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Avallone F, Hickson F. Sexual Health Needs Among Men Who Engage in Transactional Sex with Men in the UK. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2397-2404. [PMID: 38467959 DOI: 10.1007/s10508-024-02838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/30/2023] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and-controlling for age-more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education.
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Affiliation(s)
- Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada.
- Center for Outcomes Research and Evaluation Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Ford Hickson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Jiménez-Rivagorza L, Orozco R, Medina-Mora ME, Rafful C. HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1561-1574. [PMID: 38409457 PMCID: PMC10954905 DOI: 10.1007/s10508-024-02816-6] [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: 04/04/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI) = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.
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Affiliation(s)
- Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
| | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - María Elena Medina-Mora
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico.
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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Temple J, Ferretti ML, Reis-Bergan M, Irons JG. Initial Validity Evidence for a Measure of Transactional Sex in a U.S. College Student Sample. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 38240631 DOI: 10.1080/00224499.2024.2302501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The current study provides initial validity evidence for a measure of Transactional Sex (TS). Participants (N = 269) were recruited from a Northeastern University in the United States and consisted of undergraduate and graduate students. Participants completed an online survey through QuestionPro that contained the Transactional Sex Measure (TSM) as well as measures of depression, anxiety, and stress, condom use negotiation self-efficacy and sexual risk, alcohol and drug use, and materialism. Construct and criterion validity were examined. Findings revealed that the TSM provided good criterion validity evidence but the construct validity evidence was minimal. Further studies on the conceptualization of TS and distribution of the TSM across a variety of diverse samples can provide more validity evidence.
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Affiliation(s)
- Jasmine Temple
- Department of Psychological Science, University of North Carolina at Charlotte
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Jenkins WD, Phillips G, Rodriguez CA, White M, Agosto S, Luckey GS. Behaviors associated with HIV transmission risk among rural sexual and gender minority and majority residents. AIDS Care 2023; 35:1452-1464. [PMID: 36803272 DOI: 10.1080/09540121.2023.2179592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
Multiple rural states and communities experience elevated rates of human immunodeficiency virus (HIV), often associated with diminished healthcare access and increased drug use. Though a substantial proportion of rural populations are sexual and gender minorities (SGM), little is known of this group regarding substance use, healthcare utilization, and HIV transmission behaviors. During May-July 2021, we surveyed 398 individuals across 22 rural Illinois counties. Participants included cisgender heterosexual males (CHm) and females (CHf) (n = 110); cisgender non-heterosexual males and females (C-MSM and C-WSW; n = 264); and transgender individuals (TG; n = 24). C-MSM participants were more likely to report daily-to-weekly alcohol and illicit drug use prescription medication misuse (versus CHf; aOR = 5.64 [2.37-13.41], 4.42 [1.56-12.53], and 29.13 [3.80-223.20], respectively), and C-MSM participants more frequently reported traveling to meet with romantic/sex partners. Further, more C-MSM and TG than C-WSW reported healthcare avoidance and denial due to their orientation/identity (p < 0.001 and p = 0.011, respectively); 47.6% of C-MSM and 58.3% of TG had not informed their provider about their orientation/identity; and only 8.6% of C-MSM reported ever receiving a pre-exposure prophylaxis (PrEP) recommendation. More work is needed to explore the substance use and sexual behaviors of rural SGM, as well as their healthcare interactions, to better target health and PrEP engagement campaigns.
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Affiliation(s)
- Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University, Springfield, IL, USA
| | - Gregory Phillips
- Department of Medical Social Services and Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Christofer A Rodriguez
- Health Promotion and Disease Prevention, Stempel College, Florida International University, Miami, FL, USA
| | - Megan White
- Department of Population Science and Policy, Southern Illinois University, Springfield, IL, USA
| | - Stacy Agosto
- Behavioral Health, Shawnee Health Service, Carbondale, IL, USA
| | - Georgia S Luckey
- Department of Family and Community Medicine, Southern Illinois University, Springfield, IL, USA
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Dickson MF, Tillson M, Calvert JM, Staton M. Transactional sex among rural, justice-involved Appalachian women who use drugs. J Rural Health 2023; 39:789-794. [PMID: 36648452 PMCID: PMC10350464 DOI: 10.1111/jrh.12741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Transactional sex is associated with an array of other health risk behaviors and adverse health outcomes, including HIV. However, despite concerns regarding a potential HIV outbreak, there is limited understanding of transactional sex among rural Appalachians who engage in high-risk behaviors. Thus, the current study describes the prevalence and correlates of transactional sex among a sample of rural, justice-involved Appalachian women who use drugs. METHODS Participants (N = 400) were randomly selected, screened, and interviewed face-to-face at 3 rural Appalachian jails in Kentucky. Bivariate analyses were used to examine differences between those who reported trading sex for drugs, money, goods, or services in the year prior to incarceration and those who had not, and multivariable logistic regression was used to examine independent correlates of transactional sex. FINDINGS On average, participants were 33 years old with 11 years of education. They were predominantly White (99.0%), about half (43.7%) reported lifetime transactional sex, and 25.9% reported past year transactional sex. Past year transactional sex was positively associated with experiencing money problems, substance use problem severity, injection drug use, unprotected sex with a casual partner, and number of sexual partners in the year prior to incarceration. CONCLUSIONS Results suggest that transactional sex is fairly common among rural Appalachian women who use drugs and are justice-involved and may signal other HIV-related risk behaviors. Given limited service availability throughout rural Appalachia, findings emphasize a need for increased access to risk-reduction interventions, including jail-based interventions, to educate vulnerable, hard-to-reach populations on the risks associated with HIV.
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Affiliation(s)
- Megan F. Dickson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Joseph M. Calvert
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
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Jackson KJ, Santos GM. Advertising Patterns of internet-Based Male Sex Workers Who Have Sex With Men (MSMSW): The Association Between LGBTQIA+ Events and Advertising for Work During the 2022 Pride Season. Am J Mens Health 2023; 17:15579883231205984. [PMID: 37822094 PMCID: PMC10571702 DOI: 10.1177/15579883231205984] [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] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
Research into populations of male sex workers who have sex with men (MSMSW) has historically been stymied given the illegal, stigmatized nature of the profession. The internet has shaped how many sex workers advertise their services to clients. Few studies, however, have leveraged internet advertising data to inform MSMSW-specific public health programming and/or outreach efforts. The primary aim of this study was to describe the association between MSMSW advertising during LGBTQIA+ events in U.S. cities during the 2022 pride season. Data were web-scraped at weekly intervals from an internet platform popular among MSMSW in 16 U.S. cities with scheduled LGBTQIA+ events over 18 weeks June to October 2022. For each city, a Poisson regression was fitted for the outcome of number MSMSW advertisements/week and the association with LGBTQIA+ pride events (binary, no/yes), adjusted for month. Cities with the greatest number of MSMSW advertisements were New York City, San Francisco, and Chicago, with 848.2 (SD = 48.0), 293.3 (SD = 34.7), and 252.3 (SD = 22.8) mean weekly advertisements, respectively. LGBTQIA+ events were significantly (p < .05) associated with an increased number of MSMSW advertisements in San Francisco (incidence rate ratios (IRRs) = 1.16, 95% confidence interval (CI) = 1.07-1.25, p < .001), New York City (IRR = 1.15, 95% CI = 1.05-1.26, p < .005), and Chicago (IRR = 1.25, 95% CI = 1.12-1.39, p < .001). In these jurisdictions, LGBTQIA+ events could represent opportunities to overcome barriers to reaching MSMSW; findings from this study may assist in identifying priority cities for MSMSW-specific sexual health initiatives.
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Affiliation(s)
- Kristopher J. Jackson
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA
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Remch M, Scheidell JD, Cleland CM, Turpin R, Duncan DT, Dyer TT, Kaufman JS, Mazumdar M, Brewer R, Feelemyer J, Mayer KH, Khan MR. Mediation of the Effect of Incarceration on Selling Sex Among Black Sexual Minority Men and Black Transgender Women in the HPTN 061 Study. AIDS Behav 2023; 27:2791-2802. [PMID: 36746876 DOI: 10.1007/s10461-023-04003-5] [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: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Incarceration among Black sexual minority men and Black transgender women (BSMM/BTW) is disproportionately high in the United States. Limited research has documented the disruptive effect of incarceration on sexual networks and sexual partnership exchange among BSMM/BTW. We estimate the influence of incarceration on selling sex and mediating pathways among 1169 BSMM/BTW enrolled in the HIV Prevention Trials Network (HPTN) 061 cohort to assess this relationship. Mediators investigated were social support, violence, illicit drug use, and distress due to experienced racism and homophobia. During the 6 months following baseline, 14% of the cohort was incarcerated, including 24% of BTW. After adjustment, recent incarceration was associated with 1.57 (95% CI 1.02, 2.42) times the risk of subsequently selling sex. The hypothesized mediators together explained 25% of the relationship, with an indirect effect risk ratio of 1.09 (95% CI 0.97, 1.24). Our results document an association and call for more research investigating mechanisms.
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Affiliation(s)
- Molly Remch
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, CB 7435, McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA.
| | - Joy D Scheidell
- Department of Health Sciences, University of Central Florida, Orlando, FL, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rodman Turpin
- Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Typhanye T Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montreal, QC, Canada
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Blair CS, Javanbakht M, Comulada WS, Bolan R, Shoptaw S, Gorbach PM, Needleman J. Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1102-1114. [PMID: 37328629 PMCID: PMC10795486 DOI: 10.1007/s11121-023-01561-x] [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: 06/06/2023] [Indexed: 06/18/2023]
Abstract
Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Reid SC, Wang V, Assaf RD, Kaloper S, Murray AT, Shoptaw S, Gorbach P, Cassels S. Novel Location-Based Survey Using Cognitive Interviews to Assess Geographic Networks and Hotspots of Sex and Drug Use: Implementation and Validation Study. JMIR Form Res 2023; 7:e45188. [PMID: 37347520 DOI: 10.2196/45188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The Ending the HIV Epidemic initiative in the United States relies on HIV hotspots to identify where to geographically target new resources, expertise, and technology. However, interventions targeted at places with high HIV transmission and infection risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity. OBJECTIVE We described the implementation and validation of a web-based activity space survey on HIV risk behaviors. The survey was intended to collect geographic information that will be used to map risk behavior hotspots as well as the geography of sexual networks in Los Angeles County. METHODS The survey design team developed a series of geospatial questions that follow a 3-level structure that becomes more geographically precise as participants move through the levels. The survey was validated through 9 cognitive interviews and iteratively updated based on participant feedback until the saturation of topics and technical issues was reached. RESULTS In total, 4 themes were identified through the cognitive interviews: functionality of geospatial questions, representation and accessibility, privacy, and length and understanding of the survey. The ease of use for the geospatial questions was critical as many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks was critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The geospatial questions increased the length of the survey and warranted the inclusion of features to simplify it and speed it up. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete it. The long-standing relationship between participants and the research team improved comfort to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive and validating language in the survey alleviated concerns related to privacy and representation. CONCLUSIONS This study provides promising results regarding the feasibility of using a web-based mapping survey to collect sensitive location information relevant to ending the HIV epidemic. Data collection at several geographic levels will allow for insights into spatial recall of behaviors as well as future sensitivity analysis of the spatial scale of hotspots and network characteristics. This design also promotes the privacy and comfort of participants who provide location information for sensitive topics. Key considerations for implementing this type of survey include trust from participants, community partners, or research teams to overcome concerns related to privacy and comfort. The implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial components.
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Affiliation(s)
- Sean C Reid
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Vania Wang
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Ryan D Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sofia Kaloper
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Alan T Murray
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Steven Shoptaw
- Family Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Pamina Gorbach
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Susan Cassels
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
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Kisaakye P, Bukuluki P, Nabulya A, Nakijoba B, Kasirye R, Mutaawe R. Substance use and watching pornography are drivers of transactional sex: evidence from young women receiving care from Uganda Youth Development Link. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2183907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Anna Nabulya
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Barbara Nakijoba
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Rogers Kasirye
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Rogers Mutaawe
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
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Freeman JQ, Cha S, Wejnert C, Baugher A. Physical and Sexual Violence and Sexual Behaviors Among Men Who Have Sex with Men in 22 U.S. Cities-National HIV Behavioral Surveillance, 2017. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP37-NP59. [PMID: 35365046 DOI: 10.1177/08862605221078821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
National prevalence of physical and sexual violence and its relationship to sexual behaviors are unknown among men who have sex with men (MSM). We estimated 12-month prevalence of physical and sexual violence and assessed relationships between violence and sexual behaviors among MSM. Data were obtained from National HIV Behavioral Surveillance 2017 that used time-space sampling methods to recruit and interview MSM in 22 U.S. cities. Weighted percentages with 95% confidence intervals (CI) were reported. Adjusted prevalence ratios (aPR) and 95% CIs were calculated using logistic regression with predicted marginal means. Overall, 10.2% (95% CI: 9.3%-11.2%) of MSM experienced physical violence only, 3.2% (95% CI: 2.7%-3.7%) experienced sexual violence only, and 2.3% (95% CI: 1.9%-2.7%) experienced both types of violence, in the past 12 months. Compared to MSM who did not experience violence, those who did reported higher percentages of unemployment, poverty, homelessness, same-sex discrimination, non-injection drug use, and binge drinking. Violence was not independently associated with condomless anal sex among MSM. MSM who experienced both types of violence were more likely than those who did not experience violence to have had four or more male sex partners (aPR=1.18, 95% CI: 1.02-1.37). MSM who experienced both types of violence (aPR=2.49, 95% CI: 1.52-4.09), sexual violence (aPR=2.27, 95% CI: 1.47-3.52), or physical violence (aPR=1.76, 95% CI: 1.27-2.44) were more likely than those who did not experience violence to have had exchange sex. Recent physical violence and sexual violence are common among MSM. Findings highlight the importance of violence screening and suggest the need for tailored interventions that improve the safety and economic security of MSM who experience violence, including those who exchange sex.
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Affiliation(s)
- Jincong Q Freeman
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Cha
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Baugher
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ellis MS, Kasper ZA, Takenaka B, Buttram ME, Shacham E. Associations of Transactional Sex and Sexually Transmitted Infections Among Treatment-Seeking Individuals With Opioid Use Disorder. Am J Prev Med 2023; 64:17-25. [PMID: 36085260 DOI: 10.1016/j.amepre.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Coinciding with the rise in opioid use across the U.S., the rates of sexually transmitted infections have reached historically high levels, underscoring the need to understand multiple pathways of disease spread. Although prevention is often focused on injection-related behaviors, this study sought to identify the prevalence and associations of a little understood pathway, transactional sex, among individuals with opioid use disorder, including associations of transactional sex with the prevalence of sexually transmitted infection diagnoses. METHODS Data were sourced from a nationwide opioid surveillance program of treatment-seeking individuals with opioid use disorder utilizing a serial, cross-sectional survey of 4,366 new entrants to 1 of 99 substance use treatment programs for opioid use disorder in 37 states from October 2018 to June 2021. RESULTS A quarter of the sample (24.9%) self-reported a lifetime history of transactional sex for drugs, with rates highest for sexual (56.6%) and gender (53.8%) minority, female (33.4%), Latinx (30.4%), and Black (29.6%) subgroupings. Lifetime diagnoses of all specific sexually transmitted infections analyzed were significantly higher (p<0.001) among those reporting transactional sex, particularly syphilis (14.3% vs 4.4%) and HIV (4.0 vs 0.9%). Financial hardship, trauma, and psychiatric disorder were significantly associated with transactional sex engagement. CONCLUSIONS Transactional sex is relatively common among patients with opioid use disorder, particularly among sexual/gender minorities, which was associated with a greater lifetime prevalence of all sexually transmitted infections assessed. Sexually transmitted infection testing remains at low levels within substance use treatment programs, occurring in just 26.3% of programs; sexual health screenings and sexually transmitted infection prevention/testing need to be prioritized and integrated into opioid use disorder patient care.
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Affiliation(s)
- Matthew S Ellis
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri.
| | - Zachary A Kasper
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri
| | - Bryce Takenaka
- College for Public Health and Social Justice, St Louis University, Saint Louis, Missouri
| | - Mance E Buttram
- Department of Health, Human Performance and Recreation, College of Education and Health Professions, University of Arkansas, Fayetteville, Arkansas
| | - Enbal Shacham
- College for Public Health and Social Justice, St Louis University, Saint Louis, Missouri
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Causevic S, Salazar M, Ekström AM, Berglund T, Ingemarsdotter Persson K, Jonsson M, Jonsson J, Strömdahl S. Prevalence and risk factors for transactional sex among Swedish-born and foreign-born MSM in Sweden. BMC Public Health 2022; 22:2412. [PMID: 36550432 PMCID: PMC9774071 DOI: 10.1186/s12889-022-14764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Little is known about transactional sex (TS) (selling and buying sex) among men who have sex with men (MSM) in Sweden, especially among foreign-born MSM. This study aims to assess the prevalence and risk factors of TS (ever and in the previous five years) among MSM living in Sweden and to determine if there is a difference between Swedish-born MSM and foreign-born MSM. METHODS Swedish data from a multicountry online banner survey (EMIS-2017) was used (n = 4443). Multivariable regression analysis was applied to analyse the data. RESULTS The prevalence of ever-selling sex among all MSM participants was 13.2% and 5.9% in the previous five years. Selling sex ever and in the previous five years was higher among foreign-born MSM (16% and 8.4%, respectively) than Swedish-born MSM (12.7% and 5.4%, respectively). Among all participants, younger age (aOR:3.19, 95% CI:1.57-6.45) and really struggling to live on current income (aOR:3.37, 95% CI:2.29-4.96) increased the odds of selling sex. Being foreign-born MSM (aOR:1.33, 95% CI:1.02-1.73) and having had sex with a woman in the previous 12 months increased the odds of selling sex (aOR:1.44, 95% CI:1.00-2.07). The prevalence of ever buying sex among MSM participants in Sweden was 10.8% and 6.7% in the previous five years, with the same trend among foreign-born MSM (11.6% and 6.9%, respectively) and Swedish-born MSM (10.7% and 6.6%, respectively). Higher education and not having a current partner increased the odds of buying sex. Younger age was protective for buying sex (aOR:0.05, 95% CI:0.02-0.14). Among the foreign-born MSM, the length of stay in Sweden decreased the odds of buying sex (aOR: 0.98, 95% CI: 0.96-0.99). CONCLUSIONS The comparatively high prevalence of TS among MSM participants in Sweden, where buying sex is illegal, with a higher prevalence among foreign-born MSM participants, calls for sexual and reproductive health and rights interventions in this population. Increased attention, including HIV prevention programming and education, should be aimed at younger MSM, MSM struggling with their current income, and foreign-born MSM, as they are more likely to report selling sex.
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Affiliation(s)
- Sara Causevic
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Mariano Salazar
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Anna Mia Ekström
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden ,Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Torsten Berglund
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Kristina Ingemarsdotter Persson
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Mikael Jonsson
- The Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights (Riksförbundet För Homosexuellas, Bisexuellas, Transpersoners, Queeras Och Intersexpersoners Rättigheter, RFSL), Stockholm, Sweden
| | - Jonas Jonsson
- The Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights (Riksförbundet För Homosexuellas, Bisexuellas, Transpersoners, Queeras Och Intersexpersoners Rättigheter, RFSL), Stockholm, Sweden
| | - Susanne Strömdahl
- grid.4714.60000 0004 1937 0626Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77 Stockholm, Sweden ,grid.8993.b0000 0004 1936 9457 Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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HIV, chemsex, and the need for harm-reduction interventions to support gay, bisexual, and other men who have sex with men. Lancet HIV 2022; 9:e717-e725. [PMID: 35926550 DOI: 10.1016/s2352-3018(22)00124-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
Abstract
Numerous studies have identified an association between the use of drugs in sexual contexts (chemsex) and HIV among gay, bisexual, and other men who have sex with men (GBMSM), although whether a causal relationship exists is contentious. An intricate relationship exists between chemsex, HIV treatment and prevention, harm reduction, and the provision of community-grounded health services. Furthermore, potential harms exist beyond HIV, such as intoxication and overdose. Community-engaged responses to chemsex involve social and cultural strategies of harm reduction and sexual health promotion before, during, and after a chemsex session. Ultimately, this Review calls for actions and collaborations aimed at developing a greater understanding of chemsex as a practice within different GBMSM subpopulations and to develop tailored harm-reduction models that can accommodate GBMSM who engage in chemsex in various ways and with varied effects.
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Liboro RM, Fehr C, Da Silva G. Kinky Sex and Deliberate Partner Negotiations: Case Studies of Canadian Transgender Men Who Have Sex with Men, Their HIV Risks, Safer Sex Practices, and Prevention Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11382. [PMID: 36141655 PMCID: PMC9517264 DOI: 10.3390/ijerph191811382] [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: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Growing research in the last two decades has begun to investigate the HIV risks and sexual health practices of transgender men, especially as a subpopulation of men who have sex with men (MSM) that likely shares certain HIV risks and sexual health practices with cisgender MSM, the sociodemographic group that continues to be at highest risk for HIV in many developed countries since the start of the epidemic. As part of our Community-Based Participatory Research project and larger strengths-based qualitative study that was dedicated to examine multiple factors that promote resilience to HIV utilizing the perspectives and lived experiences of middle-aged and older MSM, the case studies we present in this article feature the distinct insights and experiences of three HIV-negative transgender MSM from Downtown Toronto, Ontario, Canada, who participated in our one-on-one interviews. The three case studies provide not only an enlightening snapshot of some of the specific contexts, HIV risks, safer sex practices, and HIV prevention needs of transgender MSM, but also a unique opportunity to critically reflect on the potential implications of the insights and experiences that were shared by our participants, particularly for adapting and developing current and future HIV services and programs to maximally benefit transgender MSM.
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Affiliation(s)
- Renato M. Liboro
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - Charles Fehr
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
| | - George Da Silva
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
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Javanbakht M, Lin J, Ragsdale A, Kim S, Siminski S, Gorbach P. Comparing single and multiple imputation strategies for harmonizing substance use data across HIV-related cohort studies. BMC Med Res Methodol 2022; 22:90. [PMID: 35369872 PMCID: PMC8978400 DOI: 10.1186/s12874-022-01554-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although standardized measures to assess substance use are available, most studies use variations of these measures making it challenging to harmonize data across studies. The aim of this study was to evaluate the performance of different strategies to impute missing substance use data that may result as part of data harmonization procedures.
Methods
We used self-reported substance use data collected between August 2014 and June 2019 from 528 participants with 2,389 study visits in a cohort study of substance use and HIV. We selected a low (heroin), medium (methamphetamine), and high (cannabis) prevalence drug and set 10–50% of each substance to missing. The data amputation mimicked missingness that results from harmonization of disparate measures. We conducted Monte Carlo simulations to evaluate the comparative performance of single and multiple imputation (MI) methods using the relative mean bias, root mean square error (RMSE), and coverage probability of the 95% confidence interval for each imputed estimate.
Results
Without imputation (i.e., listwise deletion), estimates of substance use were biased, especially for low prevalence outcomes such as heroin. For instance, even when 10% of data were missing, the complete case analysis underestimated the prevalence of heroin by 33%. MI, even with as few as five imputations produced the least biased estimates, however, for a high prevalence outcome such as cannabis with low to moderate missingness, performance of single imputation strategies improved. For instance, in the case of cannabis, with 10% missingness, single imputation with regression performed just as well as multiple imputation resulting in minimal bias (relative mean bias of 0.06% and 0.07% respectively) and comparable performance (RMSE = 0.0102 for both and coverage of 95.8% and 96.2% respectively).
Conclusion
Our results from imputation of missing substance use data resulting from data harmonization indicate that MI provided the best performance across a range of conditions. Additionally, single imputation for substance use data performed comparably under scenarios where the prevalence of the outcome was high and missingness was low. These findings provide a practical application for the evaluation of several imputation strategies and helps to address missing data problem when combining data from individual studies.
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Javanbakht M, Rosen A, Ragsdale A, Richter EI, Shoptaw S, Gorbach PM. Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California. J Urban Health 2022; 99:305-315. [PMID: 35235134 PMCID: PMC8890012 DOI: 10.1007/s11524-022-00607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA.
| | - Allison Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Amy Ragsdale
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - E India Richter
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Steven Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
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18
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Shoptaw S, Li MJ, Javanbakht M, Ragsdale A, Goodman-Meza D, Gorbach PM. Frequency of reported methamphetamine use linked to prevalence of clinical conditions, sexual risk behaviors, and social adversity in diverse men who have sex with men in Los Angeles. Drug Alcohol Depend 2022; 232:109320. [PMID: 35093681 PMCID: PMC8885921 DOI: 10.1016/j.drugalcdep.2022.109320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study tested the hypothesis that reported frequency of methamphetamine use is significantly associated with measures of social adversity, sexual risk behaviors, chronic health conditions, bacterial STIs and HIV-related factors among diverse men who have sex with men (MSM). METHODS Data were 2428 visits from 515 mSTUDY participants (261 people living with HIV; 254 HIV-negative). mSTUDY is an ongoing longitudinal study of racially/ethnically diverse MSM in Los Angeles County. Logistic regression with random intercepts modeled associations between self-reported past 6-month methamphetamine use (none, monthly or less, weekly or more) with reported adverse social outcomes (unemployment, housing instability, intimate partner violence), sexual risk behaviors, chronic health conditions, and biomarkers of bacterial STIs (chlamydia, gonorrhea, or syphilis) and detectable HIV viral load (among HIV-positive). Models controlled for confirmed HIV-serostatus. RESULTS Prevalence of reported monthly or less methamphetamine use was 19%; weekly or more use was 18%. Multivariable models showed escalating odds of adverse social outcomes and sexual risk behaviors (p's < 0.001) with increased methamphetamine use frequency. Frequency of methamphetamine use associated with increased odds of a positive bacterial STI test (p < .001), detectable viral load (in HIV-positive participants) (p < .001), renal condition (p = .047), neurological condition (p = .008), and psychological condition (p = .001). CONCLUSIONS Findings show cross-sectional links between reported methamphetamine use frequency and adverse social and health outcomes among MSM in Los Angeles and suggest there may be fewer social and physical health harms corresponding to less frequent use of methamphetamine in this group.
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Affiliation(s)
- Steve Shoptaw
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles, United States; David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | - Michael J. Li
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles
| | - Marjan Javanbakht
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - Amy Ragsdale
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - David Goodman-Meza
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles
| | - Pamina M. Gorbach
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
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19
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Blair CS, Needleman J, Javanbakht M, Comulada WS, Ragsdale A, Bolan R, Shoptaw S, Gorbach PM. Examining the Relative Contributions of Methamphetamine Use, Depression, and Sexual Risk Behavior on Rectal Gonorrhea/Chlamydia Among a Cohort of Men Who Have Sex With Men in Los Angeles, California. Sex Transm Dis 2022; 49:216-222. [PMID: 34654768 PMCID: PMC8821317 DOI: 10.1097/olq.0000000000001568] [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: 11/26/2022]
Abstract
BACKGROUND Methamphetamine use, sexual risk behaviors, and depression contribute to ongoing human immunodeficiency virus (HIV) and sexually transmitted infection (STI) disparities among men who have sex with men (MSM). The relative contributions of these effects longitudinally are not well understood. METHODS This analysis used visit-level data from a longitudinal cohort of MSM, half with HIV, in Los Angeles, CA. From August 2014 to March 2020, participants completed follow-up visits every 6 months and underwent testing for rectal gonorrhea/chlamydia (GC/CT) and completed questionnaires including depressive symptoms, number of receptive anal intercourse (RAI) partners, and methamphetamine use. Path analysis with structural equation modeling using concurrent and lagged covariates was used to identify relative contributions of methamphetamine use and depression on number of RAI partners and rectal GC/CT across time. RESULTS Five hundred fifty-seven MSM with up to 6 visits (3 years) were included for a total of 2437 observations. Methamphetamine use and depressive symptoms were positively associated with number of RAI partners (β = 0.28, P < 0.001; β = 0.33, P = 0.018, respectively), which was positively associated with rectal GC/CT (β = 0.02, P < 0.001). When stratified by HIV status, depressive symptoms were positively associated with RAI partners for HIV-negative MSM (β = 0.50, P = 0.007) but were not associated for MSM living with HIV (β = 0.12, P = 0.57). Methamphetamine use was positively associated with RAI partners in both strata. CONCLUSIONS Factors and patterns, which contribute to risk behaviors associated with rectal GC/CT, may differ by HIV status. Our findings demonstrate the importance of combined treatment and prevention efforts that link screening and treatment of stimulant use and depression with STI prevention and treatment.
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Affiliation(s)
- Cheríe S. Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - W. Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amy Ragsdale
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M. Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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Jenkins WD, Williams LD, Pearson WS. Sexually Transmitted Infection Epidemiology and Care in Rural Areas: A Narrative Review. Sex Transm Dis 2021; 48:e236-e240. [PMID: 34264905 PMCID: PMC8595853 DOI: 10.1097/olq.0000000000001512] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although rural areas contain approximately 19% of the US population, little research has explored sexually transmitted infection (STI) risk and how urban-developed interventions may be suitable in more population-thin areas. Although STI rates vary across rural areas, these areas share diminishing access to screening and limited rural-specific testing of STI interventions. METHODS This narrative review uses a political ecology model of health and explores 4 domains influencing STI risk and screening: epidemiology, health services, political and economic, and social. Articles describing aspects of rural STI epidemiology, screening access and use, and intervention utility within these domains were found by a search of PubMed. RESULTS Epidemiology contributes to risk via multiple means, such as the presence of increased-risk populations and the at-times disproportionate impact of the opioid/drug use epidemic. Rural health services are diminishing in quantity, often have lesser accessibility, and may be stigmatizing to those needing services. Local political and economic influences include funding decisions, variable enforcement of laws/statutes, and systemic prevention of harm reduction services. Social norms such as stigma and discrimination can prevent individuals from seeking appropriate care, and also lessen individual self-efficacy to reduce personal risk. CONCLUSIONS Sexually transmitted infection in rural areas is significant in scope and facing diminished prevention opportunities and resources. Although many STI interventions have been developed and piloted, few have been tested to scale or operationalized in rural areas. By considering rural STI risk reduction within a holistic model, purposeful exploration of interventions tailored to rural environments may be explored.
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Affiliation(s)
- Wiley D. Jenkins
- Research Associate Professor and Chief Epidemiology and Biostatistics, Department of Population Science and Policy, SIU School of Medicine, 201 E. Madison Street, Springfield, Illinois 62794-9664
| | - Leslie D. Williams
- Assistant Professor, Community Health Sciences, University of Illinois at Chicago, School of Public Health, 677 SPHPI, 1603 W. Taylor St
| | - William S. Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Armstrong HL, Sang JM, Skala A, Wang L, Zhu J, Lachowsky NJ, Card KG, Benoit C, Olarewaju G, Hogg RS, Moore DM, Roth EA. Factors associated with transactional sex among a cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada. Sex Health 2021; 18:487-497. [PMID: 34844666 DOI: 10.1071/sh21128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022]
Abstract
Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Ales Skala
- University of British Columbia, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of Victoria, Victoria, BC, Canada
| | | | | | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
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22
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Wise A, Kianian B, Chang H, Linton S, Wolfe ME, Smith J, Tempalski B, Des Jarlais D, Ross Z, Semaan S, Wejnert C, Broz D, Cooper H. Place-Based Correlates of Exchange Sex Among People Who Inject Drugs in 19 U.S. Metropolitan Areas, 2012. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2897-2909. [PMID: 33796991 DOI: 10.1007/s10508-020-01883-9] [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: 04/01/2019] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
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Affiliation(s)
- Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA.
| | - Behzad Kianian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E Wolfe
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY, USA
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Health System, New York, NY, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 549, Atlanta, GA, 30322, USA
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Leblanc NM, Crean HF, Dyer TP, Zhang C, Turpin R, Zhang N, Smith MDR, McMahon J, Nelson L. Ecological and Syndemic Predictors of Drug Use During Sex and Transactional Sex among U.S. Black Men Who Have Sex with Men: A Secondary Data Analysis from the HPTN 061 Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2031-2047. [PMID: 33903969 DOI: 10.1007/s10508-020-01871-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Abstract
Threats to sexual health among U.S. Black men who have sex with men (MSM) may manifest in a context of social adverse experiences. Situational sex is one such context, which we characterize as sexual behaviors driven either by a desire to cultivate a specific sexual experience or attributable to social vulnerability. Two characterizations of situational sex explored in this study were drug use during sex and transactional sex. Guided by ecological and syndemic frameworks, we conducted a secondary data analysis of social conditions and sexual behaviors among a prospective cohort of Black MSM from the HIV Prevention Trial Network (HPTN) 061 study. Using structural equation modeling, this analysis examined the indirect effect of syndemic factors (substance use, depression, violence exposure) in the relationship between ecological constructs (anti-Black/homophobic stigma, childhood violence, and economic vulnerability) and situational sex (drug use during sex, transactional sex). Model fit indices, CFI (.870) and SRMR (.091), demonstrated reasonable fit. Significant indirect effects emerged via substance use for economic vulnerability (indirect effect = .181, 95% CI [.078, .294]) and anti-Black/homophobic violence and stigma (indirect effect = .061, 95% CI [.008, .121]) on drug use during sex; as well as on transactional sex (economic vulnerability indirect effect = .059, 95% CI [.018, .121] and anti-Black/homophobic stigma and violence indirect effect = .020, 95% CI [.003, .051]). Findings implicate the need for social and fiscal intervention to address upstream, ecological, and syndemic factors that influence inherent vulnerability of situational sex and overall threats to sexual health among Black MSM.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA.
| | - Hugh F Crean
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - Typhanye P Dyer
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - Rodman Turpin
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martez D R Smith
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - James McMahon
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14623, USA
| | - LaRon Nelson
- Yale University School of Nursing, New Haven, CT, USA
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Ogunbajo A, Abubakari GM, Edeza A, Iwuagwu S, Williams R, Biello K, Mimiaga MJ. Transactional Sex Is Associated with Income Level and Psychosocial Health Problems among Gay and Bisexual Men (GBM) in Nigeria, Africa. JOURNAL OF SEX RESEARCH 2021; 58:706-712. [PMID: 33284044 PMCID: PMC8180523 DOI: 10.1080/00224499.2020.1854649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Gay and bisexual men (GBM) who report engagement in transactional sex are at increased risk for HIV acquisition. The current study aimed to assess the prevalence of transactional sex and its association with demographic characteristics, social marginalization, HIV sexual risk behaviors, psychosocial health problems, and access to healthcare services among a multi-site sample of GBM in Nigeria. Bivariate and multivariable logistic regression were used to examine factors associated with engagement in transactional sex in the previous 3 months. More than a third (39.6%) of the participants reported engagement in transactional sex in the previous 3 months. In the multivariable model, factors associated with engagement in transactional sex included: reporting a monthly income of 30,000 Naira [adjusted odds ratio (aOR) 1.98; 95% CI: 1.12 to 3.35], compared to 30,000 or more Naira monthly income, reporting 4 or more receptive anal sex acts in the previous 30 days (aOR 2.45; 95% CI: 1.31 to 4.57) compared to reporting none, and having depressive symptoms (aOR 1.82; 95% CI: 1.06 to 3.14). There is an urgent need for interventions that address the economic disenfranchisement and psychosocial problems experienced by GBM in Nigeria, which has implications for sexual health.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Corresponding Author: Adedotun Ogunbajo, PhD, MPH, MHS, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115,
| | - Gamji M’Rabiu Abubakari
- Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, CT, United States of America
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | | | - Rashidi Williams
- Equality Triangle for Health and Peoples Development Initiative, Warri, Delta, Nigeria
| | - Katie Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States of America
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Food insecurity partially mediates the association between drug use and depressive symptoms among men who have sex with men in Los Angeles, California. Public Health Nutr 2021; 24:3977-3985. [PMID: 34103117 DOI: 10.1017/s1368980021002494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand the relationship between drug use, food insecurity (FI) and mental health among men who have sex with men (MSM). DESIGN Cohort study (2014-2019) with at least one follow-up. SETTING Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modelling tested whether FI mediates the relationship between drug use and depressive symptoms. PARTICIPANTS Data were from HIV-positive and high-risk HIV-negative MSM in Los Angeles, CA (n 431; 1192 visits). RESULTS At baseline, FI was reported by 50·8 % of participants, depressive symptoms in 36·7 % and 52·7 % of urine screening tests were positive for drugs (i.e. marijuana, opioids, methamphetamine, cocaine and ecstasy). A positive drug test was associated with a 96 % increase in the odds of being food insecure (95 % CI 1·26, 3·07). Compared to those with high food security, individuals with very low food security have a nearly sevenfold increase in the odds of reporting depressive symptoms (95 % CI 3·71, 11·92). Findings showed 14·9 % of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator). CONCLUSION The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV transmission.
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Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094961. [PMID: 34066948 PMCID: PMC8125585 DOI: 10.3390/ijerph18094961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Though the transmission of HIV is preventable, there were still 37,968 new documented cases in the United States in 2018. HIV incidence is disproportionate in sexual minority men of color. The purpose of this study was to examine sexual relationship power risk profiles to identify distinct subgroups within the profiles who carry the highest HIV risk. Latent class profile analysis was used to identify subgroups of sexual minority men of color at the highest risk for contracting HIV based on their sexual power profiles. Among 322 sexual minority men, we identified four latent profiles. Profile 1: Low transactional sex and high power (n = 133; 14.3%); Profile 2: Transactional sex, high decision-making in sexual relationships, and low control in sexual relationship (n = 99; 30.7%); Profile 3: Low transactional sex, low decision-making, and moderate control (n = 43; 13.4%); Profile 4: High transactional sex and low power (n = 47; 14.6%). LPA was useful to identify distinct subgroups based on measures of sexual risk and relationship sexual power. Findings carry significant implications for developing tailored strategies to increase HIV knowledge and related HIV prevention and risk reduction services for sexual minority men of color who engage in transactional sex.
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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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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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Swendeman D, Sumstine S, Aguilar E, Gorbach PM, Comulada WS, Gelberg L. Feasibility and Acceptability of Mobile Phone Self-monitoring and Automated Feedback to Enhance Telephone Coaching for People With Risky Substance Use: The QUIT-Mobile Pilot Study. J Addict Med 2021; 15:120-129. [PMID: 32732684 PMCID: PMC7855429 DOI: 10.1097/adm.0000000000000707] [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: 11/25/2022]
Abstract
OBJECTIVES This study evaluates the feasibility, acceptability, and perceived benefits of mobile-phone delivered self-monitoring queries and feedback integrated into the evidence-based Quit Using Drugs Intervention Trial (QUIT) screening and brief telephone health coaching intervention to prevent progression from risky drug use to addiction as the QUIT-Mobile intervention. METHODS Participants (n = 20) were primarily Black/African American and Latino men in Los Angeles with risky substance use. Self-monitoring surveys were sent by text-message twice-weekly for 6 weeks and once-weekly from 6 to 12-weeks. Surveys consisted of 10 questions regarding drug and alcohol use (ie, # days of use) and cravings, quality of life, and medication adherence. Feedback messages praised or encouraged drug use reductions. Coaches monitored patient responses and discussed them in QUIT's telephone coaching sessions. Participants' experiences were assessed qualitatively at 3-month follow-up. RESULTS Nineteen out of 20 participants that completed the qualitative evaluation from the 12-week follow-up reported: (1) self-monitoring surveys helped them adhere to drug use reduction goals and reflect on associations between self-monitoring domains; (2) preference for higher frequency (twice-weekly) self-monitoring during the 6-week coaching period, and then weekly surveys thereafter but not monthly; and (3) self-monitoring and coaching were mutually reinforcing for their drug use reduction goals. CONCLUSIONS Results are consistent with prior similar research suggesting that mobile phone self-monitoring of drug use and related factors is feasible and acceptable among diverse adults with risky drug use. Findings also suggest the potential benefits of integrating electronic self-monitoring and feedback into substance use reduction interventions such as QUIT to enhance patient self-management and coaching or counseling intervention components.
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Affiliation(s)
- Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024
| | - Stephanie Sumstine
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024
| | - Efren Aguilar
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024
| | - Pamina M. Gorbach
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, California 90095-1772
| | - W. Scott Comulada
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024
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Gorbach PM, Javanbakht M, Ragsdale A, Bolan RB, Flynn R, Mandler R, Shoptaw S. Methamphetamine Injection Among Young Men Who Have Sex With Men: Risk for Human Immunodeficiency Virus Transmission in a Los Angeles Cohort. J Infect Dis 2021; 222:S471-S476. [PMID: 32877561 DOI: 10.1093/infdis/jiz610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevalence of methamphetamine (meth) injection and associated human immunodeficiency virus (HIV) risks among men who have sex with men (MSM) are unclear. METHODS A total of 532 MSM completed 1880 mSTUDY study visits between August 2014 and June 2018 in Los Angeles, California. Assessments every 6 months included computer-assisted self-interviews and testing for sexually transmitted infections. Analyses by person and across visits adjusted for repeated measures. RESULTS Of 532 participants, 51% (n = 276) reported meth use (past 6 months). Across 1880 visits, mutually exclusive substance use categories were as follows: 5% meth injection (5%), meth use without injection (33%), other substance use excluding meth (36%), and no substance use (26%). Comparisons across these categories respectively found that meth injectors reported higher prevalence of new sex partners (89%, 70%, 68%, and 51%, respectively), more were HIV positive (83%, 65%, 34%, and 50%), fewer were virally suppressed (53%, 48%, 61%, and 67%), and more had sexually transmitted infections (31%, 22%, 15%, and 15% (all P <.01). CONCLUSIONS Among the young MSM reporting meth injection in this Los Angeles cohort, elevated risks of acquiring or transmitting HIV suggest that they contribute significantly to sustaining the local HIV epidemic. Preventing transition to injection use has potential for HIV prevention.
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Affiliation(s)
- Pamina M Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | - Robert B Bolan
- Los Angeles LGBT Center, Risa Flynn, Los Angeles, California, USA
| | - Risa Flynn
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles,California, USA
| | | | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, California, USA
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Mimiaga MJ, Hughto JM, Klasko-Foster L, Jin H, Mayer KH, Safren SA, Biello KB. Substance Use, Mental Health Problems, and Physical and Sexual Violence Additively Increase HIV Risk Between Male Sex Workers and Their Male Clients in Northeastern United States. J Acquir Immune Defic Syndr 2021; 86:305-312. [PMID: 33148992 PMCID: PMC8343953 DOI: 10.1097/qai.0000000000002563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW. SETTING Community-based organization and health center in 2 Northeastern US cities. METHODS Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus. RESULTS Mean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62). CONCLUSIONS Internet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
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Affiliation(s)
- Matthew J. Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M.W. Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Harry Jin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical, Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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32
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Westmoreland DA, Carrico AW, Goodwin RD, Pantalone DW, Nash D, Grov C. Higher and Higher? Drug and Alcohol Use and Misuse among HIV-Vulnerable Men, Trans Men, and Trans Women Who Have Sex with Men in the United States. Subst Use Misuse 2020; 56:111-122. [PMID: 33153358 PMCID: PMC8218329 DOI: 10.1080/10826084.2020.1843057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance use (SU) and misuse are disproportionately more common among sexual and gender minority (SGM) individuals compared to their heterosexual peers. Yet, little is known about regional and demographic differences in use and misuse among SGM. In this study, we investigated regional and demographic differences in SU and misuse in a U.S. national, internet-based cohort (n = 6,280) of men and trans persons who have sex with men. Methods: Data collected included the WHO ASSIST (substance) and AUDIT (alcohol) SU scales to estimate recent (≤ 3 months) non-problematic use (≤ 3 ASSIST, ≤ 10 AUDIT) and misuse (≥4 ASSIST, ≥11 AUDIT). We used bivariate and multivariable logistic models to examine demographic and regional factors associated with SU and misuse. Results: Participants reported using alcohol (85.6%), cannabis (53.9%), and inhalants (39.1%) in the past three months. More than one-third self-reported misuse of cannabis, Gamma-Hydroxybutyrate (GHB), inhalants, methamphetamines, and prescription sedatives. We observed regional differences in substance use for cannabis (Southeast aOR = 0.76, 95% CI: 0.63-0.93; West aOR = 1.27, 95% CI: 1.02-1.59, ref. Northeast) and prescription Stimulants (Midwest aOR = 1.39, 95% CI: 1.00-1.93), as well as for cannabis misuse (Southeast aOR = 0.83, 95% CI: 0.69-0.99). We also observed significant associations between socioeconomic factors with use and misuse. Conclusions: Findings suggest geographic differences in misuse of certain substances among men and trans persons who have sex with men in the US, and that socio-economic factors, also play a key role in indicating risk.
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Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Adam W. Carrico
- Departments of Public Health Sciences and Psychology, University of Miami, Miami, Florida, USA
| | - Renee D. Goodwin
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Health and Health Policy, New York, New York, USA
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Health and Health Policy, New York, New York, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- Department of Community Health and Social Science, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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34
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Yang C, Zaller N, Clyde C, Tobin K, Latkin C. Association between Recent Criminal Justice Involvement and Transactional Sex among African American Men Who Have Sex with Men in Baltimore. J Urban Health 2020; 97:635-641. [PMID: 30815776 PMCID: PMC7560689 DOI: 10.1007/s11524-019-00350-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-Hispanic Black/African American men who have sex with men (AAMSM) have been disproportionately affected by criminal justice (CJ) involvement and HIV. One potential pathway between CJ involvement and high HIV prevalence and incidence among AAMSM is through risky sexual behavior. The goal of this study was to explore the association between recent CJ involvement, i.e., having been arrested and/or in prison/jail in the past 6 months, and transactional sex in a sample of AAMSM in Baltimore. We analyzed the baseline data of 396 AAMSM from a pilot behavioral HIV intervention conducted in Baltimore, MD, between October 2012 and November 2015. A multivariate logistic regression model was conducted to explore the association between recent CJ involvement and transactional sex. A total of 65 (16%) participants reported recent CJ involvement, and 116 (29%) reported transactional sex in the past 90 days. After adjusting for age, education, employment, sexual identity, HIV status, and drug use, recent CJ involvement was significantly associated with transactional sex (AOR 3.31; 95% CI 1.72; 5.70). Being 24-40 years (AOR 2.73; 95% CI 1.17, 6.33) or over 40 years older (AOR 3.80; 95% CI 1.61, 8.98) vs. younger and using drugs (AOR 4.47; 95% CI 2.43, 8.23) also remained independently associated with recent transactional sex. Findings of the current study contribute to the literature on the association between recent history of CJ involvement and transactional sex among AAMSM. More evidence-based HIV prevention interventions for people involved in the CJ system who are at high risk for contracting HIV, particularly racial and sexual minorities such as AAMSM, are urgently needed.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nick Zaller
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Catie Clyde
- Clinical and Translational Science Center, University of California-Davis, Davis, CA, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cassels S, Meltzer D, Loustalot C, Ragsdale A, Shoptaw S, Gorbach PM. Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles. J Urban Health 2020; 97:609-622. [PMID: 32996024 PMCID: PMC7560688 DOI: 10.1007/s11524-020-00481-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 01/21/2023]
Abstract
The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.
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Affiliation(s)
- Susan Cassels
- Department of Geography, University of California, Santa Barbara, CA, USA.
| | - Dan Meltzer
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Colin Loustalot
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Amy Ragsdale
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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36
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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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37
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Blair CS, Javanbakht M, Comulada WS, Richter EI, Bolan R, Shoptaw S, Gorbach PM. Lubricants and rectal douching: associations with rectal gonorrhea, chlamydia, and/or syphilis infection among men who have sex with men. Int J STD AIDS 2020; 31:1040-1046. [PMID: 32753001 DOI: 10.1177/0956462420938485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11-2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00-1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - E India Richter
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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38
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Walters SM, Braksmajer A, Coston B, Yoon I, Grov C, Downing MJ, Teran R, Hirshfield S. A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1965-1978. [PMID: 31965453 PMCID: PMC7321855 DOI: 10.1007/s10508-020-01628-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 05/18/2023]
Abstract
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, 380 2nd Ave., Suite 306, NY 10010, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | | | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Irene Yoon
- Research and Advisory, Gartner L2, New York, NY, USA
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy and the CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | | | - Richard Teran
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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39
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Understanding HIV risk and vulnerability among cisgender men with transgender partners. Lancet HIV 2020; 7:e201-e208. [PMID: 32032535 DOI: 10.1016/s2352-3018(19)30346-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
In the HIV pandemic, cisgender (ie, non-transgender) men with transgender partners are an underserved population. Complexities of sexuality and gender affect HIV vulnerability for this group, including not identifying with conventional sexual orientation categories (eg, bisexual, heterosexual, or gay) and having attractions based on gender role or expression rather than genital anatomy. Only one HIV prevention interventional study in this population was identified, and one study that assessed the perceived acceptability of an intervention. We found no data for interventions using pre-exposure prophylaxis, interventions for cisgender men with transgender men partners, or cisgender men with casual or transactional sexual partnerships with transgender people. Cisgender men with transgender partners are not easily categorised using traditional HIV risk categories. Additional research is needed to understand stigma and other structural drivers of HIV vulnerability, sexual networks and practices, substance use patterns, and biomedical prevention interest and uptake for this group. Studies that use an intersectional lens and syndemic framework could offer key insights.
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40
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Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend 2020; 207:107770. [PMID: 31841750 PMCID: PMC6981056 DOI: 10.1016/j.drugalcdep.2019.107770] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.
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Affiliation(s)
- Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
| | - Ron Brookmeyer
- UCLA Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | | | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
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