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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dawes HC, Eden TM, Hall WJ, Srivastava A, Williams DY, Matthews DD. Which types of social support matter for Black sexual minority men coping with internalized homophobia? Findings from a mediation analysis. Front Psychol 2024; 15:1235920. [PMID: 38379621 PMCID: PMC10876838 DOI: 10.3389/fpsyg.2024.1235920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
Background Minority stress theory views social support as a protective factor against the effects of minority-specific stressors like internalized homophobia (IH) on mental health in sexual minority populations. However, much of the empirical validation of this theory has been conducted within predominantly White samples, resulting in a limited understanding of how the theory applies to Black sexual minority individuals. Current examinations of social support fail to capture the nuances of how Black sexual minority men may access support systems differently, resulting in a need to investigate how social support, IH, and mental health operate for Black sexual minority men. This study examined relationships between IH, depression, and different types of social support (i.e., family, friends, Black community, gay community) using a mediation model. Methods We used data from the POWER (Promoting Our Worth Equity and Resilience) Study, which recruited Black sexual minority men at Black Pride events across six cities in the United States from 2014 to 2017, to test four mediation pathways concurrently in Stata 17. Participants (N = 4,430) completed a questionnaire assessing a variety of health and life domains, including depression symptoms, internalized homophobia, and social support. Results IH was positively associated with depression. Lower levels of family, friend, and Black community support were all positively associated with depression symptoms. Additionally, IH was positively associated with all types of support. Finally, family, friend, and Black community support partially mediated the relationship between IH and depression. Conclusions and implications Results suggest that the relationship between social support and depression is complex for Black sexual minority men. Findings suggest family support is an important factor for clinical intervention efforts targeting depression, and that gay community support systems should assess how their environments can better support Black sexual minority men. Overall, findings demonstrate the necessity of future examination of how social support functions differently within Black sexual minority communities.
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Affiliation(s)
- Hayden C. Dawes
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tiffany M. Eden
- Department of Public Mental Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, United States
| | - William J. Hall
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ankur Srivastava
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Denise Yookong Williams
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Derrick D. Matthews
- Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Shamrock OW, Abu-Ba'are GR, Zigah EY, Apreku A, Agbemedu GRK, Boyd DT, Adjaka G, Nelson LE. Family rejection of non-hetero sexuality-Sexual orientation and behavior anonymity among sexual minority men in slum communities-BSGH 001. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001659. [PMID: 38039264 PMCID: PMC10691700 DOI: 10.1371/journal.pgph.0001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
It can be challenging for sexual minority men (SMM) to decide whether or not to disclose their sexual orientation or behavior. The implications of this decision are significant, especially when considering how their family might react. We interviewed individuals living in slum communities (n = 12) in Accra and Kumasi, Ghana. Our study found that two factors primarily influenced the decision of SMM to disclose their sexual orientation. Firstly, SMM feared facing harm from their families and, secondly, the close ties of SMM families to religious institutions in their communities, which taught against LGBTQ+ activities in the country. These findings contribute to understanding why SMM in Ghanaian slum communities choose to keep their sexual orientation anonymous. While no single intervention is enough to address the challenges associated with coming out, participants in the study agreed that a social support intervention that provides opportunities to educate and inform their families and community on LGBTQ+ activities could help them assimilate comfortably in their communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, Ohio, United States of America
| | | | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
- School of Nursing, Yale, Connecticut, United States of America
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Corey J, Duggan M, Travers Á. Risk and Protective Factors for Intimate Partner Violence Against Bisexual Victims: A Systematic Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2130-2142. [PMID: 35435063 PMCID: PMC10486155 DOI: 10.1177/15248380221084749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bisexual-identifying individuals appear to be at increased risk of experiencing intimate partner violence (IPV) compared to people of other sexualities. The purpose of this systematic scoping review was to examine risk and protective factors for the perpetration of IPV against bisexual victims and to provide a preliminary quality assessment of the included studies. A systematic search of academic and grey literature was conducted in February 2021. Inclusion criteria specified that study participants identified as bisexual, that the study examined risk or protective factors for IPV, and that findings were disaggregated by sexual identity. All potentially eligible references were independently screened by two reviewers, and conflicts settled by a third reviewer. Nine articles published between 2013 and 2021 met criteria for inclusion. Data extraction was completed for all included studies, and findings presented in a narrative synthesis. The review identified a number of risk factors, including bisexual identity, internalised homophobia, discrimination, partner gender, negative childhood experiences and non-monogamy. One study included consideration of a potentially protective factor. The majority of the included studies were cross-sectional in design. More longitudinal studies are needed to clarify temporality of the associations identified and better inform support and prevention efforts. Further implications for future research, policies and practise are discussed.
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Affiliation(s)
- Julia Corey
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Marian Duggan
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Áine Travers
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
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Driver R, Schneider JA, Hickson DA, Timmins L, Brewer RA, Goedel WC, Duncan DT. Sexual Orientation, HIV Vulnerability-Enhancing Behaviors and HIV Status Neutral Care Among Black Cisgender Sexual Minority Men in the Deep South: The N2 Cohort Study. AIDS Behav 2023; 27:2592-2605. [PMID: 36648630 PMCID: PMC11034832 DOI: 10.1007/s10461-023-03984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Black sexual minority men (SMM) in the Deep South are heavily impacted by HIV; yet studies fail to consider discordance across aspects of sexual orientation (i.e., identity, attraction, behavior) or how a lack of concordance enhances vulnerability to HIV. We sought to explore the overlap across aspects of sexual orientation and examine associations between each aspect and the number of sexual partners who engaged in HIV vulnerability-enhancing behaviors, and HIV prevention and care outcomes. A total of 204 Black SMM completed surveys, reporting their sexual identity, attraction, and behavior (i.e., sex with men only vs. sex with men and women), number of condomless sex or transactional sex (e.g., buyers vs. sellers) partners in the past 6 months, and adherence to pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) among users. Less than one in four participants (22.5%) reported overlap in same-sex sexual orientations, while 17.1% of bisexual men reported overlap across aspects. In multivariable models, differences were found in how aspects of sexual orientation were associated with the number of partners who bought or sold sex; as well as how often participants tested for HIV in the past 12 months. Results suggest different aspects of sexual orientation have implications for addressing HIV among Black SMM in the Deep South.
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Affiliation(s)
- Redd Driver
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA.
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Crown School of Social Work, University of Chicago, Chicago, IL, USA
| | | | - Liadh Timmins
- School of Psychology, Swansea University, Swansea, Wales, UK
| | | | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Dustin T Duncan
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Chandler CJ, Liu Q, Brown AL, Matthews DD, Tsai AC, Bukowski LA, Eaton LA, Stall RD, Friedman MR. Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black Sexual Minority Men. STIGMA AND HEALTH 2023; 8:372-380. [PMID: 37789829 PMCID: PMC10545331 DOI: 10.1037/sah0000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This secondary analysis of a mixed serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status or some "other" reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality and Resilience (POWER), a serial, cross-sectional study conducted between 2014-2017 (N=4430). Experiences of multiple stigmas were reported by n=938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with "other" stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and SES, particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM, but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Qimin Liu
- Psychological Sciences, Vanderbilt University 2301 Vanderbilt Place · Nashville, TN 37240-7817, USA
| | - Andre L. Brown
- Behavioral and Community Health Science, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Derrick D. Matthews
- Health Behavior, Gillings School of Public Health, University of North Carolina, 361 Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital 100 Cambridge St Suite 1600, Boston, MA 02114, USA
| | - Leigh A. Bukowski
- Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Scaife Hall, Suite 600 Pittsburgh, PA 15213, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Rd, Storrs, CT 06269-1248, USA
| | - Ronald D. Stall
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
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Hill E, Moreland G, Boduszek D, Debowska A. Attribution of Blame in an Intimate Partner Violence Situation: The Effect of Victim Sexuality and Observer Sex. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8500-8523. [PMID: 36916056 DOI: 10.1177/08862605231157444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intimate partner violence (IPV) is an extensive public health concern, largely affecting women aged 20 to 24 years. Research suggests that bisexual women are more likely than heterosexual and homosexual women to be victims of IPV. Bisexual women are also more likely to be blamed for their abuse experiences after disclosing, a phenomenon known as victim blame attribution (VBA). However, very little VBA research recognizes bisexuality as a separate category. Therefore, the main aim of this quasi-experimental study was to investigate the role of female victim sexuality (bisexuality, homosexuality, and heterosexuality) and observer sex in the attribution of blame to the victim and perpetrator of IPV. Participants (N = 232; aged 18-24 years, M = 21.05, SD = 1.73) were randomly assigned into one of four conditions (heterosexual victim, bisexual victim with same-sex partner, bisexual victim with different-sex partner, homosexual victim), each containing a vignette portraying IPV within a relationship. Randomization checks were performed to ensure that participants in the four conditions did not differ significantly on underlying attitudes (institutional heterosexism (IH), aversive heterosexism (AH), heterosexual privilege (HP), sexist attitudes, just world beliefs) that may have affected their responses on outcome measures. Main analyses demonstrated that bisexual victims with a same-sex partner received the highest attribution of blame, whereas perpetrators in this condition received the lowest blame attribution. Male participants attributed significantly higher blame to victims than did female participants, regardless of victim sexuality. These findings substantiate the role of victim sexuality and observer sex in IPV blame attribution patterns. This research aimed to promote equality and rightful treatment to all victims of IPV regardless of their sexuality.
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Affiliation(s)
| | | | - Daniel Boduszek
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
- University of Huddersfield, UK
| | - Agata Debowska
- The University of Sheffield, UK
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Wiginton JM, Tobin K, Maksut J, Davey-Rothwell M, Latkin C. Branched sexuality and sexual health among Black cisgender sexual minority men in Baltimore, Maryland: an exploratory study. CULTURE, HEALTH & SEXUALITY 2023; 25:1-18. [PMID: 35830487 PMCID: PMC9898841 DOI: 10.1080/13691058.2022.2096260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/27/2022] [Indexed: 06/02/2023]
Abstract
Branched sexuality - in form of combinations of sexual identity, behaviour and attraction (e.g. heterosexual identity, sex with men, attraction to women) that differ from coincident combinations (e.g. gay/homosexual/same-gender-loving identity, sex with men, attraction to men) - has been observed among Black sexual minority men and may correlate with sexual health. Using baseline survey data from Black sexual minority men (N = 323) enrolled in a sexual health intervention trial, we examined sexual identity, behaviour and attraction to determine the prevalence of branched sexuality and used modified Poisson regression with robust variance estimation to test associations with sexual health. Black sexual minority men reporting branched sexuality (n = 50, 15.5%) were marginally more likely to endorse negative condom-use attitudes compared to those reporting coincident sexuality (n = 273, 84.5%; adjusted prevalence ratio [aPR] = 1.48, 95% confidence interval [CI] = 0.94, 2.32) and significantly more likely to endorse negative condom-use attitudes compared to those reporting gay/homosexual/same-gender-loving-coincident sexuality (aPR = 1.85, 95% CI = 01.07, 3.22). Those reporting branched sexuality were significantly less likely to report past-year testing for sexually transmitted infections compared to those reporting coincident (PR = 0.52, 95% CI = 0.28, 0.94) or gay/homosexual/same-gender-loving-coincident sexuality (PR = 0.46, 95% CI = 0.25, 0.84) in bivariate analyses only. Increased understanding of Black sexual minority men's sexuality and improved sexuality data collection efforts are needed.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karin Tobin
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Maksut
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Davey-Rothwell
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Chen L, Jiang T, Wang H, Hong H, Ge R, Tang H, Wang S, Xu K, Chai C, Ma Q, Jiang J. Development and validation of a risk score for predicting inconsistent condom use with women among men who have sex with men and women. BMC Public Health 2023; 23:734. [PMID: 37085861 PMCID: PMC10120174 DOI: 10.1186/s12889-023-15672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Men who have sex with men and women (MSMW) are the most important bridge population for HIV transmission. Condom use plays an important role for HIV infection. However the predictors for condom ues with females are not well characterized. METHODS This was a cross-sectional study. Participants were enrolled by four community-based organizations (CBOs) by offline (bathrooms, bars), and online (gay applications, chat room) from April to December 2019. Electronic questionnare was fulfilled after a face-to-face training led by CBOs. We identified predictors of inconsistent condom use with females by creating a risk score based on regression coefficients. We externally validated this score via an independent cross-sectional survey conducted in Zhejiang Province in 2021. A total of 917, 615 MSMW were included in analysis in 2019 and 2021, seperately. RESULTS Among 917 MSMW, 73.2% reported heterosexual behavior in the prior 6 months and 38.3% reported inconsistent condom use with females (ICUF) over that time. Compared with heterosexual/unsure MSMW, bisexual MSMW reported more male and female sex partners, higher proportion of inconsistent condom use with males, less commercial sex with males (p < 0.05). Four risky predictors of ICUF were identified: Duration of local residence ≦6 months; more than one male partner in the prior 6 months; inconsistent condom use with males in the prior 6 months; and never heard post-exposure prophylaxis (PEP). The proportions of respondents indicating ICUF in the low- (0), medium- (2-4) and high-risk (6-20) groups (according to our risk scoring system) were 11.7% (14/120), 26.9% (96/357), and 78.1% (125/160), respectively (Ptrend < 0.001). In the validation survey, the respective proportions of those reporting ICUF were 13.4% (15/112), 17.8% (24/185) and 87.3% (96/110) (Ptrend < 0.001). CONCLUSIONS We developed and validated a predictive risk score for ICUF among MSMW; four factors were identified, of which inconsistent condom use with men was the most important. Risk reduction intervention programs should focus on MSM who report inconsistent condom use with males, never heard PEP, having multiple partners and living in local less than 6 months.
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Affiliation(s)
- Lin Chen
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Tingting Jiang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Hui Wang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Hang Hong
- Department of HIV/AIDS and STDs Control and Prevention, Ningbo Center for Disease Control and Prevention, Ningbo, People's Republic of China
| | - Rui Ge
- Department of HIV/AIDS and STDs Control and Prevention, Jiaxing Center for Disease Control and Prevention, Zhejiang Province, Jiaxing, People's Republic of China
| | - Huiling Tang
- Department of HIV/AIDS and STDs Control and Prevention, Jinhua Center for Disease Control and Prevention,, Jinhua, People's Republic of China
| | - Shanling Wang
- Department of HIV/AIDS and STDs Control and Prevention, Taizhou Center for Disease Control and Prevention, Taizhou, People's Republic of China
| | - Ke Xu
- Department of HIV/AIDS and STDs Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Chengliang Chai
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Qiaoqin Ma
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Jianmin Jiang
- Department of HIV/AIDS and STDs Control and Prevention; Department of Zhejiang Key Lab of Vaccine, Prevention and Control of Infectious Disease, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People's Republic of China.
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10
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Turpin RE, Dangerfield DT, Oke T, Hickson DA. Parental Sexuality Disclosure, Discrimination, and Depression Among Black Sexual Minority Men and Black Transgender Women. FAMILY & COMMUNITY HEALTH 2023; 46:95-102. [PMID: 36799942 PMCID: PMC9942094 DOI: 10.1097/fch.0000000000000360] [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] [Indexed: 06/18/2023]
Abstract
Racial and sexuality-based discrimination can induce depressive symptoms among Black sexual minority men and transgender women (BSMM/BTW). BSMM and BTW who disclose their sexuality to parents may be better prepared to cope with discrimination. We explored the relationship between discrimination and depression among BSMM and BTW and whether parental disclosure modified this relationship. Secondary analysis of The MARI Study was used to test the relationship between discrimination and depression modified by level of disclosure of sexuality to parents among 580 BSMM and BTW in Jackson, Mississippi, and Atlanta, Georgia. Bivariate tests and linear regression models were stratified by sexuality disclosure to parents. Discrimination was associated with greater depression, with significant dose-response modification across levels of disclosure. After adjustment, maximum discrimination scores were associated with depression scores 10.7 units higher among participants with very open disclosure (95% CI, 10.4-11.8), 15.3 units higher among participants with somewhat open disclosure (95% CI, 3.7-26.9), and 19.5 units higher among participants with no disclosure (95% CI, 10.2-26.8). Disclosure of sexuality to supportive parents can substantially benefit the mental health of BSMM and BTW. Future studies should explore intervention approaches to providing social support for BSMM and BTW in unsupportive families.
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Affiliation(s)
- Rodman E Turpin
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia (Dr Turpin); George Washington University, Milken Institute School of Public Health, Washington, District of Columbia (Dr Dangerfield); School of Social Work, University at Buffalo, Buffalo, New York (Mr Oke); and Us Helping Us, People Into Living Inc, Washington, District of Columbia (Drs Hickson and Dangerfield, and Mr Oke)
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11
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Henderson ER, Haberlen SA, Coulter RW, Weinstein AM, Meanley S, Brennan-Ing M, Mimiaga MJ, Turan JM, Turan B, Teplin LA, Egan JE, Plankey MW, Friedman MR. The role of social support on cognitive function among midlife and older adult MSM. AIDS 2023; 37:803-811. [PMID: 36728912 PMCID: PMC10157348 DOI: 10.1097/qad.0000000000003464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV. DESIGN We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. METHODS We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. RESULTS Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. CONCLUSION Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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Affiliation(s)
- Emmett R. Henderson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea M. Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York City, New York
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Linda A. Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine, Infectious Diseases, Feinberg School of Medicine, Chicago, Illinois
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W. Plankey
- Department of Medicine, Division of General Internal Medicine, George town University Medical Center, Washington, District of Columbia
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Eschliman EL, Poku OB, Winiker AK, Latkin CA, Tobin KE. Associations between social network characteristics and sexual minority disclosure concern among Black men who have sex with men living with and without HIV. THE JOURNAL OF SOCIAL ISSUES 2023; 79:390-409. [PMID: 37215260 PMCID: PMC10195063 DOI: 10.1111/josi.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/01/2022] [Indexed: 05/24/2023]
Abstract
In addition to the pervasive anti-Black racism faced by Black people in the United States, Black men who have sex with men (BMSM) face sexual minority stigma and, among BMSM living with HIV, HIV-related stigma. These multilevel social forces shape social networks, which are important sources of resources, support, and behavior regulation. This study quantitatively examined the relationship between social network characteristics and sexual minority stigma (e.g., homophobia, biphobia), assessed by reported concerns around disclosing one's sexual minority status, among BMSM in Baltimore, Maryland in 2014 (N = 336). A majority of participants (63.7%) reported experiencing medium or high levels of sexual minority disclosure concern. In a multiple linear regression model, participants with higher sexual minority disclosure concern reported lower network density and having fewer good friends who are gay or bisexual men. Stratifying the same multiple linear regression model by HIV status supports the importance of an intersectional understanding of sexual minority and HIV-related stigma. These findings can help health-related programs address the complex relationships between sexual minority stigma, social networks, and HIV status within this multiply-marginalized and high-priority population.
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Affiliation(s)
- Evan L. Eschliman
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
| | - Ohemaa B. Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York Psychiatric Institute
| | - Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Carl A. Latkin
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
| | - Karin E. Tobin
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health
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13
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López DJ, Chandler C, Whitfield DL, Adams B, Burdick J, Friedman MR. "Take It Out on the Floor": Experiences of Violence Among Black LGBT House and Ball Community Youth in a Rust Belt City. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3950-3978. [PMID: 36004529 PMCID: PMC10105583 DOI: 10.1177/08862605221113025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Black, lesbian, gay, bisexual, and transgender (LGBT), individuals experience higher rates of violent victimization compared to their cisgender heterosexual counterparts over their life course. Among Black LGBT people, witnessing and experiencing violence have been related to poor health outcomes, including depression, risky sexual behavior, substance use, and lower engagement in healthcare services. We engaged in research to better understand the effects of violence experienced by the Black LGBT youth community. We conducted a qualitative, phenomenological study focused on the causes of violence occurring in the lives of Black LGBT youth engaged in a recreation-based community health program. The study consisted of four focus groups with Black LGBT youth (N = 24) and in-depth individual interviews with medical and social service providers who work with Black LGBT youth (N = 4). Data analysis presented three themes: (1) causes of violence, (2) the context of intracommunity violence, and (3) solutions to violence. The first theme describes the reasoning, motivation, or explanation for violence experienced by the Black LGBT youth community. The second theme, the context of intracommunity violence, describes how violence occurs specifically within Black LGBT young adult communities. The third theme, solutions to violence, describes the recommendations for addressing, reducing, and/or eliminating violence within the Black LGBT youth community. Our findings highlight the need for safe spaces, culturally-relevant services, and trusted figures for Black LGBT young adults, which can serve as mechanisms for mitigating violence.
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Affiliation(s)
| | | | | | | | - Jessica Burdick
- Project Silk, Community Health Services, Pittsburgh, PA, USA
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14
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Yu B, Feng C, Yang X, Wang Z, Zou H, Jia P, Yang S. Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition. Int J Public Health 2023; 68:1605202. [PMID: 36743343 PMCID: PMC9894890 DOI: 10.3389/ijph.2023.1605202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives: This study examined whether social capital (SC) mediated the association between internalized homophobia (IH) and condomless sex among men who have sex with men (MSM), with the interaction of SC and IH considered. Methods: A cross-sectional study was conducted between November 2018 and April 2019 in Sichuan Province, China. A total of 540 participants were recruited to investigate their IH, SC, and condomless sex. A four-way decomposition of causal mediation analysis was used to test SC's roles in the association between IH and condomless sex. Results: Condomless sex was prevalent (46.7%) among the participants, which was significantly associated with IH [odds ratio (OR) = 1.70] and SC (OR = 0.55). A direct effect [excess risk ratio (RR = 0.32)] and an indirect effect (excess RR = 0.16) of SC were found to be significant in the association between IH and condomless sex. Heterogeneities in effects were observed when taking the SC's domains (e.g., individual and family-based SC) as mediators. SC's effects were significant only in the homosexual subgroup. Conclusion: IH-based intervention with consideration of SC can be tailored to MSM to decrease condomless sex and curb the spread of HIV, especially for the homosexual subgroup.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Department of Health Management Center, Clinical Medical College and Affiliated Hospital, Chengdu University, Chengdu, China,*Correspondence: Shujuan Yang,
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15
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Wu D, Zhong X, Deng R, Pan H, Gao Y, Lin B, Tang X, Dai J, Liang H, Huang A. Study on anxiety and depression of men who have sex with men: An application of group-based trajectory model. Front Psychol 2023; 13:857203. [PMID: 36660287 PMCID: PMC9842664 DOI: 10.3389/fpsyg.2022.857203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence of anxiety and depression is high among men who have sex with men (MSM), but limited studies focus on their development trends. This study examined the prevalence and influencing factors of anxiety and depression in HIV-negative MSM. In this study, 711 subjects were followed up every 24 weeks for 96 weeks. A group-based trajectory model was used to identify different development trends and a logistic regression model was used to explore the influencing factors of different trajectories. Low, moderate, and high anxiety groups accounted for 32.56, 56.12, and 11.32%; and low and high depression groups accounted for 73.90 and 26.10%. High anxiety was associated with a lower education degree, little HIV-related knowledge, and other characteristics (more agreed that "HIV is a threat to me/my family," had high frequency of seeking sexual partners via the Internet, had a history of sexually transmitted disease (STD), and a sense of discrimination by doctors). High depression was associated with a lower education degree, little HIV-related knowledge, being bisexual and the following characteristics: they felt that HIV infection rate of MSM around them was high, and more agreed that "HIV is a threat to me/my family," had a high frequency of seeking sexual partners through the Internet and alcohol drinking, had a history of STD, and felt being discriminated against by doctors and others. There is heterogeneity in the development trends of anxiety and depression. We need to improve intervention in the mental health of MSM, especially those with high anxiety and depression development trends. Clinical Trial Registration [http://www.chictr.org.cn/showproj.aspx?proj=5716], identifier [ChiCTR-TRC-13003849].
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Affiliation(s)
- Dan Wu
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Xiaoni Zhong
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoni Zhong,
| | - Ruibin Deng
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hong Pan
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yuwen Gao
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xian Tang
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Hao Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology, Ministry of Molecular Biology, Chongqing, China
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16
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Berman M, Eaton LA, Watson RJ, Earnshaw VA, Wiginton JM, Layland E. Factors Associated with Disclosure of Sexual Orientation Among Black Sexual Minority Men. LGBT Health 2023; 10:51-61. [PMID: 36099207 PMCID: PMC10039276 DOI: 10.1089/lgbt.2021.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: This study evaluated the characteristics associated with sexual orientation disclosure among HIV-negative Black sexual minority men (BSMM) in the greater Atlanta, Georgia area. Survey data were collected from 475 HIV-negative BSMM from 2017 to 2019 as part of a larger behavioral intervention study focused on stigma, prejudice, and HIV-testing uptake. Methods: Participants reported their levels of sexual orientation disclosure globally, to their community, and to their family. Data were analyzed using one-way analysis of variance and multinomial logistic regression to determine whether demographic, minority stress, substance use, and mental health were associated with sexual orientation disclosure globally, to community members, and to family members. Results: Findings revealed that participants with older age, bisexual identity, and higher levels of internalized homophobia had higher odds of global, community, and family sexual orientation nondisclosure. Furthermore, participants with higher levels of resilience had lower odds of partial sexual orientation disclosure compared with their fully disclosed counterparts. Conclusions: These findings reveal variations associated with sexual orientation disclosure across varying contexts among HIV-negative BSMM, particularly among family member disclosure.
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Affiliation(s)
- Marcie Berman
- Department of Psychological Science, Central Connecticut State University, New Britain, Connecticut, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Layland
- Department of Public Health, Yale University, New Haven, Connecticut, USA
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17
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Quinn KG, Dickson-Gomez J, Craig A, John SA, Walsh JL. Intersectional Discrimination and PrEP uSe Among Young Black Sexual Minority Individuals: The Importance of Black LGBTQ Communities and Social Support. AIDS Behav 2023; 27:290-302. [PMID: 35788926 PMCID: PMC9255535 DOI: 10.1007/s10461-022-03763-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Intersectional stigma and discrimination have increasingly been recognized as impediments to the health and well-being of young Black sexual minority men (YBSMM) and transgender women (TW). However, little research has examined the relationship between intersectional discrimination and HIV pre-exposure prophylaxis (PrEP) outcomes. This study with 283 YBSMM and TW examines the relationship between intersectional discrimination and current PrEP use and likelihood of future PrEP use. Path models were used to test associations between intersectional discrimination, resilience and social support, and PrEP use and intentions. Individuals with higher levels of anticipated discrimination were less likely to be current PrEP users (OR = 0.59, p = .013), and higher levels of daily discrimination were associated with increased likelihood of using PrEP in the future (B = 0.48 (0.16), p = .002). Greater discrimination was associated with higher levels of resilience, social support, and connection to the Black LGBTQ community. Social support mediated the effect of day-to-day discrimination on likelihood of future PrEP use. Additionally, there was a significant and negative indirect effect of PrEP social concerns on current PrEP use via Black LGBTQ community connectedness. The results of this study highlight the complexity of the relationships between discrimination, resilience, and health outcomes.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Psychiatry and Behavioral Medicine, CAIR Medical College of Wisconsin, 2071 N. Summit Ave, 53202, Milwaukee, WI, USA.
| | - Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amber Craig
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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18
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Sallabank G, Blackburn NA, Threats M, Pulley DV, Barry MC, LeGrand S, Harper GW, Bauermeister JA, Hightow-Weidman LB, Muessig KE. Media representation, perception and stigmatisation of race, sexuality and HIV among young black gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2022; 24:1729-1743. [PMID: 34895082 PMCID: PMC9188628 DOI: 10.1080/13691058.2021.2008506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Young Black gay and bisexual men who have sex with men experience stigma related to race, gender expression, sexuality and HIV status. Stigma impacts access to HIV care and prevention as well as interactions with healthcare providers. The amplification of stigma through popular media is under-researched in the health sciences. HealthMpowerment is a mobile phone optimised intervention to reduce sexual risk and support community-building for young Black gay and bisexual men (age 18-30). We analysed Forum conversations from 48 participants, 45.8% living with HIV. Of 322 stigma-relevant conversations, 18.9% referenced the media (e.g. television, news, social media) as a source of stigma. Forum conversations covered media representations of Black gay and bisexual men, media's influence on identity, and the creation of stigma by association with media representations. Cultural messages embedded in the media may accentuate stereotypes that influence perceptions of Black gay and bisexual men and disregard intersectional identities. HealthMpowerment provided a space to challenge stigmatising representations. Participants used HealthMpowerment to garner social support and celebrate positive media representations. Interventions for young Black gay and bisexual men should consider the influential role of media and include spaces for participants to process and address stigma.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Natalie A. Blackburn
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Threats
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deren V. Pulley
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Information Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan C. Barry
- Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gary W. Harper
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kathryn E. Muessig
- Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mohamad Fisal ZA, Minhat HS, Mohd Zulkefli NA, Ahmad N. Biopsychosocial approach to understanding determinants of depression among men who have sex with men living with HIV: A systematic review. PLoS One 2022; 17:e0264636. [PMID: 35286312 PMCID: PMC8920233 DOI: 10.1371/journal.pone.0264636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach. METHODOLOGY We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer. RESULTS We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches. CONCLUSION The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV prevention and care outcomes and improve access to mental healthcare.
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Affiliation(s)
- Zul Aizat Mohamad Fisal
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Halimatus Sakdiah Minhat
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norliza Ahmad
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Del Pino HE, Steers WN, Lee M, McCuller J, Hays RD, Harawa NT. Measuring Gender Role Conflict, Internalized Stigma, and Racial and Sexual Identity in Behaviorally Bisexual Black Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1019-1030. [PMID: 34136991 PMCID: PMC8674384 DOI: 10.1007/s10508-021-01925-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Black men who have sex with men and women (BMSMW) experience pressure to fill hypermasculine ideals and may not identify with "gay" cultural norms. Existing measures of gender role expectations and internalized homophobia are not culturally appropriate for BMSMW. Researchers generally measure categorical identification with race, gender, and sexual orientation groups separately, whereas BMSMW may identify with multiple categories. We modified the Gender Role Conflict Scale to create the M-GRCS and the Internalized Homophobia Scale to include biphobia (Internalized Bi/Homophobia Scale, IBHS). To examine identification at the intersection of race, gender, and sexual orientation, we created 11 Integrated Race and Sexuality Scale (IRSS) items. With data from 429 BMSMW, we conducted exploratory factor analysis of the 59 items using categorical principal axis factoring with unweighted least squares extraction and Promax factor rotation. We created simple-summated multi-item scales and evaluated their construct validity. The rotated solution yielded four factors with 47 items and a simple factor structure: M-GRCS defined two factors (α = .93 for restricted emotionality/affection; .87 for success/power/competition); the IBHS (α = .89) and IRSS (α = .74) each defined a single factor. The IRSS factor was positively correlated with the Lukwago Racial Pride Scale, r(417) = .40. The IBHS factor was negatively correlated with the IRSS factor, r(414) = - .22. The two M-GRCS factors suggest that the construct of hypermasculinity impacts BMSMW. The high IBHS reliability indicates that homophobia and biphobia were positively correlated in this sample. These three scales have potential for future studies with BMSMW.
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Affiliation(s)
- Homero E Del Pino
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - W Neil Steers
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Martin Lee
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jason McCuller
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Ron D Hays
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA
| | - Nina T Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Medicine, David Geffen School of Medicine at UCLA, Suite 850, 1100 Glendon Ave., Los Angeles, CA, 90024, USA.
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21
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Greenwood GL, Wilson A, Bansal GP, Barnhart C, Barr E, Berzon R, Boyce CA, Elwood W, Gamble-George J, Glenshaw M, Henry R, Iida H, Jenkins RA, Lee S, Malekzadeh A, Morris K, Perrin P, Rice E, Sufian M, Weatherspoon D, Whitaker M, Williams M, Zwerski S, Gaist P. HIV-Related Stigma Research as a Priority at the National Institutes of Health. AIDS Behav 2022; 26:5-26. [PMID: 33886010 PMCID: PMC8060687 DOI: 10.1007/s10461-021-03260-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.
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Affiliation(s)
- Gregory L Greenwood
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, 5601 Fishers Lane, 9G19, Bethesda, MD, 20852, USA.
| | - Amber Wilson
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Geetha P Bansal
- Division of International Training and Research, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Christopher Barnhart
- Sexual and Gender Minority Research Office, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Rick Berzon
- Division of Scientific Programs, National Institute of Minority Health and Health Disparities, Bethesda, MD, 20892, USA
| | - Cheryl Anne Boyce
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - William Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | | | - Mary Glenshaw
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Rebecca Henry
- Division of Extramural Science Programs, National Institute of Nursing Research, Bethesda, MD, 20892, USA
| | - Hiroko Iida
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Richard A Jenkins
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, 20852, USA
| | - Sonia Lee
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA
| | - Arianne Malekzadeh
- Division of International Science Policy, Planning and Evaluation, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Kathryn Morris
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Peter Perrin
- Division of Digestive Diseases & Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20892, USA
| | - Elise Rice
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Meryl Sufian
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Darien Weatherspoon
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Miya Whitaker
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Makeda Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - Sheryl Zwerski
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, 20852, USA
| | - Paul Gaist
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
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22
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Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2825-2841. [PMID: 33483851 PMCID: PMC8295412 DOI: 10.1007/s10508-020-01850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 05/10/2023]
Abstract
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Anthony J Maiolatesi
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
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23
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Timmins L, Schneider JA, Chen YT, Goedel WC, Brewer R, Callander D, Knox J, Eavou R, Hanson H, Duncan DT. Sexual Identity, Sexual Behavior and Pre-exposure Prophylaxis in Black Cisgender Sexual Minority Men: The N2 Cohort Study in Chicago. AIDS Behav 2021; 25:3327-3336. [PMID: 33852095 PMCID: PMC8419005 DOI: 10.1007/s10461-021-03246-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/04/2023]
Abstract
This study investigated sexual identity and behavior and their potential associations with PrEP use and attitudes in cisgender Black gay and bisexual men. A total of N = 173 (mean age 25.2) participants from the Neighborhoods and Networks (N2) Study in Chicago were included. Of these, 104 were gay-identified and reported sex with men only (GSMO), 26 were gay-identified and reported sex with men and women (GSMW), 8 were bisexual-identified and reported sex with men only (BSMO), and 35 were bisexual-identified and reported sex with men and women (BSMW). Reporting sex with men and women in the past 6 months, RR = 0.39, 95% CI [0.17, 0.89], identifying as bisexual, RR = 0.52, 95% CI [0.29, 0.92], and the combination of the two, RR = 0.24, 95% CI [0.07, 0.76] were significantly associated with lower rates of current oral PrEP use. Black bisexual-identifying men who reported sex with men and women were significantly more likely to have discontinued oral PrEP, RR = 2.50, 95% CI [1.14, 5.50], than Black gay-identified men who reported sex with men only. Participants who had not used oral PrEP before reported lower levels of interest in long-acting injectable PrEP than those who were currently using oral PrEP, RR = 0.56, 95% CI [0.40, 0.79]. No other significant differences were found. Overlooking the combination of sexual identity and behavior may mischaracterize PrEP rates and miss uniquely vulnerable subgroups. Black gay and bisexual men who had not used oral PrEP may be particularly disinterested in long-acting injectable PrEP.
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Affiliation(s)
- Liadh Timmins
- Columbia Spatial Epidemiology Lab, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 729, New York, NY, 10032, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL, USA
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL, USA
| | - Denton Callander
- Columbia Spatial Epidemiology Lab, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 729, New York, NY, 10032, USA
| | - Justin Knox
- Columbia Spatial Epidemiology Lab, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 729, New York, NY, 10032, USA
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Dustin T Duncan
- Columbia Spatial Epidemiology Lab, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 729, New York, NY, 10032, USA
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24
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Diamond LM. The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity. JOURNAL OF SEX RESEARCH 2021; 58:818-837. [PMID: 33620277 DOI: 10.1080/00224499.2021.1879721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8-25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one's relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.
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25
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McCann E, Brown MJ, Taylor J. The views and experiences of bisexual people regarding their psychosocial support needs: a qualitative evidence synthesis. J Psychiatr Ment Health Nurs 2021; 28:430-443. [PMID: 32780489 DOI: 10.1111/jpm.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Bisexual people experience significantly poorer mental health and higher rates of self-harm and suicidality than their gay, lesbian or heterosexual counterparts. Although little is understood about why these disparities exist, bisexual people have been found to have unique life experiences that separate them from other sexual minority groups. Despite these health disparities and unique experiences, in research and in clinical settings, bisexual people are often incorporated under the LGBTQI+ umbrella and their needs are not seen as being different to those of other sub-groups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper brings together the findings of the small but growing body of literature reporting on the psychosocial support needs of bisexual people. The findings reported on herein provide novel insights, collated and synthesized that will prove valuable to policy makers, service providers and researchers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper clearly illustrates that bisexual people experience significant barriers to accessing the support services they need and that current competent service provision for this population is severely limited. The findings presented in this paper shed light on the unique psychosocial needs of bisexual people and highlight the need for practice change to reduce barriers to service access and ensure inclusive and culturally competent care for this community. ABSTRACT: Introduction Despite consistent evidence of poor mental health among what is a relatively large population group, research examining bisexual mental health remains sparse. Aim To identify the psychosocial needs of people who are bisexual and establish factors that may support or inhibit access to appropriate psychosocial interventions and supports. Method A qualitative evidence syntheses of the empirical evidence. Results A total of 15 papers were included in the review. The PRISMA process was used. Following data analysis, four main themes emerged that were (a) experiences of being bisexual, (b) mental health experiences and concerns, (c) service access and responses and (iv) communities and supports. Discussion Bisexual people have unique and specific psychosocial support needs that relate to, but are also different from, the needs of the broader LGBTIQ+ community. This study provides valuable insights into how future policy, practice, education and training and research can better address the needs of this highly vulnerable group. Implications for Practice This study highlights the psychosocial complexities associated with bisexuality and provides evidence for the need for improvement in current support services to ensure inclusivity and culturally competent care.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College, University of Dublin, Dublin, Ireland
| | - Michael J Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Julia Taylor
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
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26
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Brennan-Ing M, Haberlen S, Ware D, Egan JE, Brown AL, Meanley S, Palella FJ, Bolan R, Cook JA, Okafor CN, Friedman MR, Plankey MW. Psychological Connection to the Gay Community and Negative Self-Appraisals in Middle-Aged and Older Men Who Have Sex With Men: The Mediating Effects of Fitness Engagement. J Gerontol B Psychol Sci Soc Sci 2021; 77:39-49. [PMID: 33945614 PMCID: PMC8755915 DOI: 10.1093/geronb/gbab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. METHOD Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. RESULTS The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. DISCUSSION Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, USA,Address correspondence to: Mark Brennan-Ing, PhD, Brookdale Center for Healthy Aging, Hunter College, the City University of New York, 2180 Third Avenue, 8th Floor, New York, NY 10035, USA. E-mail:
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert Bolan
- Department of Family Medicine, University of Southern California, Los Angeles, USA
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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27
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Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
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Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Turpin R, Dyer T, Watson L, Mayer K. Classes of Sexual Identity, Homophobia, and Sexual Risk among Black Sexual Minorities in HPTN 061. JOURNAL OF SEX RESEARCH 2021; 58:638-647. [PMID: 33630695 PMCID: PMC8154646 DOI: 10.1080/00224499.2021.1886228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Homophobia is associated with sexual risk among sexual minorities, including Black sexual minority men, though experienced homophobia may differ across sexual identities. We conducted latent class analysis of sexual identities and experienced homophobia associated with sexual risk, and tested mediators of this association. We used longitudinal data from the HIV Prevention Trials Network Study 061 (n = 1,553). We generated rate ratios between baseline latent classes of experienced homophobia and sexual identity and 12-month outcomes: Condomless receptive anal intercourse (CRAI), number of partners, and transactional sex. Mediators included 6-month internalized homophobia, depression, social support, and substance use. We selected the following 7-class model: "Bisexual, rare homophobia" (reference), "Mixed identities, mixed homophobia", "Bisexual, frequent homophobia", "Heterosexual/Same-gender loving, frequent homophobia", "Gay, frequent homophobia", " Gay/Same-gender loving, frequent homophobia," and "Gay, rare homophobia." All other classes had greater CRAI than the reference. For bisexual/mixed/heterosexual classes, approximately 20% of this association was positively mediated through our mediators (p < .05). The Heterosexual/Same-gender loving class had the largest proportion mediated through internalized homophobia. For gay-identifying classes, mediation was marginally significant (.05 < p < .10). Classes of sexual identity and experienced homophobia were associated with CRAI among Black sexual minority men, partially mediated through internalized homophobia, depression, social support, and substance use.
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Affiliation(s)
- Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
| | - Lakeshia Watson
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD
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29
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Transactional Sex and Incident Chlamydia and Gonorrhea Among Black Men Who Have Sex With Men in Atlanta, Georgia. Sex Transm Dis 2021; 47:355-360. [PMID: 32187168 DOI: 10.1097/olq.0000000000001168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black men who have sex with men (BMSM) are disproportionately affected by sexually transmitted infections (STI), including chlamydia and gonorrhea. Transactional sex is an hypothesized risk factor for STI acquisition in BMSM. METHODS We estimated the association of transactional sex with incident chlamydia/gonococcal infection among BMSM using longitudinal data from a randomized trial in Atlanta (2012-2015). BMSM were eligible for inclusion if they tested human immunodeficiency virus (HIV)-antibody-negative and reported both ≥2 male sex partners and any condomless anal sex in the last year. We defined chlamydia/gonorrhea incidence as the first occurrence of either rectal or urogenital chlamydia or gonococcal infections after a negative result at enrollment. We used Poisson regression to estimate the incidence rate (IR) for chlamydia/gonorrhea over 12 months. Incidence rate ratios (IRR) compared estimates by reported experience of transactional sex. Subgroup analyses assessed potential heterogeneity by age and sexual identity. RESULTS This analysis included 416 BMSM, of whom 191 (46%) were gay-identified, 146 (42%) reported a history of transactional sex, and 57 (14%) had prevalent chlamydia/gonococcal infection at baseline. Over a median of 1 year of follow-up, an additional 55 men tested laboratory-positive for chlamydia/gonorrhea (IR, 17.3 per 100 person-years). Transactional sex was not associated with chlamydia/gonorrhea incidence overall. However, among gay-identified BMSM, transactional sex was associated with incident chlamydia/gonorrhea (IRR, 2.9; 95% confidence interval, 1.2-6.8). CONCLUSIONS Economic and social vulnerabilities may motivate engagement in high-risk sexual behaviors through commodified sex, potentially increasing the burden of STIs among BMSM. In this investigation, the relationship between transactional sex and chlamydia/gonorrhea was not homogenous across BMSM with diverse sexual identities in Atlanta, suggesting that within select sexual networks, transactional sex may drive STI risks. Delivering accessible and targeted STI screening for marginalized BMSM should be prioritized for STI and HIV prevention.
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Latent Profile Analysis of a Syndemic of Vulnerability Factors on Incident Sexually Transmitted Infection in a Cohort of Black Men Who Have Sex With Men Only and Black Men Who Have Sex With Men and Women in the HIV Prevention Trials Network 061 Study. Sex Transm Dis 2021; 47:571-579. [PMID: 32496390 DOI: 10.1097/olq.0000000000001208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are important public health concerns among black men who have sex with men only (BMSMO), as well as those who have sex with both men and women (BMSMW). Sexually transmitted infections also increase risk of acquiring and HIV, which is also a critical concern. Compared with BMSMO, research shows that BMSMW experience elevated levels of HIV/STI vulnerability factors occurring at the intrapersonal, interpersonal, and social/structural levels. These factors may work independently, increasing one's risk of engaging in high-risk sexual behaviors, but often work in a synergistic and reinforcing manner. The synergism and reinforcement of any combination of these factors are known as a syndemic, which increases HIV/STI risk. METHODS Data from the HIV Prevention Trials Network (HPTN) 061 study (n = 799) was used to conduct a latent profile analysis to identify unique combinations of risk factors that may form a syndemic and that may vary between BMSMO and BMSMW. We hypothesized that the convergence of syndemic factors would differ between groups and predict sexual risk and subsequent incident STI. RESULTS For BMSMO who had a high sexual risk profile, the syndemic factors characterizing this group included perceived racism, incarceration, intimate partner violence, depression, and binge drinking. For BMSMW with a high sexual risk profile, the syndemic factors that characterized this group were incarceration, depression, and binge drinking. CONCLUSIONS The current analysis highlights syndemic profiles that differentiated BMSMO and BMSMW from one another and supports the need for tailored interventions that address specific syndemic factors for both subpopulations of black men who have sex with men.
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Keene LC, Heath RD, Bouris A. Disclosure of Sexual Identities Across Social-Relational Contexts: Findings from a National Sample of Black Sexual Minority Men. J Racial Ethn Health Disparities 2021; 9:201-214. [PMID: 33415706 DOI: 10.1007/s40615-020-00944-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Black sexual minority men (BSMM) in the USA navigate a range of factors that may influence the extent to which they disclose or conceal their sexual identity in various social contexts. To date, few studies have investigated the correlates of sexual identity disclosure or concealment among BSMM across multiple life domains. Guided by a minority stress perspective and intersectionality, we analyzed data from N = 809 BSMM who participated in the Social Justice Sexuality Survey. We conducted ordinary least squares regression to examine the relative weight of perceptions of homophobia, religiosity, LGBT community connectedness, racial identity salience, and sexual identity salience on disclosure of sexual identity in six social-relational contexts: (1) family, (2) friends, (3) neighbors, (4) religious community, (5) work, and (6) online. Findings indicate that BSMM disclosed their sexual identity unevenly across social-relational contexts. Notably, LGBTQ community connectedness and sexual identity importance were consistent predictors of sexual identity disclosure across contexts. In contrast, perceptions of homophobia were not related to sexual identity disclosure, suggesting that other factors may be more salient for BSMM when deciding to disclose their sexual identity. Finally, bisexual men consistently reported lower levels of sexual identity disclosure relative to gay men in all six contexts. Study findings have important implications for future research on sexual identity disclosure with diverse samples of BSMM.
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Affiliation(s)
- Lance C Keene
- New York University Center for Latino Adolescent and Family Health, 15 Washington Pl, New York, NY, 10003, USA.
| | - Ryan D Heath
- Syracuse University School of Social Work, Syracuse, NY, USA
| | - Alida Bouris
- University of Chicago School of Social Service Administration, Chicago, IL, USA
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Pachankis JE, Mahon CP, Jackson SD, Fetzner BK, Bränström R. Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychol Bull 2020; 146:831-871. [PMID: 32700941 PMCID: PMC8011357 DOI: 10.1037/bul0000271] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Williams D, Dodge B, Berger B, Kimbrough A, Bostwick WB. Self-Reported Health Concerns and Healthcare Experiences among Diverse Bisexual Men: An Exploratory Qualitative Study. JOURNAL OF BISEXUALITY 2020; 20:301-323. [PMID: 34733119 PMCID: PMC8562778 DOI: 10.1080/15299716.2020.1822256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bisexual individuals have disproportionately higher rates of physical and mental health concerns compared to both heterosexual and gay/lesbian individuals. Few studies have examined diverse bisexual-identified men's perceived health concerns for themselves and other bisexual men or their experiences in healthcare settings. This qualitative study explored health and healthcare experiences among cisgender and transgender bisexual men, most of whom were also men of color. Data were collected through semi-structured interviews. Participants included 31 self-identified bisexual men from the Chicago area. Participants were asked questions surrounding bisexual men's health and healthcare experiences in general and their personal experiences, drawing connections between intersecting bisexual and racial/ethnic identities. Interview transcripts were analyzed using thematic analysis. Participants reported sexual health and mental health as the top health concerns for bisexual men. Participants viewed their bisexual identity as a motivator for seeking healthcare services and adopting safer sex practices. Mental health challenges faced by respondents were connected to bisexual stereotypes and fear of disclosing bisexual and transgender identities. Furthermore, perceptions of masculinity amongst bisexual men of color were particularly salient in connecting to their mental health experiences. The intersection of participants' transgender and bisexual identities impacted their healthcare experiences in general healthcare settings, with many participants reporting a lack of cultural competence and provider knowledge concerning their identities. LGBTQ Federally Qualified Health Centers, however, were described as providing compassionate care. Our findings suggest the need for more interventions that account for bisexual men's intersecting identities. Furthermore, increased provider training is necessary for providing affirmative care to bisexual men.
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Affiliation(s)
- Deana Williams
- School of Public Health, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Brian Dodge
- School of Public Health, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Bria Berger
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alex Kimbrough
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wendy B. Bostwick
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
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Siconolfi D, Tucker JS, Shadel WG, Seelam R, Golinelli D. Health, Homelessness Severity, and Substance Use among Sexual Minority Youth Experiencing Homelessness: A Comparison of Bisexual Versus Gay and Lesbian Youth. JOURNAL OF SEX RESEARCH 2020; 57:933-942. [PMID: 31809204 PMCID: PMC7274857 DOI: 10.1080/00224499.2019.1695723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85-10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41-17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41-11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.
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Affiliation(s)
| | - Joan S Tucker
- RAND Social and Economic Well-Being, RAND Corporation
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Syndemic latent transition analysis in the HPTN 061 cohort: Prospective interactions between trauma, mental health, social support, and substance use. Drug Alcohol Depend 2020; 214:108106. [PMID: 32652374 PMCID: PMC7423755 DOI: 10.1016/j.drugalcdep.2020.108106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Substance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. METHODS Using a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. RESULTS Our analysis identified four statuses: A "low-risk" status characterized by the lowest proportions of syndemic factors, and 3 "high-risk" statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with "high-risk status C" (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). CONCLUSIONS Our findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.
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Sullivan MC, Cruess DG, Huedo-Medina TB, Kalichman SC. Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2005-2018. [PMID: 31863314 DOI: 10.1007/s10508-019-01531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/31/2019] [Indexed: 05/22/2023]
Abstract
People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, β = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (β = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.
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Affiliation(s)
- Matthew C Sullivan
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
- Allied Health Sciences Department, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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Tao J, Montgomery MC, Chu CT, Sosnowy C, Almonte A, Goedel WC, Silva ES, Reisopoulos A, Marshall SA, Zaller ND, Rogers BG, Nunn AS, Marshall BD, Chan PA. HIV Pre-Exposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men Only and Men Who Have Sex with Both Men and Women. AIDS Patient Care STDS 2020; 34:327-330. [PMID: 32706624 DOI: 10.1089/apc.2020.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jun Tao
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Madeline C. Montgomery
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Christina T. Chu
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Collette Sosnowy
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Alexi Almonte
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | | | - Sarah Alexandra Marshall
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nickolas D. Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brooke G. Rogers
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
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Sarno EL, Newcomb ME, Feinstein BA, Mustanski B. Bisexual Men's Experiences with Discrimination, Internalized Binegativity, and Identity Affirmation: Differences by Partner Gender. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1783-1798. [PMID: 32378076 PMCID: PMC7313263 DOI: 10.1007/s10508-020-01712-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 06/03/2023]
Abstract
Bisexual individuals experience unique forms of discrimination related to their sexual orientation (e.g., anti-bisexual prejudice), which occurs from both heterosexual and gay/lesbian individuals. Bisexual individuals may experience stigma differently depending on the gender of their relationship or sexual partners, because they may be perceived as heterosexual if they have a partner of a different gender and as gay/lesbian if they have a partner of the same gender. The present longitudinal study investigated within-persons differences in anti-bisexual experiences, internalized binegativity, and bisexual identity affirmation based on the gender of participants' serious relationship partners and gender of sex partners in a sample of 180 young bisexual men. Results indicated that young bisexual men experienced more interpersonal hostility from both heterosexual and gay/lesbian individuals when their serious relationship partner was female. No significant differences were found in other types of anti-bisexual prejudice, internalized binegativity, or bisexual identity affirmation by serious partner gender. For sexual partner gender, men who had only male sex partners experienced more sexual orientation instability attitudes from heterosexual and lesbian/gay individuals; men with only female sex partners experienced more sexual irresponsibility attitudes from heterosexuals, but not from lesbian/gay individuals; and, like those with female serious relationship partners, men with only female sex partners had more frequent experiences of interpersonal hostility from heterosexual and lesbian/gay individuals. Results indicate that bisexual men experience unique forms of prejudice based on the gender of their relationship and sexual partners. Implications for the mental health of bisexual men are discussed.
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Affiliation(s)
- Elissa L Sarno
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian A Feinstein
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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Buttram ME. The Social Environmental Context of Resilience Among Substance-Using African American/Black Men Who Have Sex With Men. JOURNAL OF HOMOSEXUALITY 2020; 67:816-832. [PMID: 30614402 PMCID: PMC6612474 DOI: 10.1080/00918369.2018.1557952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Resilience theory has been suggested as a framework for research on HIV prevention among men who have sex with men. Among this population, literature indicates that African American/Black men who have sex with men experience additional health disparities including elevated HIV incidence rates, victimization, and poor physical health. Conceptualizing resilience as a part of one's social environment, this qualitative study investigates resilience processes and HIV transmission risk among a sample of 21 substance-using African American/Black men who have sex with men. Data from in-depth interviews describe the social environmental context in which resilience is exhibited and document the influence of homophobia, expressions of agency, and access to social, economic, and cultural capital on resilience processes. Central to this are expressions of hidden resilience, in which African American/Black men who have sex with men mitigate risk and experience their lives as subjectively successful, whether or not outsiders see it as such.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida, USA
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Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014-2017. Drug Alcohol Depend 2020; 207:107808. [PMID: 31855657 PMCID: PMC7552112 DOI: 10.1016/j.drugalcdep.2019.107808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Black gay, bisexual, and other men who have sex with men (BMSM) are at elevated risk for HIV infection in the United States. BMSM who inject drugs may be face even higher HIV risk. METHODS Random time-location sampling was used to survey BMSM attending Black Pride events in 6 U.S. cities about HIV risk and protective behaviors, including injection drug use, prior HIV testing, and pre-exposure prophylaxis (PrEP). 3429 individuals who reported a HIV negative/unknown serostatus at enrollment were included in the analysis. HIV status was determined by in-field rapid HIV testing. RESULTS 3.6% of BMSM had injected drugs in their lifetime and 58.5% of BMSM who had injected drugs reported sharing syringes in the past six months. BMSM who had injected drugs more commonly reported current PrEP use than BMSM who had never injected (32.5% vs. 8.2%, p < 0.001). BMSM who had injected drugs were 3.6-fold (95% CI: 2.4, 5.4) more likely to report currently using PrEP than BMSM who had never injected after adjustment for sociodemographic, substance use, and sexual risk characteristics. Among BMSM who reported ever injecting drugs (n = 123), 31.7% tested HIV positive. HIV prevalence did not differ by self-reported PrEP use among BMSM who had injected drugs (p = 0.59). CONCLUSIONS BMSM who inject drugs who reported currently using PrEP were no less likely to test positive for HIV than those who did not use PrEP. Wrap-around services to support consistent PrEP use and long-acting PrEP formulations may improve the effectiveness of PrEP among BMSM who inject drugs.
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Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support. J Urban Health 2019; 96:760-771. [PMID: 31037482 PMCID: PMC6814667 DOI: 10.1007/s11524-019-00355-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.
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Bukowski LA, Hampton MC, Escobar-Viera CG, Sang JM, Chandler CJ, Henderson E, Creasy SL, Stall RD. Intimate Partner Violence and Depression among Black Transgender Women in the USA: The Potential Suppressive Effect of Perceived Social Support. J Urban Health 2019; 96:760-771. [PMID: 31037482 DOI: 10.1007/s11524-11019-00355-11523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.
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Affiliation(s)
- Leigh A Bukowski
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Melvin C Hampton
- NYU Langone Health New York University, 514 49th Street, Brooklyn, NY, 11220, USA
| | - Cesar G Escobar-Viera
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for Research on Media, Technology, & Health, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA, USA
| | - Jordan M Sang
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Cristian J Chandler
- Department of Epidemiology Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 400, Atlanta, GA, 30322, USA
| | - Emmett Henderson
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Ronald D Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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Friedman MR, Sang JM, Bukowski LA, Chandler CJ, Egan JE, Eaton LA, Matthews DD, Ho K, Raymond HF, Stall R. Prevalence and Correlates of PrEP Awareness and Use Among Black Men Who Have Sex with Men and Women (MSMW) in the United States. AIDS Behav 2019; 23:2694-2705. [PMID: 30820849 PMCID: PMC6713621 DOI: 10.1007/s10461-019-02446-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014-2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p < 0.001). Among PrEP-aware MSM, MSMW were more likely than MSMO to report PrEP use (p < 0.05). MSMW receiving gay community support were more likely to be PrEP-aware (p < 0.01). MSMW reporting any past-year STI diagnoses were more likely to report PrEP use (p < 0.01). Findings suggest that PrEP awareness campaigns tailored for Black MSMW, concomitant with STI-to-PrEP interventions, will facilitate greater PrEP uptake in this population.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cristian J Chandler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James E Egan
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ken Ho
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including game-based elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 min during the 3-month intervention period (n = 50, 25.8%), we estimated 4.85 (95% CI 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.
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