1
|
Oi K, Pollitt AM. The roles of non-heterosexuality outside of identity and gender non-conformity in Allostatic Load among young adults. SSM Popul Health 2023; 22:101400. [PMID: 37114240 PMCID: PMC10126916 DOI: 10.1016/j.ssmph.2023.101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/05/2022] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Using the National Longitudinal Study of Adolescent to Adult Health, this study contrasted levels of Allostatic Load at the baseline and change observed between the age 20s and 30s, among self-identified Lesbians/Gays/Bisexuals and heterosexuals with non-heterosexual attraction/behavior (discordant heterosexuals), against heterosexuals without (concordant heterosexuals). In addition, the study tested if Allostatic Load differs for each of the sexual orientation group differs jointly or independently of gender non-conformity. The study found no Allostatic Load elevation for self-identified non-heterosexual men and women. For women only, a significantly greater elevation of Allostatic Load is observed among discordant heterosexuals. Independently, Allostatic Load is found higher for females appearing more androgynous. The findings suggest expanding the current scope of sexual minority research to consider the relevance of minority stress to those without a LGB identity, who may be exposed to stress from disparate sources related to their gender identity.
Collapse
|
2
|
Bogart LM, Mahoney TF, Sadler KR, Ojikutu BO. Correlates of Homonegativity Towards Men Who Have Sex With Men Among Black Individuals in the United States. JOURNAL OF HOMOSEXUALITY 2022:1-19. [PMID: 35549662 DOI: 10.1080/00918369.2022.2059968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study aims to identify the factors that are associated with homonegativity toward men who have sex with men (MSM) within Black communities since the expansion of LGBTQ rights. A survey was completed in 2016 by a nationally representative sample of 868 Black respondents, 18-50 years old, via e-mail. Demographics, perception of same-gender sexual behaviors, religiosity, experienced racism, and contact with the carceral system (CS) were assessed. 61.6% of respondents endorsed at least one homonegative belief. Being male, residing in the South, attending religious services, receiving homonegative faith messaging, and having contact with the CS were significantly associated with homonegativity toward MSM while experiencing racism, older age, and residing in a non-metropolitan area were not. Education efforts on LGBTQ identities in Black communities should engage faith communities, extend to metropolitan and non-metropolitan areas of the South, and include younger and older adults. Programs that decrease the arrest of Black individuals may also help reduce homonegativity toward MSM.
Collapse
Affiliation(s)
| | - Taylor F Mahoney
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Keron R Sadler
- National Association for the Advancement of Colored People (NAACP), Baltimore, Maryland, USA
| | - Bisola O Ojikutu
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Silva T, Fetner T. Sexual Identity-Behavior Discordance in Canada. CANADIAN REVIEW OF SOCIOLOGY = REVUE CANADIENNE DE SOCIOLOGIE 2022; 59:156-180. [PMID: 35129300 DOI: 10.1111/cars.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper uses two surveys to examine sexual identity-behavior discordance in Canada. The first is the Sex in Canada survey (SCS), which is a private survey of 2,303 Canadians. The second is the 2015-2016 Canadian Community Health Survey (CCHS), which is a large nationally representative government-administered survey with 109,659 respondents. Results from the CCHS show that identity-behavior discordance and overall rates of same-sex contact are lower in Canada than in the US, UK, or Australia. An estimated .7 percent of males and 2.7 percent of females aged 15-64 who had had lifetime sex identified as heterosexual yet have had same-sex contact, figures which equate to an estimated 65,700 males and 255,100 females. Few demographic factors were associated with discordance. Results from the SCS show that about two-thirds of heterosexuals with identity-behavior discordance were moderately supportive of LGBQ rights and one-third were moderately homophobic. Future research will need to uncover why a lower proportion of Canadians report same-sex partners and identity-behavior discordance than their counterparts in the US, UK, or Australia. Cet article utilise deux enquêtes pour examiner la discordance entre l'identité sexuelle et le comportement au Canada. La première est l'enquête Sex in Canada (SCS), qui est une enquête privée menée auprès de 2 303 Canadiens. La seconde est l'Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2015-2016, qui est une grande enquête représentative à l'échelle nationale administrée par le gouvernement auprès de 109 659 répondants. Les résultats de l'ESCC montrent que la discordance identité-comportement et les taux globaux de contacts entre personnes de même sexe sont plus faibles au Canada qu'aux États-Unis, au Royaume-Uni ou en Australie. On estime que 0,7 % des hommes et 2,7 % des femmes âgés de 15 à 64 ans ayant eu des rapports sexuels au cours de leur vie se sont identifiés comme hétérosexuels, mais ont eu des contacts avec des personnes du même sexe, ce qui correspond à environ 65 700 hommes et 255 100 femmes. Peu de facteurs démographiques étaient associés à la discordance. Les résultats de l'enquête SCS montrent qu'environ deux tiers des hétérosexuels présentant une discordance entre identité et comportement étaient modérément favorables aux droits des LGBQ et qu'un tiers était modérément homophobe. Les recherches futures devront découvrir pourquoi une plus faible proportion de Canadiens déclarent avoir des partenaires de même sexe et être en désaccord avec leur identité et leur comportement que leurs homologues aux États-Unis, au Royaume-Uni ou en Australie.
Collapse
|
4
|
He Y, Dangerfield Ii DT, Fields EL, Dawkins MR, Turpin RE, Johnson D, Browne DC, Hickson DA. Health care access, health care utilisation and sexual orientation disclosure among Black sexual minority men in the Deep South. Sex Health 2020; 17:421-428. [PMID: 33176906 DOI: 10.1071/sh20051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
Background Black gay, bisexual, and other sexual minority men (BSMM) account for 39.1% of new HIV infections among men who have sex with men and 78.9% of newly diagnosed cases among Black men. Health care access, health care utilisation and disclosing sexuality to providers are important factors in HIV prevention and treatment. This study explored the associations among sexual orientation disclosure, health care access and health care utilisation among BSMM in the Deep South. METHODS Secondary analysis of existing data of a population-based study in Jackson, Mississippi, and Atlanta, Georgia, was conducted among 386 BSMM. Poisson regression models were used to estimate prevalence ratios (PR) between sexual orientation disclosure to healthcare providers, health care access and health care utilisation. RESULTS The mean (±s.d.) age of participants was 30.5 ± 11.2 years; 35.3% were previously diagnosed with HIV and 3.7% were newly diagnosed with HIV. Two-thirds (67.2%) self-identified as homosexual or gay; 70.6% reported being very open about their sexual orientation with their healthcare providers. After adjustment, BSMM who were not open about their sexual orientation had a lower prevalence of visiting a healthcare provider in the previous 12 months than those who were very open with their healthcare provider (PR 0.42; 95% confidence interval 0.18-0.97). CONCLUSION Clinics, hospitals and other healthcare settings should promote affirming environments that support sexuality disclosure for BSMM.
Collapse
Affiliation(s)
- Ying He
- My Brother's Keeper, Inc., 407 Orchard Park, Ridgeland, MS 39157, USA
| | - Derek T Dangerfield Ii
- Johns Hopkins School of Nursing, 525 N Wolfe Street, Baltimore, MD 21205, USA; and Us Helping Us, People Into Living, Inc., 3636 Georgia Avenue NW, Washington, DC 20010, USA; and Corresponding author.
| | - Errol L Fields
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Baltimore, MD 21287, USA
| | - Milton R Dawkins
- My Brother's Keeper, Inc., 407 Orchard Park, Ridgeland, MS 39157, USA; and Department of Psychology, Jackson State University, Jackson, MS 39213, USA
| | - Rodman E Turpin
- School of Public Health, University of Maryland, 4200 Valley Drive #2242, College Park, MD 20742, USA
| | - Damon Johnson
- USA National AIDS and Education Services for Minorities, Inc., 2140 Martin Luther King Jr Drive SW, Atlanta, GA 30310, USA
| | - Dorothy C Browne
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; and University of Duy Tan, 254 Nguyen Van Linh, Thanh Khe District, Da Nang, Vietnam
| | - DeMarc A Hickson
- My Brother's Keeper, Inc., 407 Orchard Park, Ridgeland, MS 39157, USA; and Us Helping Us, People Into Living, Inc., 3636 Georgia Avenue NW, Washington, DC 20010, USA
| |
Collapse
|
5
|
Kumar N, Forastiere L, Zhang T, Yang F, Li KT, Tang W, Tucker JD, Christakis NA, Alexander M. Lack of sexual behavior disclosure may distort STI testing outcomes. BMC Public Health 2020; 20:616. [PMID: 32366241 PMCID: PMC7197169 DOI: 10.1186/s12889-020-08768-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out. METHODS This was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making. RESULTS Among 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. CONCLUSIONS Sexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.
Collapse
Affiliation(s)
- Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Laura Forastiere
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT USA
| | - Tiange Zhang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | | | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Southern Medical University Dermatology Hospital, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marcus Alexander
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| |
Collapse
|
6
|
Reback CJ, Larkins S, Clark K. Motivations for a Casual or Occasional Sexual Encounter with a Man and/or Transgender Woman among Heterosexual Men: Toward a Better Understanding of Atypical Sexual Partnering. SEXUALITY & CULTURE 2019; 23:359-374. [PMID: 31105424 PMCID: PMC6516862 DOI: 10.1007/s12119-018-9576-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little is known about the motivations for an occasional sexual encounter with a man or a transgender woman among heterosexual men. This study employed qualitative methods to better understand occasional atypical sexual partnering. Open-ended interviews were conducted with 31 heterosexual men who reported at least one sexual encounter with a man or a transgender woman in the previous 12 months. Using the principles of Grounded Theory, three themes emerged: Participants were motivated by (1) the easy, uncomplicated nature of a sexual encounter with a man and/or a trans woman that often circumvented the sexual politics of a typical male-female interaction and/or, (2) the sexual experimentation that took place with these partners; and/or, (3) the default nature of such encounters when a cisgender woman sexual partner was unavailable or perceived to be unattainable. These findings indicated that, among this sample of heterosexual men, the motivations for occasional atypical sexual partnering with a man or a transgender woman were varied, complex and could be multifaceted. Furthermore, these findings support prior studies that have demonstrated that sexual behavior can span beyond sexual identity.
Collapse
Affiliation(s)
- Cathy J. Reback
- Friends Research Institute, Inc. 1419 N. La Brea Avenue, Los Angeles, CA 90028, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024 USA
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California, 11075 Santa Monica Blvd., Suite. 200, Los Angeles, CA 90025 USA
| | - Sherry Larkins
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California, 11075 Santa Monica Blvd., Suite. 200, Los Angeles, CA 90025 USA
| | - Kirsty Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Box 951772, Los Angeles, CA 90095 USA
| |
Collapse
|
7
|
Mendle J, Beltz AM, Carter R, Dorn LD. Understanding Puberty and Its Measurement: Ideas for Research in a New Generation. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:82-95. [PMID: 30869839 DOI: 10.1111/jora.12371] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The measurement of puberty is an intricate and precise task, requiring a match between participants' developmental age and appropriate techniques to identify and capture variations in maturation. Much of the foundational work on puberty and its psychosocial correlates was conducted several decades ago. In this article, we review the biological foundation of puberty; the operationalization of puberty in statistical analyses; and strategies for considering diversity and social context in research to help researchers align measurement with meaningful conceptual questions. These three areas are particularly important, given new statistical techniques, greater awareness of individual variations in development, and key differences between past cohorts and youth coming of age today.
Collapse
|
8
|
Sun CJ, Tobin K, Spikes P, Latkin C. Correlates of same-sex behavior disclosure to health care providers among Black MSM in the United States: implications for HIV prevention. AIDS Care 2018; 31:1011-1018. [PMID: 30449137 DOI: 10.1080/09540121.2018.1548753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006-2009 identified individual and social network characteristics of Black MSM (n = 226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR = 0.32, 95% CI = 0.11-0.95), bisexual identity (AOR = 0.29, 95% CI = 0.12-0.70), and meeting criteria for alcohol use disorders (AOR = 0.32, 95% CI = 0.14-0.75) were negatively associated with disclosure. Disclosers were more likely to self-report being HIV-positive (AOR = 4.47, 95% CI = 1.54-12.98), having more frequent network socialization (AOR = 2.15, 95% CI = 1.24-3.73), and having a social network where all members knew the participant had sex with men (AOR = 4.94, 95% CI = 2.06-11.86). These associations were not moderated by self-reported HIV status. Future interventions to help MSM identify social network members to safely disclose their same-sex behavior may also help disclosure of same-sex behavior to HCPs among Black MSM.
Collapse
Affiliation(s)
- Christina J Sun
- a Oregon Health & Science University-Portland State University School of Public Health , Portland , OR , USA
| | - Karin Tobin
- b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Pilgrim Spikes
- c Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Carl Latkin
- b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| |
Collapse
|
9
|
Mattera B, Levine EC, Martinez O, Muñoz-Laboy M, Hausmann-Stabile C, Bauermeister J, Fernandez MI, Operario D, Rodriguez-Diaz C. Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men. CULTURE, HEALTH & SEXUALITY 2018; 20:607-624. [PMID: 28929893 PMCID: PMC5959808 DOI: 10.1080/13691058.2017.1367420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.
Collapse
Affiliation(s)
- Brian Mattera
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ethan C. Levine
- College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Miguel Muñoz-Laboy
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | | | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - M. Isa Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
| | | |
Collapse
|
10
|
O'Leary A. Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:213-224. [PMID: 29969306 DOI: 10.1521/aeap.2018.30.3.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.
Collapse
Affiliation(s)
- Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
11
|
Moody RL, Starks TJ, Grov C, Parsons JT. Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1133-1144. [PMID: 28608294 PMCID: PMC5726951 DOI: 10.1007/s10508-017-1009-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 05/04/2023]
Abstract
The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.
Collapse
Affiliation(s)
- Raymond L. Moody
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
| | - Tyrel J. Starks
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- CUNY School of Public Health, New York, NY
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
- CUNY School of Public Health, New York, NY
| |
Collapse
|
12
|
Platt LF, Scheitle CP. Sexual orientation and psychological distress: Differences by race and gender. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1437583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lisa F. Platt
- Department of Counseling, Rehabilitation Counseling, and Counseling Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Christopher P. Scheitle
- Department of Sociology and Anthropology, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
13
|
Calabrese SK, Earnshaw VA, Magnus M, Hansen NB, Krakower DS, Underhill K, Mayer KH, Kershaw TS, Betancourt JR, Dovidio JF. Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:143-156. [PMID: 28224313 PMCID: PMC5565715 DOI: 10.1007/s10508-016-0911-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/11/2016] [Accepted: 11/25/2016] [Indexed: 05/15/2023]
Abstract
Sexual stereotypes may adversely affect the health of Black men who have sex with men (MSM). Greater understanding of the nature and nuances of these stereotypes is needed. This online, survey-based study used an inductive, intersectional approach to characterize the sexual stereotypes ascribed to Black MSM by the U.S. general public, their distinctiveness from those ascribed to Black men and MSM in general, and their relative prototypicality as compared to dominant subgroups. Members of the public, recruited in 2014-2015, were randomly assigned to survey conditions that varied systematically by race (Black, White, or unspecified) and sexual orientation (gay, heterosexual, or unspecified) of a designated social group. Participants (n = 285) reported stereotypes of their assigned group that they perceived to exist in U.S. culture in an open-response format. Cross-condition comparisons revealed that, overall, Black gay male stereotypes were non-prototypical of Black men or gay men. Rather, stereotypes of Black men were more similar to Black heterosexual men and stereotypes of gay men were more similar to White gay men. Nonetheless, 11 of the 15 most frequently reported Black gay male stereotypes overlapped with stereotypes of Black men (e.g., large penis), gay men (e.g., deviant), or both (e.g., promiscuous). Four stereotypes were unique relative to both Black men and gay men: down low, diseased, loud, and dirty. Findings suggest that Black MSM face multiple derogatory sexual stereotypes, several of which are group-specific. These stereotypes are consistent with cultural (mis)representations of Black MSM and suggest a need for more accurate portrayals of existing sexual diversity within this group.
Collapse
Affiliation(s)
- Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Valerie A Earnshaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Human Development and Family Studies, University of Delaware, Newark, DE, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Columbia Law School, New York, NY, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| |
Collapse
|
14
|
Rutledge SE, Jemmott JB, O'Leary A, Icard LD. What's In an Identity Label? Correlates of Sociodemographics, Psychosocial Characteristics, and Sexual Behavior Among African American Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:157-167. [PMID: 27448292 PMCID: PMC5253329 DOI: 10.1007/s10508-016-0776-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/10/2016] [Accepted: 05/17/2016] [Indexed: 05/12/2023]
Abstract
African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity.
Collapse
Affiliation(s)
- Scott Edward Rutledge
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, 19122, USA.
| | - John B Jemmott
- Department of Psychiatry, Perelman School of Medicine and Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Larry D Icard
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, 19122, USA
| |
Collapse
|
15
|
Murray A, Gaul Z, Sutton MY, Nanin J. "We hide…": Perceptions of HIV Risk Among Black and Latino MSM in New York City. Am J Mens Health 2017; 12:180-188. [PMID: 29161954 PMCID: PMC5818124 DOI: 10.1177/1557988317742231] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Black and Latino men who have sex with men (BLMSM) are disproportionately infected with HIV; they comprised 66% of HIV diagnoses among men who have sex with men (MSM) in the United States in 2015. Risk factors for HIV infection among BLMSM include a high community prevalence of diagnosed and undiagnosed HIV/STDs, and dense sex partner networks. Perceptions of HIV risk among BLMSM were explored to inform HIV prevention efforts. During 2011-2012, semistructured interviews were conducted with BLMSM in New York City. Using computer-assisted thematic analyses (NVivo), transcribed interview responses to questions regarding HIV risk for main themes were examined. Interview data were available for 108 BLMSM: 86% Black, 13% Latino, 26% aged 18-24 years, 59% self-identified as "gay," and 33% self-identified as "bisexual." The main emergent theme was stigma. Subthemes related to stigma included: (a) homophobia in the Black and Latino community, (b) fear of losing support from family and friends, and (c) lack of support leading to low self-esteem. Addressing the stigma felt by BLMSM may be an important strategy to facilitate improved HIV prevention efforts, HIV care and treatment, and to decrease HIV-related disparities.
Collapse
Affiliation(s)
- Ashley Murray
- 1 Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA, USA
| | - Zaneta Gaul
- 1 Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA, USA.,2 ICF, Atlanta, GA, USA
| | | | - Jose Nanin
- 3 Kingsborough Community College, CUNY, New York, NY, USA
| |
Collapse
|
16
|
Bowleg L, Del Río-González AM, Holt SL, Pérez C, Massie JS, Mandell JE, A Boone C. Intersectional Epistemologies of Ignorance: How Behavioral and Social Science Research Shapes What We Know, Think We Know, and Don't Know About U.S. Black Men's Sexualities. JOURNAL OF SEX RESEARCH 2017; 54:577-603. [PMID: 28287844 DOI: 10.1080/00224499.2017.1295300] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Epistemologies of ignorance describe how ignorance influences the production of knowledge. Advancing an intersectional epistemologies of ignorance approach that examines how conscious (or unconscious) ignorance about racism, heterosexism, and classism shapes empirical knowledge about Black men's sexualities, we conducted a critical review of the behavioral and social science research on U.S. Black men, ages 18 and older, for two time frames: pre-1981 and the most recent decade, 2006-2016. Our search yielded 668 articles, which we classified into five categories: sexual violence, sexual experiences and expressions, sexual identities, cultural and social-structural influences, and sexual health and sexual risk. We found that most of the research, particularly pre-1981, centered the experiences of White heterosexual men as normative and implicitly constructed Black men as hypersexual or deviant. Most of the research also color-blinded White privilege and ignored how racism, heterosexism, and classism structured Black men's inequities. We also found notable exceptions to these trends. Black men who are gay, bisexual, or who have sex with men, and research on HIV risk were prominent in the past decade, as was research that emphasized the social-structural (e.g., poverty, heterosexism, racism) and cultural (e.g., masculinity, religion) contexts of Black men's lives and sexualities. We provide 10 recommendations to avoid intersectional epistemic ignorance in future research.
Collapse
Affiliation(s)
- Lisa Bowleg
- a Department of Psychology , The George Washington University
| | | | - Sidney L Holt
- a Department of Psychology , The George Washington University
| | - Carolin Pérez
- a Department of Psychology , The George Washington University
| | - Jenné S Massie
- a Department of Psychology , The George Washington University
| | | | - Cheriko A Boone
- a Department of Psychology , The George Washington University
| |
Collapse
|
17
|
Pence, Putin, Mbeki and Their HIV/AIDS-Related Crimes Against Humanity: Call for Social Justice and Behavioral Science Advocacy. AIDS Behav 2017; 21:963-967. [PMID: 28130629 DOI: 10.1007/s10461-017-1695-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Indiana, a large rural state in the Midwestern United States, suffered the worst North American HIV outbreak among injection drug users in years. The Indiana state government under former Governor and current US Vice President Mike Pence fueled the HIV outbreak by prohibiting needle/syringe exchange and failed to take substantive action once the outbreak was identified. This failure in public health policy parallels the HIV epidemics driven by oppressive drug laws in current day Russia and is reminiscent of the anti-science AIDS denialism of 1999-2007 South Africa. The argument that Russian President Putin and former South African President Mbeki should be held accountable for their AIDS policies as crimes against humanity can be extended to Vice President Pence. Social and behavioral scientists have a responsibility to inform the public of HIV prevention realities and to advocate for evidence-based public health policies to prevent future outbreaks of HIV infection.
Collapse
|
18
|
Gurski KF, Hoffman KA. Influence of concurrency, partner choice, and viral suppression on racial disparity in the prevalence of HIV infected women. Math Biosci 2016; 282:91-108. [PMID: 27712990 DOI: 10.1016/j.mbs.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
In 1992, Watts and May introduced a simple dynamical systems model of the spread of HIV based on disease transmission per partnership including the length of partnership duration. This model allowed for the treatment of concurrent partnerships, although it was hampered by the assumption of an important latent phase which generated a non-autonomous system. Subsequent models including concurrency have been based on networks, Monte Carlo, and stochastic simulations which lose a qualitative understanding of the effects of concurrency. We present a new autonomous deterministic model of the effect of concurrent sexual partnerships that allows for an analytical study of disease transmission. We incorporate the effect of concurrency through the newly derived force of infection term in a mathematical model of the transmission of HIV through sexual contact in a population stratified by sexual behavior and race/ethnicity. The model also includes variations in population mixing (partner choice) and non-uniform Highly Active Anti-Retroviral Treatment (HAART) leading to viral suppression. We use this mathematical model to understand the non-uniform spread of HIV in women who were infected through heterosexual contact. In addition, an analytical study shows the importance of continued condom use in virally suppressed MSM. Numerical simulations of the reproduction number as a function of concurrency, viral suppression level, and mixing show a reservoir of disease present in both heterosexual and MSM populations. Statistical analysis of parameter values show that viral suppression level, mixing and progression to AIDS without viral suppression have a strong correlation (either positive or negative) with the number of HIV positive women. Concurrency and assortative mixing are shown to be essential to reproduce infection levels in women, as reported by 2010 data from the Center for Disease Control (CDC).
Collapse
Affiliation(s)
- K F Gurski
- Department of Mathematics, Howard University, Washington, DC 20059, United States.
| | - K A Hoffman
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD, United States
| |
Collapse
|
19
|
Wilson BD, Miyashita A. Sexual and Gender Diversity within the Black Men who have Sex with Men HIV Epidemiological Category. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2016; 13:202-214. [PMID: 27525047 PMCID: PMC4980082 DOI: 10.1007/s13178-016-0219-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Epidemiological categories not only reflect existing frameworks for public health, but reify how subpopulations are defined, understood, and targeted for interventions. The sweeping categorization of Black men who have sex with men (BMSM) used in HIV research and intervention work is one such example. The current paper builds upon previous critiques of the "MSM" nomenclature by delineating the sexual and gender diversity embedded in the term as it pertains specifically to Black peoples. The emphasis is on developing greater specificity about the sociocultural and structural factors that may be shared among these subgroups, such as racism and poverty, and the factors that are likely to distinguish the groups, such as levels of sexual minority identification, access to lesbian, gay, bisexual, and transgender (LGBT) services and community, and experiences with anti-bisexual or anti-transgender bias. The aim then is to provide a framework for HIV health policy work for Black sexual minority cisgender men (SMCM) and gender minorities (GM).
Collapse
Affiliation(s)
- Bianca D.M. Wilson
- University of California, Los Angeles, School of Law, Williams Institute, Box 951476, Los Angeles, CA 90095-1476, United States of America
| | - Ayako Miyashita
- University of California, Los Angeles, School of Law, Williams Institute, Box 951476, Los Angeles, CA 90095-1476, United States of America
| |
Collapse
|
20
|
Lourie MA, Needham BL. Sexual Orientation Discordance and Young Adult Mental Health. J Youth Adolesc 2016; 46:943-954. [DOI: 10.1007/s10964-016-0553-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/25/2016] [Indexed: 11/24/2022]
|
21
|
Arnold EA, Operario D, Cornwell S, Benjamin M, Smith CD, Lockett G, Kegeles SM. The Development of a Counseling-Based HIV Prevention Intervention for African American Men Who Have Sex With Men and Women: The Bruthas Project. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:505-521. [PMID: 26595264 PMCID: PMC4661787 DOI: 10.1521/aeap.2015.27.6.505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
African American men who have sex with both men and women (AAMSMW) are at high risk for acquiring and transmitting HIV, yet few interventions exist to address their unique prevention needs. We conducted 3 focus groups, 21 in-depth interviews, and a pilot test of our intervention with = 61 AAMSMW, which showed significant reductions in sexual risk behavior after 6 months. The intervention is currently being tested in a randomized controlled trial (RCT). We discuss the development of a culturally tailored, theoretically grounded counseling intervention for AAMSMW, presenting findings from our formative research, intervention development process, pilot study, and the implementation of our RCT. We describe the content of each session, our protocol for merging Bruthas with HIV testing, and best practices for recruiting AAMSMW. If Bruthas is found to be efficacious, the intervention will reach a vulnerable population to encourage uptake of regular HIV testing and reduced sexual risk taking.
Collapse
|
22
|
Jiang H, Yin J, Fan Y, Liu J, Zhang Z, Liu L, Nie S. Gender difference in advanced HIV disease and late presentation according to European consensus definitions. Sci Rep 2015; 5:14543. [PMID: 26412578 PMCID: PMC4585954 DOI: 10.1038/srep14543] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/27/2015] [Indexed: 11/09/2022] Open
Abstract
Effectiveness of highly active antiretroviral therapy is limited for a large proportion of individuals living with HIV presenting for medical care at an advanced stage. Controversial results of gender differences in risk of late HIV diagnosis were reported among existing literatures. Therefore, we conducted this meta-analysis to synthesize a summary of gender differences in risk of advanced HIV disease (AHD) and late presentation (LP) according to European consensus definitions. Totally, 32 studies were included based on predetermined selection criteria. The pooled adjusted odds ratios of males presenting with AHD and LP compared with females were 1.73 (95% confidence interval [CI], 1.59-1.89) and 1.38 (95% CI, 1.18-1.62) with significant heterogeneity observed (I(2) = 78.50%, and I(2) = 85.60%, respectively). Subgroup analysis revealed that time lag, study location, number of patients, proportion of females, study design, number of adjusted variables might be potential source of heterogeneity. Sensitivity analysis showed robustness of the results. No publication bias was observed in studies on AHD or LP. The current meta-analysis indicated that males are at higher risk of AHD or LP compared with females. More attention should be paid to males to make sure early testing, diagnosis, and treatment, and ultimately improve individual and population health.
Collapse
Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Jieyun Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Yunzhou Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Jianhua Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Zhixia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| |
Collapse
|
23
|
Vagenas P, Zelenev A, Altice FL, Di Paola A, Jordan AO, Teixeira PA, Frew PM, Spaulding AC, Springer SA. HIV-infected men who have sex with men, before and after release from jail: the impact of age and race, results from a multi-site study. AIDS Care 2015; 28:22-31. [PMID: 26275122 PMCID: PMC4713253 DOI: 10.1080/09540121.2015.1062464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The US HIV/AIDS epidemic is concentrated among men who have sex with men (MSM). Black men are disproportionately affected by incarceration and Black MSM experience higher infection rates and worse HIV-related health outcomes compared to non-Black MSM. We compared HIV treatment outcomes for Black MSM to other HIV-infected men from one of the largest cohorts of HIV-infected jail detainees (N = 1270) transitioning to the community. Of the 574 HIV-infected men released, 113 (19.7%) self-identified as being MSM. Compared to other male subgroups, young Black MSM (<30 years old, N = 18) were significantly less likely: (1) before incarceration, to have insurance, access to an HIV healthcare provider, and use cocaine; (2) during incarceration, to receive a disease management intervention; and (3) in the 6 months post-release, to link to HIV care. Interventions that effectively link and retain young HIV-infected Black MSM in care in communities before incarceration and post-release from jail are urgently needed.
Collapse
Affiliation(s)
- Panagiotis Vagenas
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Alexei Zelenev
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Frederick L. Altice
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT
| | - Angela Di Paola
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| | - Alison O. Jordan
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Paul A. Teixeira
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Paula M. Frew
- Rollins School of Public Health, Emory University, Atlanta, GA
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Emory University Atlanta, GA
| | - Anne C. Spaulding
- Rollins School of Public Health, Emory University, Atlanta, GA
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Emory University Atlanta, GA
| | - Sandra A. Springer
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT
| |
Collapse
|
24
|
Clark CJ, Borowsky IW, Salisbury J, Usher J, Spencer RA, Przedworski JM, Renner LM, Fisher C, Everson-Rose SA. Disparities in long-term cardiovascular disease risk by sexual identity: The National Longitudinal Study of Adolescent to Adult Health. Prev Med 2015; 76:26-30. [PMID: 25849883 PMCID: PMC4559408 DOI: 10.1016/j.ypmed.2015.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine long-term cardiovascular disease (CVD) risk disparities by sexual identity using a nationally representative sample of young adults in the United States. METHODS Data include participants in wave 4 (2008/09; ages 24-34years) of the National Longitudinal Study of Adolescent to Adult Health (7087 females; 6340 males). Sexual identity was self-reported (heterosexual, mostly heterosexual, bisexual, mostly homosexual, homosexual) and a Framingham-based prediction model was used to estimate participants' risk of a CVD event over 30years. Differences in CVD risk by sexual identity, relative to heterosexuals, were calculated with linear regression models adjusted for age, race/ethnicity, education, and financial distress. RESULTS Average 30-year CVD risk was 17.2% (95% CI: 16.7, 17.7) in males and 9.0% (95% CI: 8.6, 9.3) in females. Compared to heterosexual females, mostly heterosexual (0.8%; 95% CI: 0.2, 1.4) and mostly homosexual females (2.8%; 95% CI: 0.8, 4.9) had higher CVD risk. Bisexual and homosexual females had higher but not statistically significant CVD risk compared to heterosexuals. Among males, differences in CVD risk by sexual identity were not statistically significant. CONCLUSION Sexual identity was associated with CVD risk in sexual minority subgroups. Population- and clinic-based prevention strategies are needed to minimize disparities in subsequent disease.
Collapse
Affiliation(s)
- Cari Jo Clark
- Department of Medicine, Division of Epidemiology and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware Street, SE, Ste 166, Minneapolis, MN 55414, United States.
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St., SE, Ste. 353, Minneapolis, MN 55414, United States.
| | - John Salisbury
- Rainbow Health Initiative, 2021 E Hennepin Ave #220, Minneapolis, MN 55413, United States.
| | - Joann Usher
- Rainbow Health Initiative, 2021 E Hennepin Ave #220, Minneapolis, MN 55413, United States.
| | - Rachael A Spencer
- Independent Researcher, Ponce de Leon Avenue, Atlanta, GA 30308, United States.
| | - Julia M Przedworski
- Division of Health Policy & Management, 420 Delaware St. S.E., MMC 729, Minneapolis, MN 55455, United States.
| | - Lynette M Renner
- School of Social Work, University of Minnesota, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, United States.
| | - Colleen Fisher
- School of Social Work, University of Minnesota, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, United States.
| | - Susan A Everson-Rose
- Department of Medicine, Program in Health Disparities Research, 717 Delaware St SE, #166, Minneapolis, MN 55414, United States.
| |
Collapse
|
25
|
Gordon LE, Silva TJ. Inhabiting the sexual landscape: toward an interpretive theory of the development of sexual orientation and identity. JOURNAL OF HOMOSEXUALITY 2015; 62:495-530. [PMID: 25397814 DOI: 10.1080/00918369.2014.986417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Building on Paula Rust's (1996) concept of a sexual landscape, we propose an interpretive theory of the development of both sexual orientation and sexual identity. We seek to reconcile human agency with active and shifting influences in social context and to recognize the inherent complexity of environmental factors while acknowledging the role that biological potential plays. We ground our model in the insights of three compatible and related theoretical perspectives: social constructionism, symbolic interactionism, and scripting theory. Within this framework, we explain how sexual orientation and sexual identities develop and potentially change.
Collapse
Affiliation(s)
- Liahna E Gordon
- a Department of Sociology , California State University, Chico , Chico , California , USA
| | | |
Collapse
|
26
|
Strutz KL, Herring AH, Halpern CT. Health disparities among young adult sexual minorities in the U.S. Am J Prev Med 2015; 48:76-88. [PMID: 25241194 PMCID: PMC4274226 DOI: 10.1016/j.amepre.2014.07.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 06/20/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emerging research suggests that young adult sexual minorities (identifying as lesbian, gay, or bisexual or engaging in same-sex attractions or behaviors) experience poorer health than their majority counterparts, but many measures of health inequity remain unexamined in population-based research. PURPOSE To describe a wide range of health status and healthcare access characteristics of sexual minorities in comparison with those of the majority population in a national sample of U.S. young adults. METHODS Binary and multinomial logistic regression analyses of Wave IV data (2008) from the National Longitudinal Study of Adolescent Health (participants aged 24-32 years, n=13,088) were conducted. Health measures were self-rated health; diagnosis of any of several physical or mental illnesses or sexually transmitted infections; measured BMI; depression classified from self-reported symptoms; use of antidepressant and anxiolytic medication; uninsured; forgone care; and receipt of physical, dental, and psychological services. Analyses were conducted in 2012-2013. RESULTS Sexual minority women had elevated odds of most adverse health conditions and lower odds of receiving a physical or dental examination. Sexual minority men had elevated odds of fewer adverse health conditions. CONCLUSIONS Young adult sexual minorities are at higher risk of poor physical and mental health. The results highlight the multidimensionality of sexual minority status and respond to calls for greater understanding of the health of this population.
Collapse
Affiliation(s)
- Kelly L Strutz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Amy H Herring
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolyn Tucker Halpern
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
27
|
MacCarthy S, Brignol S, Reddy M, Nunn A, Dourado I. Making the invisible, visible: a cross-sectional study of late presentation to HIV/AIDS services among men who have sex with men from a large urban center of Brazil. BMC Public Health 2014; 14:1313. [PMID: 25535408 PMCID: PMC4364329 DOI: 10.1186/1471-2458-14-1313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background Late presentation to testing, treatment and continued care has detrimental impacts on the health of HIV-positive individuals as well as their sexual partners’ health. Men who have sex with men (MSM) experience disproportionately high rates of HIV both globally and in Brazil. However, the factors that inhibit linkage to care among MSM remain unclear. Methods We conducted a cross-sectional study of HIV-positive MSM (n = 740) enrolled in HIV/AIDS services in a large urban center of Brazil from August 2010 to June 2011. Descriptive, bivariate and multivariate statistics were conducted using STATA 12 to examine the relationship between a range of variables and late presentation, defined as having a first CD4 count <350 cells/mm3. Results Within the sample, the prevalence of LP was 63.1%. Men who self-identified as heterosexual (AOR 1.54 and 95% CI 1.08 - 2.20) compared to men who self-identified as homosexual and bisexual were at increased odds of late presentation. Additionally, men age 30 and older (AOR 1.56, 95% CI 1.01 – 2.43) compared to individuals age 18–29 experienced increased odds of late presentation among MSM. Conclusions The prevalence of LP in this population was higher than noted in the global literature on LP among MSM. Heterosexual men and older age individuals experienced substantial barriers to HIV care. The stigma around same-sex behaviors and the current focus of HIV prevention and treatment campaigns on younger age individuals may limit patients’ and providers’ awareness of the risk for HIV and access to available services. In addition to addressing HIV-specific barriers to care, developing effective strategies to reduce late presentation in Brazil will require addressing social factors - such as stigma against diverse sexualities - to concretely identify and eliminate barriers to available services. Only in so doing can we make currently invisible people, visible.
Collapse
Affiliation(s)
- Sarah MacCarthy
- Rand Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | | | | | | | | |
Collapse
|
28
|
Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:99-106. [PMID: 24243002 PMCID: PMC4532732 DOI: 10.1007/s10508-013-0208-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Men who have sex with men (MSM) remain at great risk of HIV in the United States, representing 65 % of incident HIV infections. One factor contributing to the high rate of HIV infection among MSM is use of "recreational" drugs that are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis (PrEP) is a novel biomedical HIV prevention strategy that has the potential to reduce HIV transmission in MSM. Main and casual sex partners play a role in HIV prevention efforts for MSM. The study aimed to qualitatively explore the perceived influences of sexual relationships on promoting and inhibiting PrEP use among high-risk MSM who report regular drug use. Semi-structured qualitative interviews were conducted with 40 participants recruited in Boston, Massachusetts. Data were analyzed using descriptive qualitative analysis. Casual partners presented a distinct set of concerns from primary partnerships. MSM generally viewed main partners as a potential source of support for taking PrEP. Given their informal and often temporary nature, PrEP disclosure to casual partners was considered unnecessary. HIV-related stigma and substance use were also perceived as barriers to discussing PrEP use with casual partners. MSM articulated a high degree of personal agency regarding their ability to take PrEP. Findings suggest that behavioral interventions to improve PrEP utilization and adherence for high-risk MSM should be tailored to sex partner type and the parameters established between sex partners. Approaches to PrEP disclosure and partner engagement should be informed by the relative benefits and limitations characterized by these different types of relationships.
Collapse
Affiliation(s)
- Matthew J Mimiaga
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
| | | | | | | |
Collapse
|
29
|
Brennan DJ, Asakura K, George C, Newman PA, Giwa S, Hart TA, Souleymanov R, Betancourt G. "Never reflected anywhere": body image among ethnoracialized gay and bisexual men. Body Image 2013; 10:389-98. [PMID: 23648108 DOI: 10.1016/j.bodyim.2013.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n=61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.
Collapse
Affiliation(s)
- David J Brennan
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, ON, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Finneran C, Stephenson R. Intimate partner violence among men who have sex with men: a systematic review. TRAUMA, VIOLENCE & ABUSE 2013; 14:168-85. [PMID: 23271429 PMCID: PMC4046894 DOI: 10.1177/1524838012470034] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This article presents results from a systematic review of the literature on intimate partner violence (IPV) among U.S. men who have sex with men (MSM). From 576 reviewed studies, a total of 28 met inclusion criteria and were included in the analysis. The population characteristics of each study, definitions of IPV, prevalences of different forms of IPV, and statistically tested correlates of IPV are summarized for each study. The results indicate that all forms of IPV occur among MSM at rates similar to or higher than those documented among women, although data on perpetration rates of IPV are scant, and consensus as to IPV correlates among MSM is absent. This review also finds significant limitations in the reviewed literature, notably the lack of a standardized, validated definition of IPV among MSM; use of unspecific recall periods for IPV; a lack of attention to nonphysical, nonsexual forms of IPV; and near-universal use of cross-sectional, convenience samples of urban MSM. Researchers should develop and validate an MSM-specific definition of IPV, use more rigorous epidemiological methods to measure IPV and its effects, and clarify the mental and physical health outcomes associated with both receipt and perpetration of IPV.
Collapse
Affiliation(s)
- Catherine Finneran
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA.
| | | |
Collapse
|
31
|
Tobin KE, Cutchin M, Latkin CA, Takahashi LM. Social geographies of African American men who have sex with men (MSM): a qualitative exploration of the social, spatial and temporal context of HIV risk in Baltimore, Maryland. Health Place 2013; 22:1-6. [PMID: 23518256 DOI: 10.1016/j.healthplace.2013.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 02/12/2013] [Accepted: 02/17/2013] [Indexed: 11/24/2022]
Abstract
This qualitative study utilized a time-geography framework to explore the daily routines and daily paths of African American men who have sex with men (AA MSM) and how these shape HIV risk. Twenty AA MSM aged 18 years and older completed an in-depth interview. Findings revealed (1) paths and routines were differentiated by indicators of socio-economic status, namely employment and addiction, and (2) risk was situated within social and spatial processes that included dimensions of MSM disclosure and substance use. This study highlights the critical need for future research and interventions that incorporate the social and spatial dimensions of behavior to advance our ability to explain racial disparities in HIV and develop effective public health responses.
Collapse
Affiliation(s)
- K E Tobin
- Department of Health, Behavior and Society Bloomberg, School of Public Health Johns Hopkins University, 2213 McElderry Street, Second floor, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
32
|
Everett BG. Sexual orientation disparities in sexually transmitted infections: examining the intersection between sexual identity and sexual behavior. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:225-36. [PMID: 22350122 PMCID: PMC3575167 DOI: 10.1007/s10508-012-9902-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 08/27/2011] [Accepted: 12/01/2011] [Indexed: 05/18/2023]
Abstract
The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.
Collapse
Affiliation(s)
- Bethany G Everett
- Institute of Behavioral Science, Population Program, University of Colorado, Campus Box 484, Boulder, CO, 80309-0484, USA.
| |
Collapse
|
33
|
Calabrese SK, Rosenberger JG, Schick VR, Novak DS, Reece M. An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STDS 2013; 27:77-84. [PMID: 23373663 DOI: 10.1089/apc.2012.0355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM (n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention.
Collapse
Affiliation(s)
- Sarah K. Calabrese
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Joshua G. Rosenberger
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Vanessa R. Schick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts
| | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| |
Collapse
|
34
|
Kim HJ, Fredriksen-Goldsen KI. Nonresponse to a question on self-identified sexual orientation in a public health survey and its relationship to race and ethnicity. Am J Public Health 2013; 103:67-9. [PMID: 23153153 PMCID: PMC3518335 DOI: 10.2105/ajph.2012.300835] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2012] [Indexed: 11/04/2022]
Abstract
We examined whether nonresponse to the survey question on self-identified sexual orientation was associated with race and ethnicity, utilizing Washington State Behavioral Risk Factor Surveillance System data. The results of adjusted multinomial logistic regression indicated that the nonresponse rates of Asian Americans, Hispanics, and African Americans are higher than those of non-Hispanic Whites. Innovative ways of measuring sexual orientation to reduce racially and ethnically driven bias need to be developed and integrated into public health surveys.
Collapse
Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
| | | |
Collapse
|
35
|
Schrimshaw EW, Downing MJ, Siegel K. Sexual venue selection and strategies for concealment of same-sex behavior among non-disclosing men who have sex with men and women. JOURNAL OF HOMOSEXUALITY 2013; 60:120-45. [PMID: 23241205 PMCID: PMC3531913 DOI: 10.1080/00918369.2013.735945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In order to conceal their same-sex behavior, men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to female partners must be cautious in their attempts to find potential male partners. This study interviewed 46 non-gay-identified, non-disclosing MSMW to identify the venues where they meet male sexual partners and the strategies they use to reduce the likelihood of discovery when at such venues. Most (74%) reported meeting a male partner in a sexual venue (e.g., bar or club, park) in the past year. Strategies to reduce the risk of discovery while seeking male partners included: a) avoiding certain venues, b) attending venues away from home, c) meeting partners on the Internet, d) preferring venues that have potential nonsexual uses, e) having sex at the partner's place, and f) limiting their onsite sexual activities. These findings provide insight into the coping strategies these men use to manage the conflicting needs to conceal their behavior and meet sexual partners.
Collapse
Affiliation(s)
- Eric W Schrimshaw
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA.
| | | | | |
Collapse
|
36
|
Durso LE, Gates GJ. Best Practices: Collecting and Analyzing Data on Sexual Minorities. INTERNATIONAL HANDBOOK ON THE DEMOGRAPHY OF SEXUALITY 2013. [DOI: 10.1007/978-94-007-5512-3_3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
37
|
Paxton KC, Williams JK, Bolden S, Guzman Y, Harawa NT. HIV Risk Behaviors among African American Women with at-Risk Male Partners. ACTA ACUST UNITED AC 2013; 4:221. [PMID: 24455447 PMCID: PMC3895435 DOI: 10.4172/2155-6113.1000221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background HIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV. Method To understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach. Results Five themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships. Conclusion The findings of this study support that social and contextual factor such as emotional and financial issues, culture, history, and relationship dynamics need to be considered when developing tailored sexual health interventions for this population.
Collapse
Affiliation(s)
- Keisha C Paxton
- Department of Psychology, California State University, Dominguez Hills, USA
| | - John K Williams
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles (UCLA), USA
| | - Sherica Bolden
- Department of Psychology, California State University, Dominguez Hills, USA
| | | | - Nina T Harawa
- Department of Research/Medical Sciences Institute, College of Medicine, Charles R. Drew University of Medicine and Science, USA
| |
Collapse
|
38
|
Wagner GJ, Aunon FM, Kaplan RL, Karam R, Khouri D, Tohme J, Mokhbat J. Sexual stigma, psychological well-being and social engagement among men who have sex with men in Beirut, Lebanon. CULTURE, HEALTH & SEXUALITY 2013; 15:570-82. [PMID: 23730919 PMCID: PMC3742541 DOI: 10.1080/13691058.2013.775345] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This qualitative study sought to explore sexual identity development among men who have sex with men in Beirut, Lebanon; the stigma experienced by these men; and how their psychological well-being and social engagement are shaped by how they cope with this stigma. Semi-structured interviews were conducted with 31 men who have sex with men and content analysis was used to identify emergent themes. While many men reported feeling very comfortable with their sexual orientation and had disclosed their sexual orientation to family, most men struggled at least somewhat with their sexuality, often because of perceived stigma from others and internal religious conflict about the immorality of homosexuality. Most participants described experiencing verbal harassment or ridicule or being treated as different or lesser than in social relationships with friends or family. Mechanisms for coping with stigma included social avoidance (trying to pass as heterosexual and limiting interaction with men who have sex with men to the internet) or withdrawal from relationships in an attempt to limit exposure to stigma. Findings suggest that effective coping with both internal and external sexual stigma is central to the psychological well-being and social engagement of men who have sex with men in Beirut, much as has been found in Western gay communities.
Collapse
|
39
|
Benoit E, Pass M, Randolph D, Murray D, Downing MJ. Reaching and engaging non-gay identified, non-disclosing Black men who have sex with both men and women. CULTURE, HEALTH & SEXUALITY 2012; 14:975-90. [PMID: 22937767 PMCID: PMC3464186 DOI: 10.1080/13691058.2012.709640] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the men's need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City, including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities.
Collapse
Affiliation(s)
- Ellen Benoit
- National Development and Research Institutes Inc., New York, USA.
| | | | | | | | | |
Collapse
|
40
|
Maulsby C, Sifakis F, German D, Flynn CP, Holtgrave D. Differences and Similarities in HIV Testing Among Men Who have Sex with Men and Women (MSMW) and Men Who Have Sex with Men Only (MSMO). Open AIDS J 2012; 6:53-9. [PMID: 22833774 PMCID: PMC3401883 DOI: 10.2174/1874613601206010053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/12/2012] [Accepted: 04/23/2012] [Indexed: 11/22/2022] Open
Abstract
The study examined differences in HIV testing between men who have sex with men only (MSMO) (n=300) and men who have sex with men and women (MSMW) (n=105) and assessed associations with HIV testing among MSMW. A venue-based cross-sectional HIV surveillance study in 2008 (BESURE-MSM2) was examined. Prevalence of HIV testing was similar for MSMO and MSMW. One-on-one counseling (excluding counseling that is part of HIV testing) and having seen a health care provider in the past twelve months were associated with HIV testing in the past six months among MSMW in multivariate analyses. One-on-one counseling interventions may increase rates of HIV testing among MSMW.
Collapse
Affiliation(s)
- Cathy Maulsby
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
41
|
Mayer KH. Sexually transmitted diseases in men who have sex with men. Clin Infect Dis 2012; 53 Suppl 3:S79-83. [PMID: 22080272 DOI: 10.1093/cid/cir696] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men who have sex with men (MSM) have increased rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) compared with demographically matched controls. The reasons for the disproportionate infection burden are complex, including biological, behavioral, and sociocultural factors. HIV and syphilis may often be coprevalent among MSM. The use of nucleic acid amplification testing has enhanced the ability to detect frequently asymptomatic gonococcal and chlamydial infections of the rectum and other sites. Lymphogranuloma proctitis outbreaks among MSM were noted in the developed world several years ago but have not been common recently. MSM are at increased risk for viral hepatitis and anal human papillomavirus disease. Preventive interventions include vaccination for the former and anal cytologic screening for the latter. Because of the diverse ways in which MSM may be exposed to STDs, it is essential for clinicians to obtain a thorough sexual history in a culturally competent manner.
Collapse
Affiliation(s)
- Kenneth H Mayer
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| |
Collapse
|
42
|
Comparing Measures of Late HIV Diagnosis in Washington State. AIDS Res Treat 2011; 2012:182672. [PMID: 22162804 PMCID: PMC3226360 DOI: 10.1155/2012/182672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 08/26/2011] [Indexed: 11/18/2022] Open
Abstract
As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4+ results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis. We also conducted tests for trend to determine whether the proportion of cases diagnosed late has changed over time. Both measures lead us to similar conclusions about late HIV diagnosis, suggesting that being male, older, foreign-born, or heterosexual increase the likelihood of late HIV diagnosis. Our findings reaffirm the validity of a time-based definition of late HIV diagnosis, while at the same time demonstrating the potential value of a lab-based measure.
Collapse
|
43
|
Aholou TMC, Gale JE, Slater LM. African American clergy share perspectives on addressing sexual health and HIV prevention in premarital counseling: a pilot study. JOURNAL OF RELIGION AND HEALTH 2011; 50:330-347. [PMID: 19495984 DOI: 10.1007/s10943-009-9257-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 04/29/2009] [Indexed: 05/27/2023]
Abstract
This exploratory qualitative pilot study examined the extent to which seven African American clergy discussed and promoted sexual health dialogue with couples preparing for marriage. We explored the following topics: (a) clergy perspectives on disclosure; (b) clergy awareness about HIV/AIDS and (c) the extent to which clergy awareness about HIV is translated into their premarital counseling programs. Our results suggest that greater awareness and comfort level with discussions about sexuality mediate the inclusion of sexual health and promotion of HIV testing in premarital counseling.
Collapse
Affiliation(s)
- Tiffiany M Cummings Aholou
- Department of Child and Family Development, College of Family and Consumer Sciences, The University of Georgia, 123 Dawson Hall, Athens, GA 30602, USA.
| | | | | |
Collapse
|
44
|
Rosenberg ES, Sullivan PS, Dinenno EA, Salazar LF, Sanchez TH. Number of casual male sexual partners and associated factors among men who have sex with men: results from the National HIV Behavioral Surveillance system. BMC Public Health 2011; 11:189. [PMID: 21439069 PMCID: PMC3078881 DOI: 10.1186/1471-2458-11-189] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 03/25/2011] [Indexed: 11/12/2022] Open
Abstract
Background In 2006, the majority of new HIV infections were in MSM. We sought to describe numbers of casual sex partners among US MSM. Methods Data are from the first MSM cycle of the National HIV Behavioral Surveillance system, conducted from 2003 to 2005. Relationships between number of casual male sex partners within the previous year and demographic information, self-reported HIV status, and risk behaviors were determined through regression models. Results Among 11,191 sexually active MSM, 76% reported a casual male partner. The median casual partner number was three. Lower number of casual partners was associated with black race, Hispanic ethnicity, and having a main sex partner in the previous year. Factors associated with a higher number included gay identity, exchange sex, both injection and non-injection drug use. Being HIV-positive was associated with more partners among non-blacks only. Age differences in partner number were seen only among chat room users. Conclusions MSM who were black, Hispanic or had a main sex partner reported fewer casual sex partners. Our results suggest specific populations of MSM who may benefit most from interventions to reduce casual partner numbers.
Collapse
Affiliation(s)
- Eli S Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | | | | | | | | |
Collapse
|
45
|
Martínez-Donate AP, Zellner JA, Sañudo F, Fernandez-Cerdeño A, Hovell MF, Sipan CL, Engelberg M, Carrillo H. Hombres Sanos: evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with men and women. Am J Public Health 2010; 100:2532-40. [PMID: 21068423 PMCID: PMC2978169 DOI: 10.2105/ajph.2009.179648] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effectiveness of Hombres Sanos [Healthy Men] a social marketing campaign to increase condom use and HIV testing among heterosexually identified Latino men, especially among heterosexually identified Latino men who have sex with men and women (MSMW). METHODS Hombres Sanos was implemented in northern San Diego County, California, from June 2006 through December 2006. Every other month we conducted cross-sectional surveys with independent samples of heterosexually identified Latino men before (n = 626), during (n = 752), and after (n = 385) the campaign. Respondents were randomly selected from 12 targeted community venues to complete an anonymous, self-administered survey on sexual practices and testing for HIV and other sexually transmitted infections. About 5.6% of respondents (n = 98) were heterosexually identified Latino MSMW. RESULTS The intervention was associated with reduced rates of recent unprotected sex with both females and males among heterosexually identified Latino MSMW. The campaign was also associated with increases in perception of HIV risk, knowledge of testing locations, and condom carrying among heterosexual Latinos. CONCLUSIONS Social marketing represents a promising approach for abating HIV transmission among heterosexually identified Latinos, particularly for heterosexually identified Latino MSMW. Given the scarcity of evidence-based HIV prevention interventions for these populations, this prevention strategy warrants further investigation.
Collapse
Affiliation(s)
- Ana P Martínez-Donate
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Voetsch AC, Thomas PE, Johnson AS, Millett GA, Mundey L, Goode C, Nobles J, Sly K, Smith MR, Shiloh M, Song B, Green K, Dean H, Heffelfinger JD. Sex With Bisexual Men Among Black Female Students at Historically Black Colleges and Universities. J Natl Med Assoc 2010; 102:1198-205. [DOI: 10.1016/s0027-9684(15)30775-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
47
|
Salazar LF, Crosby RA, Head S, Siegler A. Male injecting drug users in the Deep South: bisexual behaviour is a marker for elevated HIV risk. Int J STD AIDS 2010; 21:691-6. [DOI: 10.1258/ijsa.2010.010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study determined whether bisexual male injecting drug users (IDUs) as compared with heterosexual IDUs were more likely to engage in HIV-associated risk behaviours. Respondent-driven sampling was employed to recruit a sample of 382 male IDUs residing in the southeastern USA. Data were collected in face-to-face interviews. Weighted analyses showed that bisexual IDUs in the past 12 months were 4.6 times as likely to share needles and 3.5 times as likely to share a cooker; having multiple female sexual partners and trading money or drugs for sex with women were marginally significant. Bisexual IDUs were 10 times as likely to self-report HIV. Male IDUs, who engage in bisexual behaviour, are also engaging in HIV-associated drug and to some degree sexual-risk behaviours with women more so than heterosexual IDUs. Their higher prevalence of HIV infection coupled with their risk behaviours place themselves and other IDUs at heightened risk of both acquiring and transmitting HIV.
Collapse
Affiliation(s)
- L F Salazar
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
- Emory Center for AIDS Research, Atlanta, GA
| | - R A Crosby
- College of Public Health, University of Kentucky, Lexington, KY
- Rural Center for AIDS/STD Prevention at Indiana University, Bloomington, IN, USA
| | - S Head
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
| | - A Siegler
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA
| |
Collapse
|
48
|
Chae DH, Krieger N, Bennett GG, Lindsey JC, Stoddard AM, Barbeau EM. Implications of Discrimination Based on Sexuality, Gender, and Race/Ethnicity for Psychological Distress among Working-Class Sexual Minorities: The United for Health Study, 2003–2004. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2010; 40:589-608. [DOI: 10.2190/hs.40.4.b] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated the distribution of demographic characteristics, the prevalence of discrimination based on sexuality, gender, and race, and relationships with psychological distress among 178 working-class sexual minorities (i.e., who identified as lesbian, gay, or bisexual (LGB) or had ever engaged in same-sex sexual behaviors) recruited to the United for Health Study (2003–2004). The results indicated considerable heterogeneity in responses to items assessing sexual orientation and sexual behavior, with a majority of sexual minority participants not identifying as LGB (74.2%). The authors found significant demographic differences in LGB identification by gender, race/ethnicity, nativity, and socioeconomic factors. In addition, LGB participants had higher levels of psychological distress than non-LGB-identified sexual minorities. Linear regression analyses revealed that reports of racial/ethnic discrimination and sexuality discrimination were associated with higher levels of psychological distress among sexual minority participants. The results underscore the need to collect multiple measures of sexuality in conducting research on racially diverse working-class communities; to consider demographic factors in collecting sexuality data; and to disaggregate information on sexuality by LGB identification. Findings also highlight the importance of addressing discrimination in ameliorating problematic mental health outcomes among working-class sexual minorities.
Collapse
|
49
|
Chae DH, Ayala G. Sexual orientation and sexual behavior among Latino and Asian Americans: implications for unfair treatment and psychological distress. JOURNAL OF SEX RESEARCH 2010; 47:451-459. [PMID: 19626536 DOI: 10.1080/00224490903100579] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Research on the sexuality of Asians and Latinos in the United States has been sparse, and the studies that have been done suffer from a number of limitations. Using data from the National Latino and Asian American Study (2002-2003), this study examined self-identified sexual orientation and self-reported sexual behavior among Latinos (n = 2,554; age: M = 38.1, SE = 0.5) and Asians (n = 2,095; age: M = 41.5, SE = 0.8). This study also investigated implications for unfair treatment and psychological distress among sexual minorities identified in the sample. Results indicated heterogeneity in responses to items assessing sexual orientation and sexual behavior including differences in the adoption of lesbian, gay, or bisexual (LGB) identity by gender, ethnicity, nativity, and socioeconomic status. LGB sexual minorities reported higher levels of unfair treatment and psychological distress compared to their non-LGB-identified sexual minority counterparts, and unfair treatment was positively associated with psychological distress. Results highlight the need to consider multiple demographic factors in assessing sexuality, and also suggest that measures of both self-identified sexual orientation and sexual behavior should be collected. In addition, findings provide support for the deleterious influence of unfair treatment among Asians and Latinos in the United States.
Collapse
Affiliation(s)
- David H Chae
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.
| | | |
Collapse
|
50
|
Abstract
OBJECTIVE Haitian-born persons have been historically stigmatized for introducing HIV to North America; however, no previous study has reported on the national HIV surveillance trends among this foreign-born group. METHODS Annual AIDS cases were estimated for adults and adolescents (aged >12 years) from all 50 US states and the District of Columbia who were diagnosed between 1985 and 2007, and who reported 'Haiti' as country of birth to the Centers for Disease Control and Prevention. HIV data (with or without AIDS) for Haitian-born adults and adolescents diagnosed between 2004 and 2007 were obtained from 34 US states. Denominators for AIDS rates by race/ethnicity are from postcensal estimates, the American Community Survey of the US Census Bureau and the Haitian Consulates. RESULTS In 2007, Haitian-born persons constituted 1.2% of US AIDS cases, yet accounted for 0.18% of the total US population based on the American Community Survey estimates, which suggests a seven-fold overrepresentation in the CDC AIDS surveillance data. However, when using population estimates from the Haitian Consulate, the overrepresentation ranges from three-to-four-fold, which is similar to the AIDS rate for blacks/African-Americans. CONCLUSION The importance of having accurate denominators to estimate the AIDS rate for the Haitian population is paramount.
Collapse
|