baltimore, MD 21251, USA.
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High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. J Int AIDS Soc 2016; 19:21270. [PMID: 27931519 PMCID: PMC5146323 DOI: 10.7448/ias.19.1.21270] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/07/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Sexually transmitted infection (STI) and HIV prevalence have been reported to be higher amongst men who have sex with men (MSM) in Nigeria than in the general population. The objective of this study was to characterize the prevalence of HIV, chlamydia and gonorrhoea in this population using laboratory-based universal testing. Methods TRUST/RV368 represents a cohort of MSM and transgender women (TGW) recruited at trusted community centres in Abuja and Lagos, Nigeria, using respondent-driven sampling (RDS). Participants undergo a structured comprehensive assessment of HIV-related risks and screening for anorectal and urogenital Chlamydia trachomatis and Neisseria gonorrhoeae, and HIV. Crude and RDS-weighted prevalence estimates with 95% confidence intervals (CIs) were calculated. Log-binomial regression was used to explore factors associated with prevalent HIV infection and STIs. Results From March 2013 to January 2016, 862 MSM and TGW (316 in Lagos and 546 in Abuja) underwent screening for HIV, chlamydia and gonorrhoea at study enrolment. Participants’ median age was 24 years [interquartile range (IQR) 21–27]. One-third (34.2%) were identified as gay/homosexual and 65.2% as bisexual. The overall prevalence of HIV was 54.9%. After adjusting for the RDS recruitment method, HIV prevalence in Abuja was 43.5% (95% CI 37.3–49.6%) and in Lagos was 65.6% (95% CI 54.7–76.5%). The RDS-weighted prevalence of chlamydia was 17.0% (95% CI 11.8–22.3%) in Abuja and 18.3% (95% CI 11.1–25.4%) in Lagos. Chlamydia infection was detected only at the anorectal site in 70.2% of cases. The RDS-weighted prevalence of gonorrhoea was 19.1% (95% CI 14.6–23.5%) in Abuja and 25.8% (95% CI 17.1–34.6%) in Lagos. Overall, 84.2% of gonorrhoea cases presented with anorectal infection only. Over 95% of STI cases were asymptomatic. In a multivariable model, increased risk for chlamydia/gonorrhoea was associated with younger age, gay/homosexual sexual orientation and higher number of partners for receptive anal sex. HIV infection was associated with older age, female gender identity and number of partners for receptive anal sex. Conclusions There is a high burden of infection with HIV and asymptomatic chlamydia and gonorrhoea among MSM and TGW in Nigeria. Most cases would have been missed without anorectal screening. Interventions are needed to target this population for appropriate STI screening and management beginning at a young age.
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Lachowsky NJ, Sorge JT, Raymond HF, Cui Z, Sereda P, Rich A, Roth EA, Hogg RS, Moore DM. Does size really matter? A sensitivity analysis of number of seeds in a respondent-driven sampling study of gay, bisexual and other men who have sex with men in Vancouver, Canada. BMC Med Res Methodol 2016; 16:157. [PMID: 27852234 PMCID: PMC5112687 DOI: 10.1186/s12874-016-0258-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Respondent-driven sampling (RDS) is an increasingly used peer chain-recruitment method to sample “hard-to-reach” populations for whom there are no reliable sampling frames. Implementation success of RDS varies; one potential negative factor being the number of seeds used. Methods We conducted a sensitivity analysis on estimates produced using data from an RDS study of gay, bisexual and other men who have sex with men (GBMSM) aged ≥16 years living in Vancouver, Canada. Participants completed a questionnaire on demographics, sexual behavior and substance use. For analysis, we used increasing seed exclusion criteria, starting with all participants and subsequently removing unproductive seeds, chains of ≤1 recruitment waves, and chains of ≤2 recruitment waves. We calculated estimates for three different outcomes (HIV serostatus, condomless anal intercourse with HIV discordant/unknown status partner, and injecting drugs) using three different RDS weighting procedures: RDS-I, RDS-II, and RDS-SS. We also assessed seed dependence with bottleneck analyses and convergence plots. Statistical differences between RDS estimators were assessed through simulation analysis. Results Overall, 719 participants were recruited, which included 119 seeds and a maximum of 16 recruitment waves (mean chain length = 1.7). The sample of >0 recruitment waves removed unproductive seeds (n = 50/119, 42.0%), resulting in 69 chains (mean length = 3.0). The sample of >1 recruitment waves removed 125 seeds or recruits (17.4% of overall sample), resulting in 37 chains (mean length = 4.8). The final sample of >2 recruitment waves removed a further 182 seeds or recruits (25.3% of overall sample), resulting in 25 chains (mean length = 6.1). Convergence plots and bottleneck analyses of condomless anal intercourse with HIV discordant/unknown status partner and injecting drugs outcomes were satisfactory. For these two outcomes, regardless of seed exclusion criteria used, the crude proportions fell within 95% confidence intervals of all RDS-weighted estimates. Significant differences between the three RDS estimators were not observed. Conclusions Within a sample of GBMSM in Vancouver, Canada, this RDS study suggests that when equilibrium and homophily are met, although potentially costly and time consuming, analysis is not negatively affected by large numbers of unproductive or lowly productive seeds. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0258-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathan John Lachowsky
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada. .,School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada.
| | - Justin Tyler Sorge
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada
| | - Henry Fisher Raymond
- University of California San Francisco, San Francisco, USA.,San Francisco Department of Public Health, San Francisco, USA
| | - Zishan Cui
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada
| | - Paul Sereda
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada
| | - Ashleigh Rich
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Robert S Hogg
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada.,Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- Epidemiology & Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, V6T 1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Abstract
This article describes some of the special health and safety concerns that many lesbian, gay, bisexual, and questioning youth face in schools. Among these problems are increased drug and alcohol use, sexually transmitted infections and pregnancy risks, depression and suicidality, and increased likelihood of being a victim of harassment or assault. School nurses can play a unique role in the lives of these students. A needs assessment is reviewed that describes school nurses’ perceived professional responsibility and their actual practice with regard to lesbian, gay, bisexual, and questioning youth. Five barriers to optimal health care for these students are discussed. Methods that encourage students to view the school nurse as an ally, as well as issues surrounding disclosure or “coming out,” are discussed. Special considerations of confidentiality, community agency referral, and family disclosure are discussed. Appropriate interventions at school and ways to begin to change the school climate are also presented.
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Morgan E, Khanna AS, Skaathun B, Michaels S, Young L, Duvoisin R, Chang M, Voisin D, Cornwell B, Coombs RW, Friedman SR, Schneider JA. Marijuana Use Among Young Black Men Who Have Sex With Men and the HIV Care Continuum: Findings From the uConnect Cohort. Subst Use Misuse 2016; 51:1751-9. [PMID: 27556866 PMCID: PMC5031235 DOI: 10.1080/10826084.2016.1197265] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission. OBJECTIVE Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study. METHODS A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models. RESULTS Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers. CONCLUSIONS YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones' HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission.
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Affiliation(s)
- Ethan Morgan
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
| | - Aditya S Khanna
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
| | - Britt Skaathun
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
| | - Stuart Michaels
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
| | - Lindsay Young
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
| | - Rebeccah Duvoisin
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
| | - Ming Chang
- d Department of Laboratory Medicine , University of Washington , Seattle , Washington , USA
| | - Dexter Voisin
- e School of Social Service Administration , University of Chicago , Chicago , Illinois , USA
| | - Benjamin Cornwell
- f Department of Sociology , Cornell University , Ithaca , New York , USA
| | - Robert W Coombs
- d Department of Laboratory Medicine , University of Washington , Seattle , Washington , USA
| | - Samuel R Friedman
- g National Development and Research Institutes , New York , New York , USA
| | - John A Schneider
- a Department of Public Health Sciences , University of Chicago , Chicago , Illinois , USA
- b Department of Medicine , University of Chicago , Chicago , Illinois , USA
- c NORC at the University of Chicago, University of Chicago , Chicago , Illinois , USA
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38
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Wray TB, Kahler CW, Monti PM. Using Ecological Momentary Assessment (EMA) to Study Sex Events Among Very High-Risk Men Who Have Sex with Men (MSM). AIDS Behav 2016; 20:2231-2242. [PMID: 26746212 DOI: 10.1007/s10461-015-1272-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
MSM continue to represent the largest share of new HIV infections in the United States each year due to high infectivity associated with unprotected anal sex. Ecological momentary assessment (EMA) has the potential to provide a unique view of how high-risk sexual events occur in the real world and can impart detailed information about aspects of decision-making, antecedents, and consequences that accompany these events. EMA may also produce more accurate data on sexual behavior by assessing it soon after its occurrence. We conducted a study involving 12 high-risk MSM to explore the acceptability and feasibility of a 30 day, intensive EMA procedure. Results suggest this intensive assessment strategy was both acceptable and feasible to participants. All participants provided response rates to various assessments that approached or were in excess of their targets: 81.0 % of experience sampling assessments and 93.1 % of daily diary assessments were completed. However, comparing EMA reports with a Timeline Followback (TLFB) of the same 30 day period suggested that participants reported fewer sexual risk events on the TLFB compared to EMA, and reported a number of discrepancies about specific behaviors and partner characteristics across the two methods. Overall, results support the acceptability, feasibility, and utility of using EMA to understand sexual risk events among high-risk MSM. Findings also suggest that EMA and other intensive longitudinal assessment approaches could yield more accurate data about sex events.
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Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA.
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
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39
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Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Nimmagadda N, Anand S, Vasudevan CK, Solomon S, Solomon SS, Celentano DD. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health 2016; 16:784. [PMID: 27520978 PMCID: PMC4983056 DOI: 10.1186/s12889-016-3446-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV. Methods This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. Results Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not. Conclusion This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,YR Gaitonde Centre for AIDS Research and Education, Chennai, India.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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40
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Romas L, Birse K, Mayer KH, Abou M, Westmacott G, Giguere R, Febo I, Cranston RD, Carballo-Diéguez A, McGowan I, Burgener A. Rectal 1% Tenofovir Gel Use Associates with Altered Epidermal Protein Expression. AIDS Res Hum Retroviruses 2016; 32:1005-1015. [PMID: 27316778 PMCID: PMC5067863 DOI: 10.1089/aid.2015.0381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rectal use of a 1% tenofovir (TFV) gel is currently being evaluated for HIV prevention. While careful assessment of mucosal safety of candidate microbicides is a primary concern, tools to assess mucosal toxicity are limited. Mass spectrometry-based proteomics is a sensitive and high-throughput technique that can provide in-depth information on inflammation processes in biological systems. In this study, we utilized a proteomics approach to characterize mucosal responses in study participants involved in a phase 1 clinical trial of a rectal TFV-based gel. Project Gel was a phase 1 randomized (1:1), double-blind, multisite, placebo-controlled trial in which 24 participants received rectal TFV or a universal placebo [hydroxyethyl cellulose (HEC)] over a course of 8 daily doses. Rectal mucosal swabs were collected after 0, 1, and 8 doses and were analyzed by label-free tandem mass spectrometry. Differential protein expression was evaluated using a combination of paired (time-effects) and unpaired (across study arm) t-tests, and multivariate [least absolute shrinkage and selection operator (LASSO)] modeling. Within the TFV arm, 7% (17/249, p < .05) and 10% (25/249, p < .05) of total proteins changed after 1 and 8 daily applications of TFV gel, respectively, compared to 3% (7/249, p < .05) and 6% (16/249, p < .05) in the HEC arm. Biofunctional analysis associated TFV use with a decrease in epidermal barrier proteins (adj. p = 1.21 × 10−10). Multivariate modeling identified 13 proteins that confidently separated TFV gel users (100% calibration and 96% cross-validation accuracy), including the epithelial integrity factors (FLMNB, CRNN, CALM), serpins (SPB13, SPB5), and cytoskeletal proteins (VILI, VIME, WRD1). This study suggested that daily rectal applications of a 1% TFV gel may be associated with mucosal proteome changes involving epidermal development. Further assessment of more extended use of TFV-gel is recommended to validate these initial associations.
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Affiliation(s)
- Laura Romas
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Kenzie Birse
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | | | - Max Abou
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Garrett Westmacott
- Mass Spectrometry and Proteomics Core Facility, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Irma Febo
- University of Puerto Rico, San Juan, Puerto Rico
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam Burgener
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Toomey RB, Huynh VW, Jones SK, Lee S, Revels-Macalinao M. Sexual minority youth of color: A content analysis and critical review of the literature. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016; 21:3-31. [PMID: 28367257 PMCID: PMC5370177 DOI: 10.1080/19359705.2016.1217499] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being-as well as the interpersonal and contextual experiences-of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were noncomparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-racial/ethnic). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.
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Affiliation(s)
- Russell B. Toomey
- Norton School of Family and Consumer Sciences, Family Studies and Human Development, The University of Arizona, Tucson, Arizona, USA
| | - Virginia W. Huynh
- Department of Child and Adolescent Development, California State University–Northridge, Northridge, California, USA
| | - Samantha K. Jones
- Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Sophia Lee
- Department of Women Studies, San Diego State University, San Diego, California, USA
| | - Michelle Revels-Macalinao
- Department of Child and Adolescent Development, California State University–Northridge, Northridge, California, USA
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42
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McNair LD, Prather CM. African American Women and AIDS: Factors Influencing Risk and Reaction to HIV Disease. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403261414] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women represent the fastest growing group of individuals infected with HIV in the United States. Social and contextual influences on HIV risk vulnerability in this group are discussed, with particular emphasis on risk behaviors related to heterosexual contact and injection drug use. Social factors associated with the sex-ratio imbalance and low rates of condom use in the African American community are addressed, as are contextual influences related to environmental stress and psychosocial issues. We describe interventions that directly address both social and contextual influences on African American women’s risk behaviors. Finally, mental health and psychological concerns are presented as a framework for better understanding women’s reactions to HIV/AIDS and for developing comprehensive programs and services that better meet their needs.
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Cargill VA, Stone VE, Robinson MR. HIV Treatment in African Americans: Challenges and Opportunities. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403259243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews the current standard of care for HIV infection as well as how health disparities in the HIV care of African Americans present challenges for both providers and patients. The potential side effects in these antiretroviral treatment regimens that may be a source of additional challenges in treating African Americans are highlighted. A brief review of these issues as they relate to treatment adherence further demonstrates how adherence is closely linked to the medical and psychosocial issues African Americans face including access to HIV care services. The article concludes with a discussion of gender-related issues that affect treatment and that may confound effective behavioral interventions aimed at reducing HIV risk and increasing treatment adherence.
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Wilson PA, Valera P, Martos AJ, Wittlin NM, Muñoz-Laboy MA, Parker RG. Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States. JOURNAL OF SEX RESEARCH 2016; 53:642-54. [PMID: 26241373 PMCID: PMC4740277 DOI: 10.1080/00224499.2015.1016139] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: "Black men" "Black gay/bisexual" or "Black men who have sex with men," and "qualitative" and/or "ethnography." We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.
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Affiliation(s)
- Patrick A. Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY U.S.A
| | - Pamela Valera
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY U.S.A
| | - Alexander J. Martos
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY U.S.A
| | - Natalie M. Wittlin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY U.S.A
| | - Miguel A. Muñoz-Laboy
- College of Health Professions and Social Work, Temple University, Philadelphia, PA, U.S.A
| | - Richard G. Parker
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY U.S.A
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Lee DY, Kim SH, Woo SY, Yoon BK, Choi D. Associations of Health-Risk Behaviors and Health Cognition With Sexual Orientation Among Adolescents in School: Analysis of Pooled Data From Korean Nationwide Survey From 2008 to 2012. Medicine (Baltimore) 2016; 95:e3746. [PMID: 27227939 PMCID: PMC4902363 DOI: 10.1097/md.0000000000003746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Homosexual adolescents may face significant health disparities. We examined health-risk behaviors and health cognition related to homosexual behavior in a representative sample of adolescents.Data were obtained from 129,900 adolescents between 2008 and 2012 over 5 cycles of the Korean Youth Risk Behavior Survey, a national survey of students in grades 7 to 12. Various health-risk behaviors and aspects of health cognition were compared between homosexual and heterosexual adolescents and analyzed with multiple logistic regression models.Compared with heterosexual adolescents (n = 127,594), homosexual adolescents (n = 2306) were more likely to engage in various health-risk behaviors and to have poor health cognition. In multiple logistic regression analysis, not living with parents, alcohol experience (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.78 for males and 1.66; 1.33-2.07 for females), smoking experience (1.80; 1.54-2.10 for males and 3.15; 2.61-3.79 for females), and drug experience (3.65; 2.81-4.80 for males and 3.23; 2.35-4.46 for females) were associated with homosexual behavior. Homosexual adolescents were more likely to use adult internet content (2.82; 2.27-3.50 for males and 7.42; 4.19-13.15 for females), and to be depressed (1.21; 1.03-1.43 for males and 1.32; 1.06-1.64 for females). In addition, suicide ideation (1.51; 1.26-1.81 for males and 1.47; 1.16-1.86 for females) and attempts (1.67; 1.37-2.05 for males and 1.65; 1.34-2.03 for females) were significantly more prevalent among homosexual adolescents.Homosexual adolescents report disparities in various aspects of health-risk behavior and health cognition, including use of multiple substances, adult internet content and inappropriate weight loss methods, suicide ideation and attempts, and depressive mood. These factors should be addressed relevantly to develop specific interventions regarding sexual minorities.
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Affiliation(s)
- Dong-Yun Lee
- From the Department of Obstetrics and Gynecology (D-YL, S-HK, B-KY, DC), Samsung Medical Center, Sungkyunkwan University School of Medicine; Biostatistics Team, Samsung Biomedical Research Institute (SYW), Seoul, Korea
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Valiathan R, Ashman M, Asthana D. Effects of Ageing on the Immune System: Infants to Elderly. Scand J Immunol 2016; 83:255-66. [DOI: 10.1111/sji.12413] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/15/2016] [Indexed: 12/11/2022]
Affiliation(s)
- R. Valiathan
- University of Miami - Miller School of Medicine; Miami FL USA
| | - M. Ashman
- University of Miami - Miller School of Medicine; Miami FL USA
| | - D. Asthana
- University of Miami - Miller School of Medicine; Miami FL USA
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An evaluation of factors associated with sexual risk taking among Black men who have sex with men: a comparison of younger and older populations. J Behav Med 2016; 39:665-74. [PMID: 27001255 DOI: 10.1007/s10865-016-9734-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/14/2016] [Indexed: 01/23/2023]
Abstract
In the United States, rates of human immunodeficiency virus (HIV) infection are highest among Black men who have sex with men (BMSM). Prior research indicates that younger BMSM in particular (i.e., BMSM 29 years of age and younger) are most at risk for HIV infection, and that HIV incidence in this subpopulation has risen in recent years. It remains unclear, however, why younger BMSM, relative to BMSM 30 years of age and older, are at increased risk for HIV infection. For the current study, we surveyed 450 BMSM located in the Atlanta, GA metropolitan and surrounding areas. We assessed BMSM's depressive symptoms, substance use during sex, psycho-social risk factors (i.e., HIV risk perceptions, condom use self-efficacy, internalized homophobia, and perceived HIV stigmatization), and sexual risk taking (i.e., condomless anal intercourse [CAI]). We found that younger BMSM (YBMSM) and older BMSM (OBMSM) differed with respect to factors associated with CAI. In multivariable models, alcohol use before or during sex, lower educational attainment, and sexual orientation (i.e., bisexual sexual orientation) were significantly associated with increased CAI for YBMSM, while HIV risk perceptions and internalized homophobia were significantly, negatively associated with CAI among OBMSM. Rates of engaging in CAI were similar across the two age cohorts; however, factors related to CAI varied by these two groups. Findings emphasize the need to consider targeted interventions for different generational cohorts of BMSM.
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Abstract
Black men who have sex with men (BMSM) are highest risk for HIV seroconversion in the United States. Little attention has been paid to marijuana use among BMSM and potential for HIV risk. A sample of 202 BMSM was generated through respondent driven sampling. The relationship between differential marijuana use and both HIV risk behavior and social network factors were examined using weighted logistic regression. Of the BMSM in this sample 60.4 % use marijuana in general and 20.8 % use marijuana as sex-drug. General marijuana use was significantly associated with participation in group sex (AOR 3.50; 95 % CI 1.10-11.10) while marijuana use as a sex drug was significantly associated with both participation in condomless sex (AOR 2.86; 95% CI 1.07-7.67) and group sex (AOR 3.39; 95% CI 1.03-11.22). Respondents with a moderate or high perception of network members who use marijuana were more likely to use marijuana both in general and as a sex-drug. Network member marijuana use, while not associated with risk behaviors, is associated with individual marijuana use and individual marijuana use in the context of sex is associated with risk practices. Targeting interventions towards individuals and their respective networks that use marijuana as a sex drug may reduce HIV risk.
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Wilson PA, Kahana SY, Fernandez MI, Harper GW, Mayer K, Wilson CM, Hightow-Weidman LB. Sexual Risk Behavior Among Virologically Detectable Human Immunodeficiency Virus-Infected Young Men Who Have Sex With Men. JAMA Pediatr 2016; 170:125-31. [PMID: 26641367 PMCID: PMC4821589 DOI: 10.1001/jamapediatrics.2015.3333] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Human immunodeficiency virus (HIV) diagnoses continue to increase among young men who have sex with men (YMSM). Many YMSM living with HIV engage in sexual risk behaviors, and those who have a detectable viral load can transmit HIV to sex partners. Understanding factors that are related to sexual risk taking among virologically detectable (VL+) YMSM can inform prevention and treatment efforts. OBJECTIVES To describe differences between virologically suppressed (VL-) and VL+ YMSM living with HIV and to identify correlates of condomless anal intercourse (CAI) and serodiscordant CAI among VL+ YMSM. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional survey conducted from December 1, 2009, through June 30, 2012, we studied 991 HIV-infected YMSM 15 to 26 years of age at 20 adolescent HIV clinics in the United States. Data analysis was conducted December 1, 2013, through July 31, 2015. MAIN OUTCOMES AND MEASURES Demographic, behavioral, and psychosocial assessments obtained using audio computer-assisted self-interviews. Viral load information was obtained via blood draw or medical record abstraction. RESULTS Of the 991 participants, 688 (69.4%) were VL+ and 458 (46.2%) reported CAI, with 310 (31.3%) reporting serodiscordant CAI in the past 3 months. The VL+ YMSM were more likely than the VL- YMSM to report CAI (detectable, 266 [54.7%]; suppressed, 91 [44.4%]; P = .01) and serodiscordant CAI (detectable, 187 [34.9%]; suppressed, 57 [25.0%]; P < .01). Multivariable analyses indicated that among VL+ YMSM, those reporting problematic substance use were more likely to report CAI (adjusted odds ratio [AOR], 1.46; 95% CI, 1.02-2.10) and serodiscordant CAI (AOR, 1.45; 95% CI, 1.06-1.99). Black VL+ YMSM were less likely to report CAI (AOR, 0.63; 95% CI, 0.44-0.90) or serodiscordant CAI (AOR, 0.66; 95% CI, 0.46-0.94) compared with other VL+ YMSM. In addition, VL+ YMSM who disclosed their HIV status to sex partners were more likely to report CAI compared with nondisclosing YMSM (AOR, 1.35; 95% CI, 1.01-1.81). Transgender participants were less likely to report CAI than cisgender participants (AOR, 0.35; 95% CI, 0.14-0.85). Last, VL+ YMSM who reported currently being employed were less likely to report serodiscordant CAI than those who were unemployed (AOR, 0.74; 95% CI, 0.55-0.99). CONCLUSIONS AND RELEVANCE Targeted multilevel interventions are needed to reduce HIV transmission risk behaviors among YMSM living with HIV, particularly among those who are VL+.
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Affiliation(s)
- Patrick A. Wilson
- Mailman School of Public Health, Columbia University, New York, New York
| | - Shoshana Y. Kahana
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Gary W. Harper
- School of Public Health, University of Michigan, Ann Arbor
| | - Kenneth Mayer
- The Fenway Institute, Harvard Medical School, Boston, Massachusetts
| | - Craig M. Wilson
- School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Lisa B. Hightow-Weidman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (Hightow-Weidman)
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50
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Wiewel EW, Torian LV, Merchant P, Braunstein SL, Shepard CW. HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006-2011. Am J Public Health 2015; 106:497-502. [PMID: 26691124 DOI: 10.2105/ajph.2015.302974] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems. METHODS New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM. RESULTS In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16). CONCLUSIONS Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons.
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Affiliation(s)
- Ellen Weiss Wiewel
- At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY
| | - Lucia V Torian
- At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY
| | - Pooja Merchant
- At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY
| | - Sarah L Braunstein
- At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY
| | - Colin W Shepard
- At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY
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