Modeling the Impact of Race, Socioeconomic Status, Discrimination and Cognitive Appraisal on Mental Health Concerns Among Heavy Drinking HIV+ Cisgender MSM

Sexually Explicit Media Exposure, Sexual Violence Victimization, and Sexual Risk Behaviors Among HIV-Positive Men Who Have Sex with Men with New Drug Abuse in Jinan, China

Abuse of new drugs, such as Rush poppers, methamphetamine, Magu, Ketamine, and Ecstasy, is common among men who have sex with men (MSM) in China, leading to increased risks of sexually explicit media consumption, sexual violence, and sexual risk behaviors. This study aimed to explore the prevalence and relationships of these behaviors among MSM with new drug abuse. A cross-sectional study was conducted from January to June 2021, involving 453 MSM in Jinan, China. Participants completed an online questionnaire assessing behaviors over the past six months. Multiple linear regressions were conducted to investigate the correlations among the three behaviors. Results showed that 88.7% consumed sexually explicit media, and 48.3% experienced sexual violence. Regarding sexual risk behaviors, the prevalence rates for group sex, condomless anal intercourse, and commercial sex were 29.1%, 76.4%, and 11.0%, respectively. New drug abuse was positively correlated with sexual violence victimization (b = 0.38 for methamphetamine; b = 0.50 for Magu), media consumption (b = 1.58 for methamphetamine), and sexual risk behaviors (b = 0.94 for methamphetamine; b = 0.72 for Magu). The age at first exposure to sexually explicit media was negatively correlated with sexual violence victimization (b = - 0.09) and sexual risk behaviors (b = - 0.30). Preferences for violence in media were linked to higher sexual violence risk (b = 0.76), and preferences for condomless anal intercourse and group sex to higher sexual risk behaviors (b = 1.04; b = 0.83). Significant positive correlations were found among sexual violence victimization, media consumption, and sexual risk behaviors (r = 0.22-0.82, p < 0.05). These findings provide insights for future interventions to prevent HIV transmission among MSM with new drug.

Effects of optimism and stage of change on alcohol use and problems among sexual minority men with HIV participating in a brief motivational interviewing intervention

INTRODUCTION

Disseminating effective alcohol interventions for sexual minority men (SMM) with HIV remains a crucial public health endeavor. Motivational interviewing (MI) interventions are an established approach to reducing alcohol use, yet more research is needed to determine predictors of MI treatment outcomes and underlying mechanisms related to sustained behavior change among SMM with HIV. This pre-registered secondary analysis tested whether action-related stage of change mediated effects of a MI intervention on future alcohol use and problems among SMM with HIV, and whether individual differences in trait optimism moderated these associations.

METHODS

SMM with HIV who engaged in frequent alcohol use (N = 180) were randomized to MI or assessment-only treatment as usual (TAU). Participants completed a semi-structured Timeline Follow-Back interview to measure past-month alcohol use as well as self-reports assessing stage of change, trait optimism, and alcohol problems at baseline and 3- and 12-months post-baseline.

RESULTS

Structural equation models controlling for baseline alcohol use and stage of change indicated that 3-month action significantly mediated effects of MI on 12-month drinks per week. Likewise, the indirect effect of 3-month action was moderated by higher levels of trait optimism. When employment status, education level, and annual family/household income were included as covariates in the model, being employed significantly predicted 12-month alcohol use, and mediation and moderated mediation effects were no longer statistically significant. Stage of change did not mediate effects of MI on 12-month alcohol problems, and this indirect effect was not moderated by trait optimism.

CONCLUSIONS

The present study provides further evidence supporting action-related stage of change as a mechanism linking MI to alcohol use reductions. Results demonstrated that SMM with HIV who were more optimistic tended to take more action towards reducing their alcohol use and suggest that MI-based interventions may benefit from integrating components aimed at augmenting patients' optimism. Yet, covarying for current economic status substantially impacted findings and underscores the need to critically consider how broader socioecological contexts can impact treatment outcomes.

HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review

BACKGROUND

Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored.

OBJECTIVE

This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada.

METHODS

We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed.

RESULTS

Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV.

CONCLUSIONS

Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-043055.

Intersectional forms of racism and sexual minority stress are associated with alcohol use among Latinx sexual minority men with greater Hispanic/Latinx cultural orientation

Background: Latinx sexual minorities with increased levels of acculturation report higher rates of alcohol use, and discrimination may impact this association. Yet, there is little research examining the concomitant impact of racism and sexual minority stress (i.e. intersectional discrimination) and the additive effect of acculturation on Latinx sexual minority men's risk for hazardous alcohol consumption.Objectives: This study investigated the role of perceived stressfulness of intersectional discrimination in the relation between acculturation (US cultural orientation/Hispanic cultural orientation) and alcohol use among Latinx sexual minority men.Methods: A structural equation model was utilized to test the indirect effect of discrimination between acculturation and alcohol use with a sample of 357 Latinx sexual minority men (M_age = 28.39) recruited via Amazon MTurk.Results: The indirect effect between the Hispanic cultural orientation to alcohol use through intersectional forms of discrimination was significant and positive (b = .19, SE = .03, p < .01). The indirect effect for the US cultural orientation to alcohol use through intersectional forms of discrimination was significant and negative (b = -.10, SE = .03, p < .01).Conclusion: Contrary to previous literature, Latinx sexual minority men with a higher Hispanic cultural orientation reported higher levels of intersectional forms of discrimination, which in turn was associated with increased alcohol use. Those with a higher US cultural orientation reported lower levels of intersectional forms of discrimination, which in turn was associated with decreased alcohol use. These findings may help identify mechanisms that exacerbate health disparities for Latinx sexual minority men.

Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory

There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.