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Khalifa A, Kim B, Regan S, Moline T, Chaix B, Chen YT, Schneider J, Duncan DT. Examination of multidimensional geographic mobility and sexual behaviour among Black cisgender sexually minoritized men in Chicago. GEOSPATIAL HEALTH 2024; 19. [PMID: 38752862 DOI: 10.4081/gh.2024.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/13/2024] [Indexed: 06/06/2024]
Abstract
Black sexually minoritized men (BSMM) are the most likely to acquire HIV in Chicago- a racially segregated city where their daily travel may confer different HIV-related risks. From survey and GPS data among participants of the Neighbourhoods and Networks Cohort Study, we examined spatial (proportion of total activity space away from home), temporal (proportion of total GPS points away from home), and motivation-specific (discordance between residential and frequented sex or socializing neighbourhoods) dimensions of mobility. To identify potential drivers of BSMM's risk, we then examined associations between mobility and sexual behaviours known to cause HIV transmission: condomless anal sex, condomless anal sex with a casual partner, transactional sex, group sex, and sex-drug use. Multivariable logistic regression models assessed associations. Of 269 cisgender BSMM, most were 20-29 years old, identified as gay, and lowincome. On average, 96.9% (Standard Deviation: 3.7%) of participants' activity space and 53.9% (Standard Deviation: 38.1%) of participants' GPS points occurred outside their 800m home network buffer. After covariate adjustment, those who reported sex away from home were twice as likely to report condomless sex (Odds Ratio: 2.02, [95% Confidence Interval (CI): 1.08, 3.78]). Those who reported socializing away from home were four times more likely to have condomless sex with a casual partner (Odds Ratio: 4.16 [CI: 0.99, 29.0]). BSMM are on the move in Chicago, but only motivation-specific mobility may increase HIV transmission risk. Multidimensional investigations of mobility can inform place-based strategies for HIV service delivery.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY.
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY.
| | - Seann Regan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Tyrone Moline
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Némésis Research Team, Paris.
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - John Schneider
- Department of Medicine, Public Health Sciences, University of Chicago, Chicago, IL.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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2
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Young LE, Tang JL, Schneider JA. Demographic and HIV Status Diversities as Mechanisms of Social Integration and Segregation Among Black Sexual and Gender Minorities Enrolled in a Community-Based Social Network Intervention. SOCIAL NETWORKS 2023; 73:51-61. [PMID: 36684039 PMCID: PMC9850821 DOI: 10.1016/j.socnet.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Drawing on a social integration and intersectionality framework, this study advances a dynamic network understanding of the mechanisms that enable differential patterns of within-group social integration and segregation among Black sexual and gender minorities (BSGM). Specifically, in a cohort of BSGM (18-35 years of age, n = 340) participating in a community-based network intervention for HIV prevention, we examine how sexual, gender, age, and HIV status diversities contribute to friendship formation and maintenance patterns over the 12-month study enrollment period. We found attenuated social integration (or social activity) among non-gay-identified and older BSGM and evidence of social segregation (or homophily) on the basis sexual identity and age similarities. Accounting for the moderating effects of the intervention revealed that the attenuated integration of non-gay-identified and older BSGM were stronger for participants who received the peer leadership training and integration challenges were also found for transgender BSGM who received the peer leadership training. Meanwhile, BSGM living with HIV who received the peer leadership training were significantly more integrated than their counterparts in the control arm. These findings help us understand the complicated social fabric among BSGM and the dynamics that interventions for this community may have to contend with or alter.
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Affiliation(s)
- Lindsay E Young
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA
| | - Jack Lipei Tang
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL
- Crown School of Social Work Practice and Policy, University of Chicago, Chicago, IL
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3
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Young LE, Baird A, Schneider JA. Diagnosing PrEP Communication Self-Efficacy in a Community-Based Peer Leader Intervention for Black Sexual Minority Men. AIDS Behav 2022; 26:3747-3760. [PMID: 35583572 PMCID: PMC9550693 DOI: 10.1007/s10461-022-03704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
HIV prevention interventions that leverage endogenous peer leaders to communicate about Pre-Exposure Prophylaxis (PrEP) and other HIV prevention tools in their social networks offer a way to reach greater portions of communities most impacted by HIV like Black/African American gay, bisexual, same gender-loving, and other sexual minority men (BSMM). However, the success of these interventions hinge on the communication self-efficacy of its peer leaders. In this exploratory study, we present a multi-theoretical framework that situates the PrEP communication self-efficacy (PCSE) of a cohort of young BSMM peer leaders (n = 303) in the context of personal, behavioral, social, and structural factors. Using censored regression models, our analysis shows that PCSE is influenced by evaluations of PrEP itself (its relative advantage, complexity, and compatibility), network embeddedness (degree centrality) among other BSMM, social media network exposure to HIV information, and medical mistrust. We conclude with a discussion of the practical implications of our findings for intervention design and implementation.
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Bonett S, Dowshen N, Bauermeister J, Meanley S, Wirtz AL, Celentano DD, Galai N, Arrington-Sanders R. Characterizing the PrEP Continuum for Black and Latinx Sexual and Gender Minority Youth. AIDS Behav 2022; 26:1211-1221. [PMID: 34546472 DOI: 10.1007/s10461-021-03476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) rollout efforts thus far have inadequately reached young people from underrepresented backgrounds. This study explores PrEP engagement among young Black and Latinx men who have sex with men, transgender women, and gender diverse individuals in three U.S. cities using an adapted PrEP continuum measure. We analyze data from the recruitment phase of an ongoing PrEP engagement intervention (n = 319) using partial proportional odds logistic regression. Participants reported high willingness and intention to use PrEP, yet most (82%) were not currently taking PrEP. Being insured (aOR = 2.95, 95%-CI = 1.60-5.49), having one or more PrEP users in one's sexual network (aOR = 4.19, 95%-CI = 2.61-6.79), and higher individual HIV risk scores (aOR = 1.62, 95%-CI = 1.34-1.97) were each associated with being further along the PrEP continuum. Strategies are needed to address barriers to healthcare access and leverage connections within social and sexual networks in order to bolster PrEP engagement among marginalized young people from diverse backgrounds.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Nadia Dowshen
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3550 Market St, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Renata Arrington-Sanders
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
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5
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Restar A, Surace A, Adia A, Goedel W, Ogunbajo A, Jin H, Edeza A, Hernandez L, Cu-Uvin S, Operario D. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. J Med Internet Res 2022; 24:e24126. [PMID: 34994705 PMCID: PMC8783281 DOI: 10.2196/24126] [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: 09/09/2020] [Revised: 10/14/2020] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5). Conclusions Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.
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Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,amFAR, The Foundation of AIDS Research, Washington, DC, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Anthony Surace
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
| | - William Goedel
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Harry Jin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,Providence-Boston Center for AIDS Research, Providence, RI, United States.,Department of Medicine, Miriam Hospital, Providence, RI, United States
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
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Schuyler A, Alidina Z, Dolcini MM, Harper G, Fortenberry JD, Singh R, Jamil O, Pollack L, Catania J. Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption. AIDS Behav 2021; 25:3145-3158. [PMID: 34152531 DOI: 10.1007/s10461-021-03345-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17-24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn't adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p < .03) and greater health literacy (p < .05), while sexual risk (p < .03) and education (p < .03) predicted PrEP adoption (12.2%). PrEP efficacy and side effects were primary innovation characteristics influencing adoption receptivity in the persuasion stage. Interventions to improve PrEP diffusion should be tailored to stage-specific antecedents depending on how a community is stratified across the DOI stages.
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Affiliation(s)
- Ashley Schuyler
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA.
| | - Zainab Alidina
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - M Margaret Dolcini
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - Gary Harper
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Ryan Singh
- Oregon Social Learning Center, Eugene, OR, USA
| | - Omar Jamil
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lance Pollack
- University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Catania
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
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7
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The Co-Evolution of Network Structure and PrEP Adoption among a Large Cohort of PrEP Peer Leaders: Implications for Intervention Evaluation and Community Capacity-Building. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116051. [PMID: 34199829 PMCID: PMC8200056 DOI: 10.3390/ijerph18116051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
Background: Peer leader interventions are effective strategies for promoting prevention behaviors in communities at risk for HIV, yet little is known about their effects on the social and behavioral dynamics of peer leaders themselves. Methods: Using data from PrEP Chicago, an RCT PrEP for prevention intervention for young Black MSM (YBMSM), we apply stochastic actor-based models to longitudinally model the impact of study participation on the online friendship and PrEP adoption dynamics among a network of peer leaders (n = 174) and a network of control group counterparts (n = 166). Results: Peer leaders assigned to the same leadership training workshop were more likely to form new Facebook friendships with one another, whereas control participants assigned to the same attention control workshop were no more or less likely to form new friendships. Further, peer leaders with greater PrEP intentions and those living with HIV were more active in forming new friendships with other peer leaders, effects not found in the control network. PrEP adoption was not influenced by network dynamics in either group. Conclusions: The implications of these findings are discussed through the lens of community-capacity building and the role that peer leader interventions and the networks they engage can impact public health.
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8
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Threats M, Bond K. HIV Information Acquisition and Use Among Young Black Men Who Have Sex With Men Who Use the Internet: Mixed Methods Study. J Med Internet Res 2021; 23:e22986. [PMID: 33960953 PMCID: PMC8140385 DOI: 10.2196/22986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/31/2020] [Accepted: 01/16/2021] [Indexed: 12/31/2022] Open
Abstract
Background HIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM. Objective This study aims to investigate HIV information acquisition and use among YBMSM who use the internet. Methods A web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies. Results Among the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet. Conclusions YBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.
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Affiliation(s)
- Megan Threats
- School of Communication and Information, Rutgers University, New Brunswick, NJ, United States.,Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
| | - Keosha Bond
- Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States.,Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
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Wood SM, Morales KH, Metzger D, Davis A, Fiore D, Petsis D, Barnett K, Koenig HC, Dowshen N, Gross R, Frank I. Mental Health, Social Influences, and HIV Pre-exposure Prophylaxis (PrEP) Utilization Among Men and Transgender Individuals Screening for HIV Prevention Trials. AIDS Behav 2021; 25:524-531. [PMID: 32860114 PMCID: PMC8546869 DOI: 10.1007/s10461-020-03004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence. Participants (n = 247) were 89% cis-male and 46% African-American. Median age was 27 (IQR:23-33). Thirty-seven percent had ever used PrEP, of whom 18% discontinued use. High depressive symptomology was identified in 11% and 9% were receiving mental health treatment. There were no significant associations between depressive symptoms or mental health treatment on the odds of PrEP uptake or discontinuation. Each additional PrEP contact conferred a greater odds of uptake (aOR:1.24, 95% CI: 1.09-1.42). Network-level targets may produce fruitful interventions to increase PrEP uptake.
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Affiliation(s)
- Sarah M Wood
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 11th Floor, Room 11212, 2716 South St., Philadelphia, PA, 19146, USA.
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David Metzger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Annet Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Fiore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle Petsis
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kezia Barnett
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Helen C Koenig
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Nadia Dowshen
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert Gross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ian Frank
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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10
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Identifying Missed Opportunities for Human Immunodeficiency Virus Pre-exposure Prophylaxis During Preventive Care and Reproductive Visits in Adolescents in the Deep South. Sex Transm Dis 2020; 47:88-95. [PMID: 31934955 DOI: 10.1097/olq.0000000000001104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for individuals at significant risk for Human Immunodeficiency Virus acquisition is approved for individuals weighing at least 35 kg by the Food and Drug Administration. This cross-sectional study analyzed indications for PrEP in a clinical setting. METHODS There were 429 charts reviewed from adolescents between 15 and 21 years old seen for preventive care visits at an adolescent primary care center in the Deep South during a 1-year timeframe. Univariate and multivariable regression analyses were completed to identify factors associated with indications for PrEP. RESULTS Forty-four percent of 429 adolescents (between 15 and 21 years) had a PrEP indication; 77% were women and 95% heterosexual. Significant factors associated with an indication for PrEP included living with a nonparent or nonrelative and polysubstance use. No adolescents with an indication for PrEP were prescribed PrEP. A sensitivity analysis comparing indications for PrEP between the 2014 and 2017 The Centers for Disease Control and Prevention Guidelines revealed no significant differences in percent with an indication (44.5% vs. 42.8%) or factors associated with indications. CONCLUSIONS Pre-exposure prophylaxis as a biomedical tool for adolescents and young adults (AYAs) may remain underutilized. A key factor in improving utilization involves providers being able to recognize AYAs who may have an indication for PrEP with a specific focus on those AYAs who do not live in households with parents or a surrogate family member and those who are polysubstance users.
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11
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Walsh T, Schneider JA, Ardestani BM, Young LE. Individual and Social Network Structure Characteristics Associated with Peer Change Agent Engagement and Impact in a PrEP Intervention. AIDS Behav 2020; 24:3385-3394. [PMID: 32394233 DOI: 10.1007/s10461-020-02911-4] [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: 10/24/2022]
Abstract
Interventions that utilize the influence of peer change agents (PCAs) have been shown to be effective strategies for engaging key populations in HIV prevention. To date, little is known about the characteristics of PCAs associated with their effectiveness. Drawing on data from a peer leader PrEP intervention for young Black men who have sex with men (YBMSM) (N = 423), we evaluated the effects of experiential (i.e., living with HIV, PrEP awareness, PrEP use), psychographic (i.e., self-perceived leadership, innovativeness), and network (i.e., degree centrality, eigenvector centrality, and brokerage) characteristics on three effectiveness outcomes: (1) recruiting peers into the study; (2) completing "booster" sessions; and (3) linking peers to PrEP care. For each outcome, multivariable regressions were performed. On average, PCAs recruited 0.89 peers, completed 1.99 boosters, and had 1.33 network peers linked to PrEP care. Experiential factors: Prior PrEP awareness was positively associated with booster completion. Network factors: Being a network broker (i.e., connecting otherwise disconnected communities) was positively associated with peer recruitment but negatively associated with linking peers to PrEP, and degree centrality (i.e., the number of network connections someone has) and eigenvector centrality (i.e., being connected to well-connected network associates) were positively associated with linking peers to PrEP. Psychographic characteristics were not associated with any outcome. These findings can be used to inform PCA selection and to identify subpopulations who require additional support to excel as PCAs.
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12
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PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. J Acquir Immune Defic Syndr 2020; 83:450-456. [PMID: 31939870 DOI: 10.1097/qai.0000000000002297] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite high efficacy, use of pre-exposure prophylaxis (PrEP) remains low among young men who have sex with men (MSM) and transgender women (TW), primarily because of barriers such as stigma and resource awareness. We evaluated a social marketing campaign known as PrEP4Love that works to eliminate PrEP stigma; and awareness gaps through targeted advertising. SETTING Chicago, Illinois. METHODS Participants were enrolled within a cohort study of young MSM and TW (RADAR). Data were collected between June 2017 and April 2018 from HIV-negative individuals attending a follow-up visit. Surveys assessed demographics, PrEP attitudes and perceptions, and PrEP4Love campaign awareness. Associations between PrEP4Love awareness and PrEP perceptions, uptake, and behaviors were assessed using multiple logistic regression controlling for age, race/ethnicity, gender, sexual identity, and ever having used PrEP. RESULTS Of 700 participants, the majority (75.9%) indicated seeing PrEP4Love ads in Chicago. Those who had seen ads were more likely to be out to their providers (odds ratio = 1.95; 95% confidence interval: 1.17 to 3.23) than those who had not, and those who had conversations were significantly more likely to have initiated the conversation themselves. Individuals who had seen ads were more likely to have taken PrEP in the last 6 months (odds ratio = 1.87; 95% confidence interval: 1.15 to 3.16) and more likely to believe their friends and the general public approved of and used PrEP. CONCLUSION Social marketing campaigns are promising interventions that have the potential to alleviate barriers to HIV prevention, particularly among MSM and TW. Future research should evaluate the impact of these initiatives at multiple time points.
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Hotton AL, Chen YT, Schumm P, Khanna AS, Brewer R, Skaathun B, Issema RS, Ramani S, Ramachandran A, Ozik J, Fujimoto K, Harawa NT, Schneider JA. Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women. J Urban Health 2020; 97:623-634. [PMID: 32180129 PMCID: PMC7560631 DOI: 10.1007/s11524-020-00428-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.
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Affiliation(s)
- Anna L Hotton
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA.
| | - Yen-Tyng Chen
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Phil Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Russell Brewer
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Rodal S Issema
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Santhoshini Ramani
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Arthi Ramachandran
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA.,Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | | | | | - John A Schneider
- Departments of Medicine and Public Health Sciences, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
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The Role of Social Support in HIV Testing and PrEP Awareness among Young Black Men and Transgender Women Who Have Sex with Men or Transgender Women. J Urban Health 2020; 97:715-727. [PMID: 31898199 PMCID: PMC7560661 DOI: 10.1007/s11524-019-00396-8] [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] [Indexed: 12/19/2022]
Abstract
Young black men and transgender women (transwomen) who have sex with men or transwomen are most vulnerable in terms of risk for HIV infection, also reflected in their extremely high incidence rates. As testing rates and pre-exposure prophylaxis (PrEP) uptake remain suboptimal among these groups, primarily due to unique structural barriers, the present analyses draw on data from an online survey, administered October 2014 to August 2015, to explore social support-related predictors of knowledge and behavior around HIV prevention.Participants were 169 biological men who identified as black, with a mean age of 24 (SD = 2.97, range 17-29); 8% identified as transwomen. Logistic regression models assessed whether HIV-related social support predicted HIV testing patterns, PrEP awareness, and use. Those with higher HIV-related social support reported having been more likely to have ever tested (adjusted odds ratio (aOR) = 1.48; p < 0.001) and tested in the past 6 months (aOR = 1.22; p < 0.01). They were also more likely to intend to test in the next 6 months (aOR = 1.16; p < 0.001), including at a medical office or community-based organization (aOR = 1.20; p < 0.001), yet less likely to intend to self-test (aOR = 0.81; p < 0.001). Lastly, higher social support was significantly associated with prior knowledge of self-testing (aOR = 1.19; p < 0.05), couples testing (aOR = 1.26; p < 0.001), and PrEP (aOR = 1.22; p < 0.01), as well as prevention self-efficacy (aOR = 1.30; p < 0.001), but inversely associated with prior self-testing (aOR = 0.80; p < 0.05). For young black men and transwomen who have sex with men or transwomen, HIV-related social support, which likely has a strong peer component, appears to be a facilitator of optimal testing and intentions to test, as well as awareness of novel prevention strategies (like self-testing or PrEP). However, community resourcefulness needs to be bolstered by other mechanisms, such as changes within healthcare settings, to increase actual use of novel prevention modalities.
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Role of Social and Sexual Network Factors in PrEP Utilization Among YMSM and Transgender Women in Chicago. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:1089-1097. [PMID: 30712223 DOI: 10.1007/s11121-019-00995-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite demonstrated efficacy, uptake of HIV pre-exposure prophylaxis (PrEP) remains low, particularly among high-risk demographics such as transgender women, Black men who have sex with men (BMSM), and young MSM (YMSM). Research thus far has largely focused on individual factors that may impede PrEP uptake in these demographics, leaving social network factors relatively unexplored. The present study used data collected from participants within RADAR, a longitudinal cohort study in Chicago focused on understanding the individual, dyadic, network, social, and biologic factors associated with HIV infection within YMSM. Of the 906 study participants who did not report an HIV diagnosis at baseline, 7.0% reported using PrEP in the prior 6 months. Recent PrEP use was associated with both individual-level (age and gender) and network-level factors (mean relationship strength, sexual network degree, etc.). These findings highlight the need to expand beyond focusing on individual-level drivers of PrEP uptake, as well as changing our understanding of who is most important within a network (centrality vs. strength of weak ties). Future work is needed to determine whether variables associated with PrEP uptake are similarly connected to PrEP adherence.
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Callander D, Schneider JA, Radix A, Chaix B, Scheinmann R, Love G, Smith J, Regan SD, Kawachi I, St James K, Ransome Y, Herrera C, Reisner SL, Doroshow C, Poteat T, Watson K, Bluebond-Langner R, Toussaint N, Garofalo R, Sevelius J, Duncan DT. Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. BMJ Open 2020; 10:e032876. [PMID: 32241785 PMCID: PMC7170618 DOI: 10.1136/bmjopen-2019-032876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. METHODS AND ANALYSES TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. ETHICS AND DISSEMINATION The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.
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Affiliation(s)
- Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - John A Schneider
- Department of Public Health Sciences, University of Chicago School of Medicine, Chicago, Illinois, USA
- Howard Brown Health Center, Chicago, Illinois, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Basile Chaix
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, Île-de-France, France
| | - Roberta Scheinmann
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gia Love
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jordyn Smith
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kiara St James
- New York Transgender Advocacy Group, New York, New York, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Sari L Reisner
- Harvard Medical School, Boston, Massachusetts, USA
- Fenway Institute, Boston, Massachusetts, USA
| | - Ceyenne Doroshow
- Gay and Lesbians Living in a Transgender Society, New York, New York, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kim Watson
- Community Kinship Life, New York, New York, USA
| | - Rachel Bluebond-Langner
- Hansjorg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA
| | - Nala Toussaint
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Robert Garofalo
- Department of Pediatrics & Preventive Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jae Sevelius
- Center for Excellence for Transgender Health, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Whitfield THF, Parsons JT, Rendina HJ. Rates of Pre-exposure Prophylaxis Use and Discontinuation Among a Large U.S. National Sample of Sexual Minority Men and Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:103-112. [PMID: 31845148 PMCID: PMC7028359 DOI: 10.1007/s10508-019-01602-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 05/20/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective in the prevention of HIV acquisition and was recently approved for those under 18 years of age. The primary goal of the present study was to understand the prevalence of and factors associated with PrEP use among a large sample of young and adult sexual minority men (Y/SMM). Participants came from a larger national sample of SMM. Data collected included demographics, substance use, PrEP use, and sexual risk. Participants were recruited via sexual networking/dating applications and resided in the U.S. including Puerto Rico, were at least 13 years old, self-reported being HIV-negative, and identified as male. The sample was divided into two groups: YSMM (13-24 years of age) and adult SMM (25 years of age and up). Multinomial logistic regressions examining associations with never, current, and former PrEP use were run with all variables of interest simultaneously entered into the models. Age was positively associated with both former and current PrEP use among YSMM. Additionally, YSMM who identified as gay (vs. bisexual), lived in the Northeast, Midwest, and West (vs. South), had their own health insurance (vs. those on their parent's), had recently been diagnosed with an STI, and had recently used a drug all had higher odds of being a current PrEP user compared to those that had never used PrEP. Among adult SMM, those who were older did not have higher odds of current PrEP use compared to those that had never used PrEP. Those who identified as queer (vs. gay), single, had their own or were on their partner's insurance (vs. parent's), recent condomless anal sex, recent STI diagnosis, recent drug use, and recent substance use all had higher odds of being a current PrEP user compared to those that had never used PrEP. Research is needed to address the disparities in PrEP uptake among YSMM. Interventions for PrEP access among those on their parents' insurance may also be necessary.
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Affiliation(s)
- Thomas H F Whitfield
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA
| | | | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York, New York, NY, USA.
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA.
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Westmoreland DA, Patel VV, D’Angelo AB, Nash D, Grov C. Sociocultural influences on attitudes towards pre-exposure prophylaxis (PrEP), history of PrEP use, and future PrEP use in HIV-vulnerable cisgender men who have sex with men across the U.S. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2020; 1:128-158. [PMID: 34296211 PMCID: PMC8294708 DOI: 10.1891/lgbtq-2020-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Despite its proven effectiveness in reducing HIV transmission, pre-exposure prophylaxis (PrEP) use remains low. This study used data from a 2017-2018 U.S. national cohort to investigate social influences on PrEP experience and future PrEP use among cisgender men who have sex with men. We used descriptive statistics and multivariable logistic analyses to examine social influences (e.g., how participants heard about PrEP and number of persons they knew taking PrEP) associated with each previous PrEP use and intentions to use PrEP. Among participants who knew of PrEP, commonly reported ways of first hearing about PrEP were through social media (27.4%) and friends (26.8%). These were also cited top influences on participants' current attitudes toward PrEP (friends 23.5%, social media 22.1%). Multivariable logistic regression analyses found that knowing more people taking PrEP was associated with increased odds of previously using PrEP and intending to use PrEP. Friends and social media were common and influential sources of information regarding PrEP. Results suggest that tapping into these social connections may effectively disseminate public health messaging about PrEP and encourage use among key populations to reduce HIV burden.
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Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexa B. D’Angelo
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Young LE, Fujimoto K, Alon L, Zhang L, Schneider JA. The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement. JOURNAL OF SOCIAL STRUCTURE : JOSS 2019; 20:70-95. [PMID: 32855626 PMCID: PMC7449318 DOI: 10.21307/joss-2019-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.
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Affiliation(s)
- Lindsay E Young
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Leigh Alon
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liang Zhang
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing ‘Neighborhoods and Networks (N2) Cohort Study’. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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21
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Hotton A, Quinn K, Schneider J, Voisin D. Exposure to community violence and substance use among Black men who have sex with men: examining the role of psychological distress and criminal justice involvement. AIDS Care 2019; 31:370-378. [PMID: 30280579 PMCID: PMC6382567 DOI: 10.1080/09540121.2018.1529294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Young Black MSM (YBMSM) are disproportionately affected by violence, criminal justice involvement, and other structural factors that also increase vulnerability to HIV. This study examined associations between exposure to community violence (ECV) and substance use, psychological distress, and criminal justice involvement (CJI) among YBMSM in Chicago, IL. Respondent driven sampling was used to recruit a sample of 618 YBMSM (aged 16-29) from the South Side of Chicago between June 2013 and July 2014. Weighted logistic regression assessed the direct effects of ECV, CJI, and psychological distress on substance use outcomes. Indirect effects were assessed via path analysis with mean and variance adjusted weighted least squares estimation and sampling weights. Over 90% reported lifetime exposure to violence, 41% had history of CJI, and substance use was common. Almost one-third reported daily or more frequent marijuana use; 17% reported substance use related problems and drug use other than marijuana. ECV was directly and positively associated with CJI, psychological distress, and problematic substance use, with significant indirect effects from ECV to problematic substance use via CJI and psychological distress. HIV prevention interventions for YBMSM should address the underlying contextual drivers of substance use and psychological distress, including violence exposure and criminal justice involvement.
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Affiliation(s)
- Anna Hotton
- University of Illinois at Chicago School of Public Health,
Division of Epidemiology and Biostatistics, 1603 W. Taylor St, Room 866 (M/C 923),
Chicago, IL, USA, 60612, 312-355-4753,
| | - Katherine Quinn
- Medical College of Wisconsin, Center for AIDS Intervention
Research, 2071 N. Summit, Milwaukee, WI, USA 53201,
| | - John Schneider
- University of Chicago, Section of Infectious Diseases, 5841
South Maryland, MC 5065, Chicago, IL, USA 60637, 773-702-2710,
| | - Dexter Voisin
- University of Chicago, School of Social Service
Administration, 969 East 60th Street Chicago, IL, USA 60615, (773) 702-1124,
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22
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Chen YT, Kolak M, Duncan DT, Schumm P, Michaels S, Fujimoto K, Schneider JA. Neighbourhoods, networks and pre-exposure prophylaxis awareness: a multilevel analysis of a sample of young black men who have sex with men. Sex Transm Infect 2018; 95:228-235. [PMID: 30518619 DOI: 10.1136/sextrans-2018-053639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Young black men who have sex with men (YBMSM) in the USA represent a subgroup that has the highest HIV incidence among the overall population. In the USA, pre-exposure prophylaxis (PrEP) is an effective prevention intervention to prevent HIV acquisition when taken regularly. Neighbourhood and network factors may relate to PrEP awareness, but have not been studied in YBMSM. This study aimed to examine the relationship of neighbourhood and network characteristics with PrEP awareness among YBMSM. METHODS We used data collected from a sample of 618 YBMSM in Chicago (2013-2014). Home addresses were collected for participants and enumerated network members. Administrative data (eg, 2014 American Community Survey, Chicago Department of Public Health) were used to describe residence characteristics. Network member characteristics were also collected (eg, sexual partners' sex-drug use, confidant network members who were also MSM). Multilevel analysis was performed to examine the relationships of neighbourhood and network characteristics to PrEP awareness. RESULTS Higher neighbourhood-level educational attainment (adjusted odds ratio (aOR) 1.02, p=0.03) and greater primary care density (aOR 1.38, p=0.01) were associated with greater PrEP awareness; greater neighbourhood alcohol outlet density (aOR 0.52, p=0.004) was associated with less PrEP awareness. Sexual network members residing in the same neighbourhood as the participants (aOR 2.58, p=0.03) and discussions around avoiding HIV acquisition with confidants (aOR 2.26, p=0.04) were associated with greater PrEP awareness. CONCLUSIONS The results suggest that neighbourhood and network characteristics can influence PrEP awareness in YBMSM. Additional studies are needed to understand the influences of neighbourhood (eg, MSM serving venues) and network (eg, peer to peer communication) characteristics on dissemination of PrEP information, uptake and adherence and the related mechanisms behind the associations.
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Affiliation(s)
- Yen-Tyng Chen
- Chicago Center for HIV Elimination, Chicago, Illinois, USA .,Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois, USA
| | - Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, School of Medicine, New York University, New York City, New York, USA
| | - Phil Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, Illinois, USA.,Department of Medicine, University of Chicago, Chicago, Illinois, USA
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23
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Mosley T, Khaketla M, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, Hull MW, Olarewaju G, Jollimore J, Edward J, Montaner JSG, Hogg RS, Roth EA, Moore DM. Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012-2016. AIDS Behav 2018; 22:3550-3565. [PMID: 29344740 DOI: 10.1007/s10461-018-2026-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gay, bisexual, and other men who have sex with men (gbMSM) are at the highest risk for HIV infection in British Columbia (BC). Pre-exposure prophylaxis (PrEP) has been recently licensed but is currently not publicly funded in BC. Using respondent-driven sampling, we recruited a cohort of gbMSM to complete a computer-assisted self-interview with follow-up every 6 months. Stratified by HIV status, we examined trends in awareness of PrEP from 11/2012 to 02/2016 and factors associated with PrEP awareness. 732 participants responded to the PrEP awareness question. Awareness of PrEP among HIV-negative men increased from 18 to 80% (p < 0.0001 for trend); among HIV-positive men, awareness increased from 36 to 77% (p < 0.0001). PrEP awareness was associated with factors related to HIV risk including sero-adaptive strategies and sexual sensation seeking. Eight HIV-negative men reported using PrEP. Low PrEP uptake highlights that PrEP access should be expanded for at-risk gbMSM in BC.
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Affiliation(s)
- Terrance Mosley
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada.
| | - Moliehi Khaketla
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather L Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Zishan Cui
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Paul Sereda
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Mark W Hull
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | | | - Julio S G Montaner
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
| | - David M Moore
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
- The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada
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24
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Morgan E, Moran K, Ryan DT, Mustanski B, Newcomb ME. Threefold Increase in PrEP Uptake Over Time with High Adherence Among Young Men Who Have Sex With Men in Chicago. AIDS Behav 2018; 22:3637-3644. [PMID: 29728949 DOI: 10.1007/s10461-018-2122-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The goal of this work is to better understand utilization and uptake of pre-exposure prophylaxis (PrEP) among young men who have sex with men (YMSM) and transgender women (TGW). We assessed trends and correlates of PrEP use and adherence across three time points of longitudinal data collection among 885 YMSM and TGW (aged 16-29) from the RADAR cohort in Chicago, 2015-2017. Past 6-month PrEP use increased across three visits: from 6.6 to 17.5%. In multivariable models, past 6-month PrEP use was significantly associated with participation in condomless sex, having more sexual partners, and older age. At least three-quarters of current PrEP users reported being ≥ 90% adherent to PrEP medication across all visits. Past 6-month PrEP use increased over time with those who participated in high-risk HIV behaviors also those most likely to have taken PrEP. As PrEP uptake continues to rise, more research will be needed to understand predictors of PrEP usage, as well as patterns of sexual behavior change following uptake.
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Affiliation(s)
- Ethan Morgan
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 14-044, Chicago, IL, 60611, USA.
| | - Kevin Moran
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 14-044, Chicago, IL, 60611, USA
| | - Daniel T Ryan
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 14-044, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 14-044, Chicago, IL, 60611, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 14-044, Chicago, IL, 60611, USA
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25
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Young LE, Fujimoto K, Schneider JA. HIV Prevention and Sex Behaviors as Organizing Mechanisms in a Facebook Group Affiliation Network Among Young Black Men Who Have Sex with Men. AIDS Behav 2018. [PMID: 29536285 DOI: 10.1007/s10461-018-2087-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Online social networking sites (SNS)-the Internet-based platforms that enable connection and communication between users-are increasingly salient social environments for young adults and, consequently, offer tremendous opportunity for HIV behavioral research and intervention among vulnerable populations like young men who have sex with men (YMSM). Drawing from a cohort of 525 young Black MSM (YBMSM) living in Chicago, IL, USA April 2014-May 2015, we conducted social network analysis, estimating an exponential random graph model (ERGM) to model YBMSM's group affiliations on Facebook in relation to their sex behaviors and HIV prevention traits. A group's privacy setting-public, closed, or secret-was also modeled as a potential moderator of that relationship. Findings reveal that HIV positive individuals were more likely to affiliate with Facebook groups, while those who engaged in group sex were less likely to do so. When it came to the privacy of groups, we learned that HIV positive individuals tended not to belong to groups with greater privacy (e.g., closed and secret groups), while individuals who engaged in group sex and those who engaged in regular HIV testing were more likely to belong to those groups. Results also showed that individuals who engaged in condomless sex showed significant signs of clustering around the same set of groups. HIV positive individuals, on the other hand, were significantly less likely to demonstrate clustering. Implications for interventions and future research are discussed.
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Affiliation(s)
- Lindsay E Young
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL, 60637, USA.
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, USA.
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center, Houston, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL, 60637, USA
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, USA
- Department of Public Health Sciences, University of Chicago, Chicago, USA
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26
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Morgan E, Skaathun B, Schneider JA. Sexual, Social, and Genetic Network Overlap: A Socio-Molecular Approach Toward Public Health Intervention of HIV. Am J Public Health 2018; 108:1528-1534. [PMID: 30252515 DOI: 10.2105/ajph.2018.304438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine how network-level factors influence individual risk of HIV acquisition, which is key in preventing disease transmission. METHODS We recruited a cohort of young Black men who have sex with men (n = 618) in Chicago, Illinois, from 2013 to 2016. We identified potential molecular ties via pairwise genetic distance analysis of HIV pol sequences with links inferred between individuals whose sequences were 1.5% or less genetically distant. We defined clusters as 1 or more connections to another individual. We conducted entity resolution between confidant, sexual, referral, and Facebook network data between network types. RESULTS Of 266 (43.0%) participants identified as HIV-positive, we obtained 86 (32.3%) genetic sequences. Of these, 35 (40.7%) were linked to 1 or more other sequence; however, none of these were identified in first-, second-, or third-degree confidant and sexual networks. Minimal overlap existed between genetic and Facebook ties. CONCLUSIONS These results suggest that HIV transmissions may have occurred before elicitation of network data; future studies should expand the data collection timeframe to more accurately determine risk networks. Virtual network data, such as Facebook, may be particularly useful in developing one's risk environment.
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Affiliation(s)
- Ethan Morgan
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
| | - Britt Skaathun
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
| | - John A Schneider
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
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27
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Khanna AS, Goodreau SM, Michaels S, Schneider JA. Using Partially-Observed Facebook Networks to Develop a Peer-Based HIV Prevention Intervention: Case Study. J Med Internet Res 2018; 20:e11652. [PMID: 30217793 PMCID: PMC6231846 DOI: 10.2196/11652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background This is a case study from an HIV prevention project among young black men who have sex with men. Individual-level prevention interventions have had limited success among young black men who have sex with men, a population that is disproportionately affected by HIV; peer network–based interventions are a promising alternative. Facebook is an attractive digital platform because it enables broad characterization of social networks. There are, however, several challenges in using Facebook data for peer interventions, including the large size of Facebook networks, difficulty in assessing appropriate methods to identify candidate peer change agents, boundary specification issues, and partial observation of social network data. Objective This study aimed to explore methodological challenges in using social Facebook networks to design peer network–based interventions for HIV prevention and present techniques to overcome these challenges. Methods Our sample included 298 uConnect study respondents who answered a bio-behavioral survey in person and whose Facebook friend lists were downloaded (2013-2014). The study participants had over 180,000 total Facebook friends who were not involved in the study (nonrespondents). We did not observe friendships between these nonrespondents. Given the large number of nonrespondents whose networks were partially observed, a relational boundary was specified to select nonrespondents who were well connected to the study respondents and who may be more likely to influence the health behaviors of young black men who have sex with men. A stochastic model-based imputation technique, derived from the exponential random graph models, was applied to simulate 100 networks where unobserved friendships between nonrespondents were imputed. To identify peer change agents, the eigenvector centrality and keyplayer positive algorithms were used; both algorithms are suitable for identifying individuals in key network positions for information diffusion. For both algorithms, we assessed the sensitivity of identified peer change agents to the imputation model, the stability of identified peer change agents across the imputed networks, and the effect of the boundary specification on the identification of peer change agents. Results All respondents and 78.9% (183/232) of nonrespondents selected as peer change agents by eigenvector on the imputed networks were also selected as peer change agents on the observed networks. For keyplayer, the agreement was much lower; 42.7% (47/110) and 35.3% (110/312) of respondent and nonrespondent peer change agents, respectively, selected on the imputed networks were also selected on the observed network. Eigenvector also produced a stable set of peer change agents across the 100 imputed networks and was much less sensitive to the specified relational boundary. Conclusions Although we do not have a gold standard indicating which algorithm produces the most optimal set of peer change agents, the lower sensitivity of eigenvector centrality to key assumptions leads us to conclude that it may be preferable. The methods we employed to address the challenges in using Facebook networks may prove timely, given the rapidly increasing interest in using online social networks to improve population health.
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Affiliation(s)
- Aditya Subhash Khanna
- Chicago Center for HIV Elimination, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Steven Michael Goodreau
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States.,Department of Anthropology, University of Washington, Seattle, WA, United States
| | | | - John Alexis Schneider
- Chicago Center for HIV Elimination, Department of Medicine, The University of Chicago, Chicago, IL, United States
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28
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Hotton AL, Keene L, Corbin DE, Schneider J, Voisin DR. The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2017; 30:64-81. [PMID: 30872907 PMCID: PMC6413304 DOI: 10.1080/10538720.2017.1408518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Blackgay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their white male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of YBMSM on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16-29. Cross sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing and health promotion behaviors. Closeness with the gay community was associated with greater PrEP knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.
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Affiliation(s)
- Anna L. Hotton
- School of Public Health, University of Illinois at
Chicago, Chicago, IL, USA
| | - Lance Keene
- School of Social Service Administration, University of
Chicago, Chicago, IL, USA
| | - Dennis E. Corbin
- School of Social Work, Fayetteville State University,
Fayetteville, NC, USA
| | - John Schneider
- Departments of Medicine and Health Sciences, University of
Chicago, Chicago, IL, USA
- STI/HIV Intervention Network at the University of
Chicago
- Third Coast Center for AIDS Research, Chicago, IL,
USA
- Chicago Center for HIV Elimination, University of Chicago,
Chicago, IL, USA
| | - Dexter R. Voisin
- School of Social Service Administration, University of
Chicago, Chicago, IL, USA
- STI/HIV Intervention Network at the University of
Chicago
- Third Coast Center for AIDS Research, Chicago, IL,
USA
- Chicago Center for HIV Elimination, University of Chicago,
Chicago, IL, USA
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29
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Young LE, Schumm P, Alon L, Bouris A, Ferreira M, Hill B, Khanna AS, Valente TW, Schneider JA. PrEP Chicago: A randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clin Trials 2017; 15:44-52. [PMID: 28862483 DOI: 10.1177/1740774517730012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS Advances in biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) represent a new opportunity for reducing HIV incidence among young Black men who have sex with men, for whom the number of new HIV infections continues to rise. However, studies have documented low rates of PrEP uptake in this community. Research suggests that the peer networks of young Black men who have sex with men play important roles in their sexual health decisions. PrEP Chicago is a randomized controlled trial network intervention designed to increase PrEP uptake among young Black men who have sex with men living in Chicago. The aims of this study are twofold. Aim 1 is to estimate the effectiveness of a peer change agent intervention for (1) increasing the number of referrals made to a PrEP information line, (2) increasing the rate of PrEP adoption among non-participant peers, and (3) increasing PrEP knowledge, attitudes, and intentions among participants. Aim 2 is to determine the individual and network variables that explain peer change agent effectiveness. METHODS PrEP Chicago is a social network intervention that utilizes the influence of peer change agents to link young Black men who have sex with men in Chicago to PrEP. Young Black men who have sex with men were recruited using respondent-driven sampling. Once screened for eligibility, participants were randomly assigned to either one of two treatment sequences: (1) intervention treatment in Year 1 followed by a minimal contact attention control in Year 2 or (2) the minimal contact attention control in Year 1 followed by treatment in Year 2. The treatment consists of a PrEP/peer change agent training workshop followed by booster calls for 12 months. The attention control consists of a sex diary activity designed to help participants assess sexual risk. Psychosocial, sexual health, and network data are collected from all participants at baseline and at 12- and 24-month follow-ups. RESULTS In total, 423 participants aged 18-35 have been enrolled (more than 100% target enrollment) and have completed baseline data collection. A majority of participants in both intervention and control groups reported having heard of PrEP before enrolling in the study, yet also reported having had no current or prior experience taking PrEP. Statistical analyses await completion of Year 1 of the trial in March 2018. CONCLUSION PrEP Chicago addresses a gap in HIV prevention research and intervention design by utilizing the existing social networks among young Black men who have sex with men as mechanisms for information diffusion, behavioral influence, social support, and empowerment. Therefore, interventions that leverage peer influence processes to facilitate PrEP uptake are promising strategies to improve sexual health engagement and overcome disparities in outcomes among this at-risk population.
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Affiliation(s)
- Lindsay E Young
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Phil Schumm
- 3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Leigh Alon
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Alida Bouris
- 2 Chicago Center for HIV Elimination, Chicago, IL, USA.,4 School of Social Service Administration, The University of Chicago, Chicago, IL, USA
| | - Matthew Ferreira
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Brandon Hill
- 1 The University of Chicago Medicine, Chicago, IL, USA.,5 Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Thomas W Valente
- 6 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John A Schneider
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA.,3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
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30
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Kuhns LM, Hotton AL, Schneider J, Garofalo R, Fujimoto K. Use of Pre-exposure Prophylaxis (PrEP) in Young Men Who Have Sex with Men is Associated with Race, Sexual Risk Behavior and Peer Network Size. AIDS Behav 2017; 21:1376-1382. [PMID: 28238119 PMCID: PMC5415079 DOI: 10.1007/s10461-017-1739-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is efficacious to prevent HIV infection, however, uptake among young men who have sex with men (YMSM) is relatively low. The purpose of this study was to describe PrEP use and related factors in a representative sample of YMSM in two cities, Chicago and Houston. YMSM, ages 16-29, were recruited via respondent-driven sampling (RDS) from 2014 to 2016. Correlates of PrEP uptake were assessed in weighted multivariable logistic regression models. A total of 12.2% of participants (of 394) reported ever taking PrEP; Black YMSM had the lowest rates of uptake (4.7%) and Whites the highest (29.5%). In a multivariable regression model, having an HIV positive sex partner, reporting recent group sex, peer network size, and city (Chicago) were significantly and positively associated with use of PrEP, while Black race was negatively associated with it. Given evidence of racial/ethnic disparities in PrEP uptake in this study, further research is needed to identify potential mechanisms of action and points of intervention.
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Affiliation(s)
- Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Anna L Hotton
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - John Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA
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