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Chuku CC, Silva MF, Lee JS, Reid R, Lazarus K, Carrico AW, Dale SK. A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV. AIDS Care 2024; 36:1410-1423. [PMID: 38958126 DOI: 10.1080/09540121.2024.2372714] [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: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.
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Affiliation(s)
- Chika Christle Chuku
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Maria F Silva
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Jaramillo J, Reyes N, Atuluru P, Payen N, Taylor K, Safren SA, Saber R, Harkness A. Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida. AIDS Care 2024; 36:569-579. [PMID: 38157344 PMCID: PMC10932813 DOI: 10.1080/09540121.2023.2287736] [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: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nequiel Reyes
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, FL, USA
| | - Naomie Payen
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Kayla Taylor
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Lee JS, Bainter SA, Tsai AC, Andersen LS, Stanton AM, Magidson JF, Kagee A, Joska JA, O'Cleirigh C, Safren SA. Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems. AIDS Behav 2023; 27:1741-1756. [PMID: 36309936 PMCID: PMC10148921 DOI: 10.1007/s10461-022-03906-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/27/2022]
Abstract
In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.
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Affiliation(s)
- Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Karnik NS, Kuhns LM, Hotton AL, Del Vecchio N, McNulty M, Schneider J, Donenberg G, Keglovitz Baker K, Diskin R, Muldoon A, Rivera J, Summersett Williams F, Garofalo R. Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial. JMIR Ment Health 2023; 10:e43653. [PMID: 36989027 PMCID: PMC10131684 DOI: 10.2196/43653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. OBJECTIVE The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. METHODS Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. RESULTS Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. CONCLUSIONS We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. TRIAL REGISTRATION ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-020-8154-6.
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Affiliation(s)
- Niranjan S Karnik
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Anna L Hotton
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Natascha Del Vecchio
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Moira McNulty
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - John Schneider
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, United States
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL, United States
| | | | - Rose Diskin
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Abigail Muldoon
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Juan Rivera
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
| | - Faith Summersett Williams
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Robert Garofalo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Ouafik M. L’approche syndémique appliquée à la santé des minorités sexuelles et de genre : étude de la portée. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:21-30. [PMID: 37336735 DOI: 10.3917/spub.hs2.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Sexual and gender minorities (SGM) represent a vulnerable population, disproportionately affected by mental health issues, a higher exposure to violence and a higher prevalence of sexually transmitted infections, including HIV, for some subgroups. Derived from medical anthropology, the concept of a syndemic consists in the clustering and interaction between multiple health conditions through adverse social conditions such as discrimination or precarity. Confronted to the multitude of adverse conditions affecting SGM, this framework is pertinent to study their health and to propose interventions. PURPOSE OF RESEARCH The purpose of this scoping review is to synthetize the knowledge regarding syndemic theory applied to sexual and gender minorities in order to propose concrete suggestions for scholarly research and field intervention. RESULTS 126 papers were included. European data as well as data concerning sexual minority women and transgender men are scarce. A co-occurrence of psychosocial conditions fostered by stigmatization is well-established. Furthermore, the presence of a syndemic was associated to sexual higher odds of acquiring HIV, suicidal behavior and healthcare utilization. CONCLUSIONS The syndemic framework is important to the health of SGM, both for academic and interventional purposes. Current priorities should be to act against structural disadvantages leading to a syndemic, to improve our knowledge on SGM health in European context and to develop local programs based on peer-support.
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Robles G, Bosco SC, Cardenas I, Hostetter J, Starks TJ. Psychosocial and Culturally-Specific Factors Related to Intimate Partner Violence Victimization among a Sample of Latino Sexual Minority Cis Men in the U.S. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22501-NP22527. [PMID: 35166599 PMCID: PMC9376202 DOI: 10.1177/08862605211072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A growing body of research illustrates that sexual minority men (SMM) experience elevated rates of intimate partner violence (IPV) compared to heterosexual individuals. Researchers have examined the relationship between minority stress and IPV victimization among sexual minority men. A majority of the IPV research identifying risk factors associated with IPV victimization among SMM have sampled predominately non-Hispanic White SMM, while Latino SMM are consistently under-represented in IPV research. This study examines the associations between (1) co-occurring psychosocial factors (e.g., depression, anxiety, childhood sexual abuse, drug use, and problematic drinking) and (2) Latino-specific minority stress factors (e.g., U.S.-born, language, race/ethnic identities, and discrimination) on IPV victimization in a nationwide sample of Latino SMM. Data were collected from Latino SMM aged 18 or older, identified as cis-male, and in a romantic relationship with a cis-male partner (N = 530). The participants were recruited through social media and geo-location-based dating mobile applications. A majority (72%) of the sample reported IPV victimization in their lifetime. Specific to forms of IPV, more than half (51.9%) of the sample reported monitoring behaviors, while 49.6% reported emotional IPV, 45.1% reported physical IPV, 31.5% reported controlling behaviors, and 22.3% reported HIV-related IPV. In multivariable models, psychosocial and Latino-specific factors were associated with the increased likelihood of IPV victimization. Regarding Latino-specific factors, being born in the U.S. and race-based discrimination predicted IPV victimization. These findings highlight the extent to which minority stress elevates the risk of IPV for Latino SMM and point to the need to address social factors in IPV prevention services. Further, work on SMM IPV victimization tends to focus on the potential role of sexual orientation-related discrimination, whereas the current study points to the importance of race-based discrimination.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ
| | - Stephen C. Bosco
- Doctoral Program in Health Psychology and Clinical Science, the Graduate Center of the City University of New York, New York, NY
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Iris Cardenas
- School of Social Work, Rutgers University, New Brunswick, NJ
| | | | - Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY
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Ouafik MR, Buret L, Scholtes B. Mapping the current knowledge in syndemic research applied to men who have sex with men: A scoping review. Soc Sci Med 2022; 306:115162. [PMID: 35779501 DOI: 10.1016/j.socscimed.2022.115162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022]
Abstract
Men who have sex with Men (MSM) represent a population affected by numerous health conditions. Syndemic theory has been used as a framework to study the health of MSM for nearly 20 years. However, the literature is plagued by a lack of consensus regarding what constitutes a synergy in a syndemic and recent reviews have shown that most of the papers published thus far have failed to demonstrate a synergy nor describe the bio-social interaction needed to account for a true syndemic. Moreover, to our knowledge, none of the existing reviews have focused specifically on MSM. This scoping review aims to fill this gap by mapping in detail how syndemic research on MSM has been conducted. A systematic database search was conducted between 2020 and 2021 and 115 studies were included. Our findings showed a lack of diversity regarding the location, design, subpopulation, and outcomes studied. In addition, the syndemic conditions, as well as their measurement, were not focused enough to ensure the robustness and reproducibility of the findings. Furthermore, our results support previous reviews showing a lack of empirical data to support disease interaction in syndemic research applied to MSM. Our review offers some important recommendations to help move the field forward in future work and describes some promising methodological advances.
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Affiliation(s)
- Maxence R Ouafik
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Laetitia Buret
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, General Practice Department, University of Liège, Quartier Hôpital B23, Avenue Hippocrate 13, 4000, Liège, Belgium.
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Holloway IW, Beltran R, Shah SV, Cordero L, Garth G, Smith T, Wilson BDM, Ochoa AM. Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV. J Acquir Immune Defic Syndr 2021; 88:S12-S19. [PMID: 34757988 PMCID: PMC8579986 DOI: 10.1097/qai.0000000000002806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although HIV antiretroviral treatment (ART) access and uptake have increased among racial/ethnic minority individuals, lower rates of ART adherence and viral suppression persist, especially among Black men who have sex with men (BMSM) compared with their White counterparts. SETTING Black men who have sex with men living with HIV (BMSM+) residing in Los Angeles County (N = 124) were recruited in-person (eg, clinic) and online (eg, social networking apps). METHODS Participants completed a cross-sectional survey measuring demographic characteristics, structural syndemics (poverty, criminal justice involvement, and housing instability), and psychosocial syndemics (mental health and substance use). A text message survey assessed missed doses of ART over the past week. Zero-inflated Poisson regression models were used to evaluate variables associated with the number of missed doses of ART. RESULTS On average, participants missed 1.30 doses of ART (SD = 2.09) and reported structural syndemics: poverty (56.1%), criminal justice involvement (36.6%), housing instability (26.3%), and psychosocial syndemics: childhood sexual abuse (51.8%), intimate partner violence (16.9%), depression (39%), and problem alcohol use (15.5%). After controlling for employment, age, education, and psychosocial syndemics, participants with a one-point increase in structural syndemic indicators were found to be 1.63 times more likely to have missed a dose of ART. CONCLUSIONS Structural syndemic were associated with ART nonadherence among BMSM+ after adjusting for demographic and psychosocial factors. HIV treatment interventions that incorporate financial incentives, legal support, and housing may help improve ART adherence among BMSM+. Findings suggest that key priorities to ending the HIV epidemic must include structural interventions that alleviate poverty, eliminate disproportionate policing and criminalization, and end homelessness.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Raiza Beltran
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Saanchi V. Shah
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Luisita Cordero
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Gerald Garth
- Arming Minorities Against Addiction and Disease (AMAAD) Institute, Los Angeles, CA
| | | | - Bianca D. M. Wilson
- The Williams Institute, UCLA School of Law, University of California, Los Angeles, CA
| | - Ayako M. Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
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Chuang DM, Newman PA, Fang L, Lai MC. Syndemic Conditions, Sexual Risk Behavior, and HIV Infection Among Men Who Have Sex with Men in Taiwan. AIDS Behav 2021; 25:3503-3518. [PMID: 33950337 DOI: 10.1007/s10461-021-03269-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)-childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.
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Affiliation(s)
- Deng-Min Chuang
- Graduate Institute of Social Work, National Taiwan Normal University, No. 162, Sec. 1, Heping E. Rd., Da'an Dist., Taipei, 106, Taiwan, ROC.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lin Fang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Martinez O. A review of current strategies to improve HIV prevention and treatment in sexual and gender minority Latinx (SGML) communities. Expert Rev Anti Infect Ther 2021; 19:323-329. [PMID: 32902348 PMCID: PMC10718306 DOI: 10.1080/14787210.2020.1819790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The HIV epidemic continues to disproportionately impact sexual and gender minority Latinxs (SGML). Several syndemic conditions have been linked with HIV acquisition and transmission among SGML including immigration, discrimination, environmental racism, substance use, and mental health. AREAS COVERED We provide a summary of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum among SGML. We also discuss intervention approaches and opportunities that respond at the intersection of HIV and COVID-19 prevention and treatment. EXPERT OPINION There is a dire need for the combination of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum. Interventions and combination approaches should be driven by community-based participatory action research. The inclusion of community members in all stages of the research process can assure successful implementation of program activities and deliverables, including the provision of culturally and linguistically appropriate services. Given the current COVID-19 pandemic, which is disproportionately impacting individuals living with HIV and other comorbidities, the elderly, and under-resourced communities with a ferocity not seen in other communities, intervention approaches that respond at the intersection of HIV and COVID-19 prevention and treatment are also urgently needed.
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Affiliation(s)
- Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
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Connecting the dots: a comparison of network analysis and exploratory factor analysis to examine psychosocial syndemic indicators among HIV-negative sexual minority men. J Behav Med 2020; 43:1026-1040. [PMID: 32361793 DOI: 10.1007/s10865-020-00148-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/21/2020] [Indexed: 12/18/2022]
Abstract
Syndemics, or comorbid and mutually reinforcing psychosocial problems, are associated with increased HIV risk among men who have sex with men (MSM). Although the dynamic interplay among syndemic indicators is theorized to be crucial for increasing risk of HIV acquisition, novel approaches are needed to understand how these syndemic problems interrelate. This study examined the associations between nine self-reported syndemic indicators in 194 MSM at high risk of HIV acquisition. We compared exploratory factor analyses (EFA) to a network analysis. In the present study, network analysis consisted of edges representing bidirectional partial polychoric correlations between nodes, which represent psychosocial syndemic indicators. EFA yielded a 1-factor solution including suicidal ideation (SI), injection drug use (IDU), depression, social anxiety, intimate partner violence, substance use, and sexual compulsivity, and excluded heavy drinking and childhood sexual abuse. Network analysis yielded a pattern of interconnectedness with the most central nodes being SI, IDU, substance use, and depression. Statistically significant relationships (absolute edge weights) were found between SI and depression, social anxiety, and IDU, and IDU and substance use. These results suggest that depression and substance use, especially more severe presentations of these conditions such as SI and IDU, are prominent interconnected components of the HIV syndemic among MSM at high risk for HIV acquisition. SI, IDU, substance use, and depression may indeed be prudent targets of intervention. Future research on the inclusion of these syndemic indicators in analytical models involving interaction terms may be warranted.
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