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Wiginton JM, Murray SM, Algarin AB, Baral SD, Sanchez TH, Smith LR. Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses. BMC Infect Dis 2022; 22:690. [PMID: 35964006 PMCID: PMC9375942 DOI: 10.1186/s12879-022-07672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.
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Affiliation(s)
- John Mark Wiginton
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Medicine, University of California-San Diego, San Diego, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
| | - Stefan D Baral
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
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Operario D, Sun S, Bermudez AN, Masa R, Shangani S, van der Elst E, Sanders E. Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men. Lancet HIV 2022; 9:e574-e584. [PMID: 35750058 PMCID: PMC7613577 DOI: 10.1016/s2352-3018(22)00076-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM.
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Ouafik MR, Buret L, Scholtes B. Mapping the current knowledge in syndemic research applied to men who have sex with men: A scoping review. Soc Sci Med 2022; 306:115162. [PMID: 35779501 DOI: 10.1016/j.socscimed.2022.115162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022]
Abstract
Men who have sex with Men (MSM) represent a population affected by numerous health conditions. Syndemic theory has been used as a framework to study the health of MSM for nearly 20 years. However, the literature is plagued by a lack of consensus regarding what constitutes a synergy in a syndemic and recent reviews have shown that most of the papers published thus far have failed to demonstrate a synergy nor describe the bio-social interaction needed to account for a true syndemic. Moreover, to our knowledge, none of the existing reviews have focused specifically on MSM. This scoping review aims to fill this gap by mapping in detail how syndemic research on MSM has been conducted. A systematic database search was conducted between 2020 and 2021 and 115 studies were included. Our findings showed a lack of diversity regarding the location, design, subpopulation, and outcomes studied. In addition, the syndemic conditions, as well as their measurement, were not focused enough to ensure the robustness and reproducibility of the findings. Furthermore, our results support previous reviews showing a lack of empirical data to support disease interaction in syndemic research applied to MSM. Our review offers some important recommendations to help move the field forward in future work and describes some promising methodological advances.
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Affiliation(s)
- Maxence R Ouafik
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Laetitia Buret
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
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Dworkin ER, Krahé B, Zinzow H. The Global Prevalence of Sexual Assault: A Systematic Review of International Research Since 2010. PSYCHOLOGY OF VIOLENCE 2021; 11:497-508. [PMID: 34737898 PMCID: PMC8562086 DOI: 10.1037/vio0000374] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We present a review of peer-reviewed English-language studies conducted outside the United States and Canada on the prevalence of sexual assault victimization in adolescence and adulthood published since 2010. METHOD A systematic literature search yielded 32 articles reporting on 45 studies from 29 countries. Studies that only provided prevalence estimates for sexual assault in intimate relationships or did not present separate rates for men and women were excluded. All studies were coded by two coders, and a risk of bias score was calculated for each study. Both past-year and prevalence rates covering longer periods were extracted. RESULTS The largest number of studies came from Europe (n=21), followed by Africa (n=11), Asia and Latin America (n=6 each). One study came from the Middle East and no studies were found from Oceania. Across the 22 studies that reported past-year prevalence rates, figures ranged from 0% to 59.2% for women, 0.3% to 55.5% for men, and 1.5% to 18.2% for LGBT samples. The average risk of bias score was 5.7 out of 10. Studies varied widely in methodology. CONCLUSION Despite regional variation, most studies indicate that sexual assault is widespread. More sustained, systematic, and coordinated research efforts are needed to gauge the scale of sexual assault in different parts of the world and to develop prevention measures.
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Boyd DT, Ramos SR, Quinn CR, Jones KV, Wilton L, Nelson LE. Family Support and Sociocultural Factors on Depression among Black and Latinx Sexual Minority Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6759. [PMID: 34201780 PMCID: PMC8268525 DOI: 10.3390/ijerph18136759] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Family-based approaches are critical for improving health outcomes in sexual minority men (SMM) of color. Yet, it is unclear how family context, internalized homophobia, and stress influence mental health outcomes among sexual minority men of color. From a cross-sectional sample of 448 participants, aged 16-24 years, survey data were analyzed to examine rates of family social support, the perception of sexuality by family, the stressfulness of life events, internalized homophobia, and other contextual variables on depression using linear regression. Our results indicated that an 86% increase in family social support was related to a -0.14 decrease in depression (ß = -0.14, p = 0.004). In addition, SMM who were separated by family and friends because of their sexuality were statistically significant and positively associated with depression (ß = 0.09, p < 0.001). Findings from our study suggest that the influence from the microsystem is salient in modifying mental health outcomes for SMM of color.
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Affiliation(s)
- Donte T. Boyd
- College of Social Work, Ohio State University, Columbus, OH 43210, USA;
- Center for Interdisciplinary Research on AIDS, New Haven, CT 06510, USA;
| | - S. Raquel Ramos
- Department, Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
| | - Camille R. Quinn
- College of Social Work, Ohio State University, Columbus, OH 43210, USA;
| | - Kristian V. Jones
- School of Social Work, University of Texas at Austin, Austin, TX 78712, USA;
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY 13902, USA;
- Faculty of Humanities, University of Johannesburg, Johannesburg 2006, South Africa
| | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, New Haven, CT 06510, USA;
- School of Nursing, Yale University, New Haven, CT 06477, USA
- St. Michael’s Hospital, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, ON M5B 1W8, Canada
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Rahmayani M, Waluyo A, Maria R. Sexual violence experiences and pornography media exposure with sexual risk behavior among PLWHA MSM in Bandung, Indonesia. J Public Health Res 2021; 10. [PMID: 34060744 PMCID: PMC9309623 DOI: 10.4081/jphr.2021.2338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background HIV number continues to increase, especially among the minority of Men who
have Sex with Men (MSM) due to the high risks of their sexual behavior. This
study aims to identify the correlation between sexual violence experiences
and pornography media exposure to sexual risk behavior among people with
HIV/AIDS (PLWHA) MSM. Design and Method The study employed a cross-sectional design with the consecutive sampling
technique and involved 258 PLWHA MSM under the guidance of an NGO in
Bandung, Jawa Barat, Indonesia. The data were collected by employing an
online questionnaire. Result The results show that there is a significant correlation between sexual
violence experiences and sexual risk behavior (p-value = 0.000, α = 0.05; OR
= 6.496), pornography media exposure and sexual risk behavior (p-value =
0.000, α = 0.05; OR = 4.271). The multivariate analysis of multiple
logistics regression results reveals that the sexual violence experience is
the factor that mostly influences the sexual risk behavior among PLWHA MSM
(p-value = 0.000, α = 0.05; OR = 3.784). Conclusions The sexual violence experiences and pornography media exposure have a
significant positive relationship to sexual risk behavior. Therefore, nurses
need to improve a comprehensive assessment, counseling, and personal
education to reduce sexual risk behavior that can transmit HIV and other
sexually transmitted diseases and create innovations through positive
activities to reduce pornography consumption.
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Affiliation(s)
- Melly Rahmayani
- Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Agung Waluyo
- Department of Medical surgical Nursing Faculty of Nursing, Universitas Indonesia, Depok.
| | - Riri Maria
- Department of Medical surgical Nursing Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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Couture MC, Evans JL, Draughon Moret J, Stein ES, Muth S, Phou M, Len A, Ngak S, Sophal C, Neak Y, Carrico AW, Maher L, Page K. Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:3055-3064. [PMID: 32342257 PMCID: PMC7935451 DOI: 10.1007/s10508-020-01705-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 05/23/2023]
Abstract
Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic framework to examine the effects of co-occurring psychosocial conditions on the risk of client-perpetrated physical and sexual violence against FESW. Data were collected among 1198 Cambodian FESW on recent client-perpetrated physical and sexual violence, and psychosocial conditions (psychological distress, alcohol consumption, amphetamine-type stimulant (ATS) use, debts, housing, and food insecurity). Bivariate and multivariate logistic regressions were conducted. Prevalence of physical and sexual violence from clients was 4.8% and 6.9%, respectively. Client-perpetrated physical violence was associated with housing insecurity, ATS use, and psychological distress. All psychosocial conditions, except ATS, were associated with exposure to sexual violence. In multivariable models, odds of client-perpetrated physical violence were twice higher among women with ≥ 4 compared to ≤ 3 psychosocial conditions. Risk of sexual violence increased with the number of psychosocial conditions. Compared to those with ≤ 1 condition, FESW with two psychosocial conditions had twice the odds (AOR = 2.08; 95% CI 1.00-4.31) and women with 5-6 psychosocial conditions had eightfold higher odds (AOR = 8.10; 95% CI 3.4-19.31) of sexual violence from clients. Our findings support a syndemic model of co-occurring psychosocial conditions among FESW that are associated with increased risk of violence. Violence prevention interventions targeting FESW should adopt comprehensive approaches that address co-occurring psychosocial conditions.
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Affiliation(s)
- Marie-Claude Couture
- Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton, San Francisco, CA, 94117, USA.
| | - Jennifer L Evans
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Draughon Moret
- The Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Ellen S Stein
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Chhit Sophal
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Yuthea Neak
- National Authority for Combating Drugs, Phnom Penh, Cambodia
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Passaro RC, Segura ER, Gonzales-Saavedra W, Lake JE, Perez-Brumer A, Shoptaw S, Dilley J, Cabello R, Clark JL. Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2703-2713. [PMID: 32270400 PMCID: PMC7494565 DOI: 10.1007/s10508-020-01682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 06/11/2023]
Abstract
To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.
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Affiliation(s)
- R Colby Passaro
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA.
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, TX, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven Shoptaw
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - James Dilley
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Robinson Cabello
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Asociación Civil Via Libre, Lima, Peru
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., CHS 37-121, Los Angeles, CA, 90095-1688, USA
- Department of Family Medicine, Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
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Flanders CE, Anderson RE, Tarasoff LA. Young Bisexual People's Experiences of Sexual Violence: A Mixed-Methods Study. JOURNAL OF BISEXUALITY 2020; 20:202-232. [PMID: 36213598 PMCID: PMC9536248 DOI: 10.1080/15299716.2020.1791300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bisexual people are at an increased vulnerability for sexual victimization in comparison to heterosexual people, as well as gay and lesbian people. As the majority of first sexual violence experiences happen prior to age 25 for bisexual women, young bisexual people are particularly vulnerable. Despite consistent evidence of this health disparity, little is known about what factors might increase young bisexual people's risk for sexual victimization, or how they access support post-victimization. The current study addresses this gap through a mixed-method investigation of young bisexual people's experiences of sexual violence with a sample of 245 bisexual people age 18-25. Quantitative results indicate that bisexual stigma significantly predicts a greater likelihood of reporting an experience of sexual violence. Qualitative findings support that while not all participants felt bisexual stigma related to their experience of sexual violence, some felt negative bisexual stereotypes were substantial factors. Interview participants found connecting with other survivors, particularly LGBTQ+ and bisexual survivors, to be beneficial. Some participants encountered barriers to accessing support, such as discrimination in schools. Sexual violence researchers should consider bisexual stigma as an important factor, and support services the potential positive impact of bisexual-specific survivor support.
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Affiliation(s)
- Corey E. Flanders
- Department of Psychology and Education, Mount Holyoke College, South Hadley, MA, USA
| | - RaeAnn E. Anderson
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Lesley A. Tarasoff
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, ON, Canada
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Prevalence of depression, anxiety and suicide among men who have sex with men in China: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e136. [PMID: 32536353 PMCID: PMC7303796 DOI: 10.1017/s2045796020000487] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Chinese men who have sex with men (MSM) are at high risk for depression, anxiety and suicide. The estimated prevalence of these problems is essential to guide public health policy, but published results vary. This meta-analysis aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and suicide among Chinese MSM. METHODS Systematic searches of EMBASE, MEDLINE, PsycINFO, PubMed, CNKI and Wanfang databases with languages restricted to Chinese and English for studies published before 10 September 2019 on the prevalence of depressive symptoms, anxiety symptoms, suicidal ideation, suicide plans and suicide attempts among Chinese MSM. Studies that were published in the peer-reviewed journals and used validated instruments to assess depression and anxiety were included. The characteristics of studies and the prevalence of depression and anxiety symptoms, suicidal ideation, suicide plans and suicide attempts were independently extracted by authors. Random-effects modelling was used to estimate the pooled rates. Subgroup analysis and univariate meta-regression were conducted to explore potential sources of heterogeneity. This study followed the PRISMA and MOOSE. RESULTS Sixty-seven studies were included. Fifty-two studies reported the prevalence of depressive symptoms, with a combined sample of 37 376 people, of whom 12 887 [43.2%; 95% confidence interval (CI), 38.9-47.5] reported depressive symptoms. Twenty-seven studies reported the prevalence of anxiety symptoms, with a combined sample of 10 531 people, of whom 3187 (32.2%; 95% CI, 28.3-36.6) reported anxiety symptoms. Twenty-three studies reported the prevalence of suicidal ideation, with a combined sample of 15 034 people, of whom 3416 (21.2%; 95% CI, 18.3-24.5) had suicidal ideation. Nine studies reported the prevalence of suicide plans, with a combined sample of 5271 people, of whom 401 (6.2%; 95% CI, 3.9-8.6) had suicide plans. Finally, 19 studies reported the prevalence of suicide attempts, with a combined sample of 27 936 people, of whom 1829 (7.3%; 95% CI, 5.6-9.0) had attempted suicide. CONCLUSIONS The mental health of Chinese MSM is poor compared with the general population. Efforts are warranted to develop interventions to prevent and alleviate mental health problems among this vulnerable population.
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Ulanja MB, Lyons C, Ketende S, Stahlman S, Diouf D, Kouamé A, Ezouatchi R, Bamba A, Drame F, Liestman B, Baral S. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:11. [PMID: 30832673 PMCID: PMC6399955 DOI: 10.1186/s12914-019-0186-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. METHODS 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. RESULTS Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. CONCLUSION Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
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Affiliation(s)
- Mark B Ulanja
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | | | | | | | | | - Ben Liestman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Programme National de Lutte contre le Sida, Ministère de la Santé et de la Lutte contre le Sida, Abidjan, Côte d'Ivoire.
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Hernández-Rosete D. La violencia juvenil contra emos: análisis etnográfico de su persecución en la Ciudad de México. CAD SAUDE PUBLICA 2017; 33:e00080116. [DOI: 10.1590/0102-311x00080116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 03/22/2017] [Indexed: 11/22/2022] Open
Abstract
El objetivo de este artículo es describir las creencias que han alimentado el odio y las prácticas de violencia, ejercida por diversos sectores, contra varones y mujeres que se identifican a sí mismos como emos en la Ciudad de México. Se trata de un estudio etnográfico, realizado entre 2012 y 2015, apoyado en 24 entrevistas en profundidad a jóvenes estudiantes que en 2008 cursaban algún grado de bachillerato en universidades públicas en la Ciudad de México. Se privilegia la narrativa de los emos (10); sin embargo, se exploraron también los relatos de jóvenes que se consideran punks (6), darks (5) y metaleros (3). Los hallazgos sugieren que las agresiones contra emos tienen un fuerte arraigo en creencias de género, particularmente en la noción de masculinidad hegemónica. Destaca el hecho de que no sólo provienen de colectivos juveniles, también aparece la vida familiar y escolar como contextos de violencia naturalizada y construida como legítima por su vínculo con la noción de disciplina escolar. Las estrategias utilizadas por estos jóvenes para resistir la violencia sugieren posicionamientos reflexivos frente a su contexto histórico, escolar y familiar. Aunque como colectivo lograron colocar su exigencia del derecho a la educación y a la diversidad en aulas universitarias, se advierte la necesidad de diseñar políticas de prevención de violencia, particularmente en contextos escolares universitarios.
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Semple SJ, Pitpitan EV, Goodman-Meza D, Strathdee SA, Chavarin CV, Rangel G, Torres K, Patterson TL. Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues. PLoS One 2017; 12:e0186814. [PMID: 29065132 PMCID: PMC5655432 DOI: 10.1371/journal.pone.0186814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, United States of America
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Claudia V Chavarin
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | | | - Karla Torres
- Agencia Familiar Binacional, A.C., Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Factors Associated with Sexual Risk of HIV Transmission Among HIV-Positive Latino Men Who have Sex with Men on the U.S.-México Border. AIDS Behav 2017; 21:923-934. [PMID: 27278549 DOI: 10.1007/s10461-016-1449-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present results from a cross-sectional, clinic-based survey of border-region Latino men who have sex with men (MSM) and who also are living with HIV in the El Paso-Ciudad Juárez area. Among the 66 participants who reported serodiscordant anal or vaginal intercourse, we examined levels of psychological distress and substance use and the association of these variables with condomless sex. Bivariate analyses indicated that MSM who reported condomless sex with a serodiscordant partner were more likely to report higher scores on measures of anxiety, depression, and trauma. These men were also more likely to report more days of alcohol use to the point of intoxication. In multivariate logistic regression, no variables were independently associated with sexual risk behavior, but symptoms of anxiety trended toward statistical significance. Our study is one of few reports aimed at understanding the HIV epidemic among Latino MSM living with HIV in the El Paso-Ciudad Juárez border region. Although we found no evidence of a relation between our measures of psychological distress and substance use and sexual risk behavior in multivariate analyses, psychological distress and problematic alcohol use were common in the sample and are important targets for intervention in their own right.
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