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Castro LS, Rezende GRD, Pires Fernandes FR, Bandeira LM, Cesar GA, do Lago BV, Gomes Gouvêa MS, Motta-Castro ARC. HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks. PLoS One 2021; 16:e0256818. [PMID: 34529672 PMCID: PMC8445402 DOI: 10.1371/journal.pone.0256818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.
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Affiliation(s)
- Lisie Souza Castro
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Federal University of Mato Grosso, Rondonópolis, Brazil
| | | | - Fernanda Rodas Pires Fernandes
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Ministry of Agriculture, Livestock and Food Supply/National Agricultural Laboratory, MAPA/LANAGRO, Minas Gerais, Brazil
| | | | | | | | | | - Ana R C Motta-Castro
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Mato Grosso do Sul, Brazil
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2
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Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to Health Services Among Young Adult Gay Men in New York City. Am J Mens Health 2018; 13:1557988318818683. [PMID: 30569800 PMCID: PMC6775565 DOI: 10.1177/1557988318818683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research is a cross-sectional study of young adult gay men (YAGM), ages 18 to 29, that aims to understand their health-care access including: having a primary care provider (PCP), frequency of health-care visits, and instances of foregone health care. Surveys were conducted with a modified time-space sample of 800 YAGM in New York City (NYC). Surveys were conducted between November 2015 and June 2016. This study examined associations between sociodemographic characteristics and health-care access using multivariable logistic regression models. In multivariable logistic regression models, there were higher odds of having a PCP among participants enrolled in school (Adjusted Odds Ratio [AOR] = 1.85, 95% CI [1.18, 2.91], p < .01) and covered by insurance (AOR = 21.29, 95% CI [11.77, 38.53], p < .001). Modeling indicated higher odds of more than one health visit in the past 12 months for non-White participants (AOR = 2.27, 95% CI [1.43, 3.63], p < .001), those covered by insurance (AOR = 3.10, 95% CI [1.06, 9.04], p < .05), and those who disclosed their sexual orientation to their PCP (AOR = 2.99, 95% CI [1.58, 5.69], p < .001). Participants with insurance were less likely to report instances of foregone care (AOR = 0.21, 95% CI [0.21, 0.13], p < .001). Understanding the facilitators and barriers to health-care access among YAGM populations is of critical importance, as many YAGM between the ages of 18 and 29 are establishing their access to health care without parental guidance. Health-care access, including the decision to forego care, can represent a missed opportunity for primary prevention and early diagnosis of health issues, as well as more effective, less invasive, and less costly treatments.
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Affiliation(s)
- Marybec Griffin-Tomas
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Sean Cahill
- 3 National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA
| | - Farzana Kapadia
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,4 Department of Population Health, Langone Medical Center, New York University, New York, NY, USA
| | - Perry N Halkitis
- 2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,5 Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,6 Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.,7 Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,8 Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
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3
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Marcell AV, Gibbs SE, Pilgrim NA, Page KR, Arrington-Sanders R, Jennings JM, Loosier PS, Dittus PJ. Sexual and Reproductive Health Care Receipt Among Young Males Aged 15-24. J Adolesc Health 2018; 62:382-389. [PMID: 29128296 PMCID: PMC6080721 DOI: 10.1016/j.jadohealth.2017.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to describe young men's sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt. METHODS There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics. RESULTS Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling. CONCLUSIONS Findings have implications for improving young men's SRHC delivery beyond the narrow scope of STD/HIV care.
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Affiliation(s)
- Arik V Marcell
- Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
| | - Susannah E Gibbs
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Nanlesta A Pilgrim
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen R Page
- Department of Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Jacky M Jennings
- Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Penny S Loosier
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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4
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Phillips G, Johnson AK, Adames CN, Mustanski B. Meningitis Vaccination, Knowledge, and Awareness Among YMSM in Chicago. HEALTH EDUCATION & BEHAVIOR 2018; 45:607-615. [PMID: 29325425 DOI: 10.1177/1090198117752786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Serogroup C invasive meningococcal disease (IMD) outbreaks in men who have sex with men (MSM) have been occurring with greater frequency in urban areas across the United States. An effective vaccine for IMD is available and is recommended for MSM in outbreak settings. Particular subgroups of MSM have been disproportionately represented in outbreaks, specifically young, Black, and HIV-positive MSM. As little is known about the knowledge, awareness, and vaccination status of young MSM, we sought to describe this and explore racial/ethnic differences. Data were collected from an established cohort study-RADAR-of 16- to 29-year-old MSM recruited through previous cohort studies and/or by being a partner or peer of a current study member. A total of 486 young MSM (YMSM) responded to 13 IMD-related questions. Approximately half of the sample correctly identified how IMD is spread and 58.6% accurately responded that vaccination was the best prevention method; however, more than 60% of participants felt they were at no risk of getting meningitis and only 49% self-reported vaccination. Additionally, White YMSM were significantly more likely to be vaccinated and to have accurate knowledge and risk perception of IMD compared with Black YMSM. Findings have important implications for disease control, outbreak management, and intervention development.
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Affiliation(s)
| | - Amy K Johnson
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,3 AIDS Foundation of Chicago, Chicago, IL, USA
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5
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Johns MM, Liddon N, Jayne PE, Beltran O, Steiner RJ, Morris E. Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers. LGBT Health 2017; 5:6-32. [PMID: 29271692 DOI: 10.1089/lgbt.2017.0053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.
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Affiliation(s)
- Michelle M Johns
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Nicole Liddon
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Paula E Jayne
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | - Riley J Steiner
- 1 Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Elana Morris
- 3 Division of HIV/AIDS Prevention (DHAP), Centers for Disease Control and Prevention , Atlanta, Georgia
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6
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Oswalt SB, Eastman-Mueller HP. Chlamydia and gonorrhea screening and expedited partner therapy (EPT) practices of college student health centers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:542-547. [PMID: 28708025 DOI: 10.1080/07448481.2017.1351446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. PARTICIPANTS College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. METHODS Chi-square tests were conducted with Cramer's V providing a measure of association. RESULTS Chlamydia screening of women under 25 years of age was a well-established practice. Almost one-third of SHCs did not report screening practices of men who have sex with men (MSM) consistent with current chlamydia and gonorrhea guidelines; however, there was improvement over time. Few college SHCs utilized expedited partner therapy (EPT), though fewer had blanket restrictions prohibiting its use in 2014 compared to 2010. CONCLUSIONS Over the 5-year period, more SHCs followed current best practices. Improvement in compliance with guidelines related to MSM STD screening as well as increased usage of EPT is needed to best address the needs of the diverse college student population.
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Affiliation(s)
- Sara B Oswalt
- a Department of Kinesiology , Health and Nutrition, University of Texas at San Antonio , San Antonio , Texas , USA
| | - Heather P Eastman-Mueller
- b Department of Applied Health Science , Indiana University Bloomington , Bloomington , Indiana , USA
- c University Health Center , Indiana University Bloomington , Bloomington , Indiana , USA
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7
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Scheim AI, Travers R. Barriers and facilitators to HIV and sexually transmitted infections testing for gay, bisexual, and other transgender men who have sex with men. AIDS Care 2016; 29:990-995. [PMID: 28027664 DOI: 10.1080/09540121.2016.1271937] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transgender men who have sex with men (trans MSM) may be at elevated risk for HIV and other sexually transmitted infections (STI), and therefore require access to HIV and STI testing services. However, trans people often face stigma, discrimination, and gaps in provider competence when attempting to access health care and may therefore postpone, avoid, or be refused care. In this context, quantitative data have indicated low access to, and uptake of, HIV testing among trans MSM. The present manuscript aimed to identify trans MSM's perspectives on barriers and facilitators to HIV and STI testing. As part of a community-based research project investigating HIV risk and resilience among trans MSM, 40 trans MSM aged 18 and above and living in Ontario, Canada participated in one-on-one qualitative interviews in 2013. Participants described a number of barriers to HIV and other STI testing. These included both trans-specific and general difficulties in accessing sexual health services, lack of trans health knowledge among testing providers, limited clinical capacity to meet STI testing needs, and a perceived gap between trans-inclusive policies and their implementation in practice. Two major facilitators were identified: access to trusted and flexible testing providers, and integration of testing with ongoing monitoring for hormone therapy. Based on these findings, we provide recommendations for enhancing access to HIV and STI testing for this key population.
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Affiliation(s)
- Ayden I Scheim
- a Department of Epidemiology and Biostatistics , The University of Western Ontario , London , Canada
| | - Robb Travers
- b Department of Health Sciences , Wilfrid Laurier University , Waterloo , Canada
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8
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Toomey RB, Huynh VW, Jones SK, Lee S, Revels-Macalinao M. Sexual minority youth of color: A content analysis and critical review of the literature. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016; 21:3-31. [PMID: 28367257 PMCID: PMC5370177 DOI: 10.1080/19359705.2016.1217499] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being-as well as the interpersonal and contextual experiences-of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were noncomparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-racial/ethnic). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.
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Affiliation(s)
- Russell B. Toomey
- Norton School of Family and Consumer Sciences, Family Studies and Human Development, The University of Arizona, Tucson, Arizona, USA
| | - Virginia W. Huynh
- Department of Child and Adolescent Development, California State University–Northridge, Northridge, California, USA
| | - Samantha K. Jones
- Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Sophia Lee
- Department of Women Studies, San Diego State University, San Diego, California, USA
| | - Michelle Revels-Macalinao
- Department of Child and Adolescent Development, California State University–Northridge, Northridge, California, USA
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9
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Hoover KW, Parsell BW, Leichliter JS, Habel MA, Tao G, Pearson WS, Gift TL. Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act. Am J Public Health 2015; 105 Suppl 5:S690-5. [PMID: 26447908 DOI: 10.2105/ajph.2015.302839] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues. METHODS In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity. RESULTS Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic. CONCLUSIONS Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients.
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Affiliation(s)
- Karen W Hoover
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Bradley W Parsell
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Jami S Leichliter
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Melissa A Habel
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Guoyu Tao
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - William S Pearson
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
| | - Thomas L Gift
- Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL
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10
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Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM: The P18 Cohort Study. J Acquir Immune Defic Syndr 2015; 69:466-73. [PMID: 26115438 DOI: 10.1097/qai.0000000000000616] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTENT HIV infections continue to rise in a new generation of young gay, bisexual, and other young men who have sex with men (YMSM) despite 3 decades of HIV prevention and recent biomedical technologies to deter infection. OBJECTIVES To examine the incidence of HIV and the demographic, behavioral, and structural factors associated with incident infections. DESIGN A prospective cohort study. PARTICIPANTS Six hundred YMSM who were aged 18-19 years at baseline. RESULTS At baseline, 6 prevalent cases of HIV were detected. Over the course of 36 months and 6 additional waves of data collection, we identified 43 (7.2%) incident cases of HIV. Incident infections were marginally higher among those residing in neighborhoods with higher rates of HIV prevalence. Using Cox proportional hazards models, we detected that hazard ratios (HRs) for time to HIV seroconversion were significantly higher for black YMSM (HR = 7.46) and mixed/other race YMSM (HR = 7.99), and older age at sexual debut with another man was associated with a lower risk of HIV seroconversion (HR = 0.50), whereas low perceived familial socioeconomic status was marginally associated with an increased risk for HIV seroconversion (HR = 2.45). CONCLUSIONS These findings support the disparities for HIV that exist within the population of sexual minority men and suggest that we attend to behavioral, structural, and social conditions to effectively tailor HIV prevention for a new generation of YMSM with keen eyes to the conditions faced by racial and ethnic minority YMSM, which heightened their risk for acquiring HIV.
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11
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Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study. AIDS Behav 2015; 19:970-80. [PMID: 25192900 DOI: 10.1007/s10461-014-0892-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The persistence of disparities in STI/HIV risk among a new generation of emerging adult gay, bisexual, and other men who have sex with men (YMSM) warrant holistic frameworks and new methodologies for investigating the behaviors related to STI/HIV in this group. In order to better understand the continued existence of these disparities in STI/HIV risk among YMSM, the present study evaluated the presence and persistence of syndemic conditions among YMSM by examining the co-occurrence of alcohol and drug use, unprotected sexual behavior, and mental health burden over time. Four waves of data, collected over the first 18 months of a 7 wave, 36-month prospective cohort study of YMSM (n=600) were used to examine the extent to which measurement models of drug use, unprotected sexual behavior, and mental health burden remained consistent across time using latent class modeling. Health challenges persisted across time as these YMSM emerged into young adulthood and the measurement models for the latent constructs of drug use and unprotected sexual behavior were essentially consistent across time whereas models for mental health burden varied over time. In addition to confirming the the robustness of our measurement models which capture a more holistic understandings of the health conditions of drug use, unprotected sex, and mental health burden, these findings underscore the ongoing health challenges YMSM face as they mature into young adulthood. These ongoing health challenges, which have been understood as forming a syndemic, persist over time, and add further evidence to support ongoing and vigilant comprehensive health programming for sexual minority men that move beyond a sole focus on HIV.
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Pérez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP Uptake Among Racially/Ethnically Diverse Young Men Who Have Sex With Men: The P18 Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:112-25. [PMID: 25915697 PMCID: PMC4550097 DOI: 10.1521/aeap.2015.27.2.112] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is considered an effective biomedical approach for HIV prevention. However, there is limited understanding of PrEP uptake among racially/ethnically and socioeconomically diverse young men who have sex with men (YMSM). This study examined attitudes and perceptions toward PrEP uptake among YMSM by conducting semistructured interviews with a sample (N = 100) of YMSM in New York City. Thematic analysis was employed to explore key issues related to attitudes and perceptions toward PrEP utilization. Findings suggest that self-perceived risk for HIV transmission, enjoying unprotected sex, and being in a romantic relationship were associated with PrEP uptake. The most prominent barriers to PrEP uptake included costs, adherence regimen, and access. In summary, these findings underscore the importance of addressing behavioral and structural factors in maximizing the effectiveness of PrEP. In addition, PrEP implementation programs ought to consider the role of social and structural challenges to PrEP uptake and adherence among YMSM.
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13
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Duncan DT, Kapadia F, Halkitis PN. Examination of spatial polygamy among young gay, bisexual, and other men who have sex with men in New York City: the P18 cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8962-83. [PMID: 25170685 PMCID: PMC4199000 DOI: 10.3390/ijerph110908962] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Abstract
The few previous studies examining the influence of the neighborhood context on health and health behavior among young gay, bisexual, and other men who have sex with men (YMSM) have predominantly focused on residential neighborhoods. No studies have examined multiple neighborhood contexts among YMSM or the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, health behaviors, and neighborhood concordance. In this study, we assessed spatial polygamy by determining the amount of concordance between residential, social, and sex neighborhoods (defined as boroughs) in addition to examining individual-level characteristics that may be associated with neighborhood concordance. These data come from the baseline assessment of Project 18, a cohort of racially and ethnically diverse YMSM residing in the New York City metropolitan area. Participants (N = 598) provided information on their residential, social, and sex boroughs as well as information on their sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors (e.g., substance use and condomless sex). Descriptive analyses were conducted to examine the distribution of boroughs reported across all three contexts, i.e., residential, social, and sex boroughs. Next, concordance between: (1) residential and social boroughs; (2) residential and sex boroughs; (3) social and sex boroughs; and (4) residential, social, and sex boroughs was assessed. Finally, bivariable analyses were conducted to examine the relationships between sociodemographic characteristics, psychosocial factors, social support network characteristics, and health behaviors in relation to borough concordance. Approximately two-thirds of participants reported concordance between residential/socializing, residential/sex, and sex/socializing boroughs, whereas 25% reported concordance between all three residential/socializing/sex boroughs. Borough concordance varied by some individual-level characteristics. For example, White YMSM and YMSM reporting lower perceived socioeconomic status were significantly more likely to report residential/socializing/sex borough concordance (p < 0.001). With regard to psychosocial factors, YMSM who reported experiencing gay-related stigma in public forums were more likely to report discordant socializing/sex and residential/socializing/sex boroughs (p < 0.001). Greater frequency of communication with network members (≥weekly) was associated with less residential/social borough concordance (p < 0.05). YMSM who reported residential/socializing/sex borough concordance were more likely to report recent (last 30 days) alcohol use, recent marijuana use, and recently engaging in condomless oral sex (all p < 0.05). These findings suggest that spatial polygamy, or an individual moving across and experiencing multiple neighborhood contexts, is prevalent among urban YMSM and that spatial polygamy varies by multiple individual-level characteristics. Future research among YMSM populations should consider multiple neighborhood contexts in order to provide a more nuanced understanding of how and which neighborhood contexts influence the health and well-being of YMSM. This further examination of spatial polygamy (and individual-level characteristics associated with it) may increase understanding of the most appropriate locations for targeted disease prevention and health promotion interventions (e.g., HIV prevention interventions).
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Affiliation(s)
- Dustin T. Duncan
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Population Center, New York University, New York, NY 10012, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-646-501-2674; Fax: + 1-646-501-2706
| | - Farzana Kapadia
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
| | - Perry N. Halkitis
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA; E-Mails: (F.K.); (P.N.K.)
- Global Institute of Public Health, New York University, New York, NY 10003, USA
- Population Center, New York University, New York, NY 10012, USA
- Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY 10003, USA
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA
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Zou H, Prestage G, Fairley CK, Grulich AE, Garland SM, Hocking JS, Bradshaw CS, Cornall AM, Tabrizi SN, Morrow A, Chen MY. Sexual behaviors and risk for sexually transmitted infections among teenage men who have sex with men. J Adolesc Health 2014; 55:247-53. [PMID: 24661735 DOI: 10.1016/j.jadohealth.2014.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/13/2014] [Accepted: 01/21/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report on sexual behaviors and sexually transmitted infections (STIs) among men who have sex with men (MSM) in their teens, when many MSM engage in their first sexual experiences. METHODS MSM aged 16 to 20 years were recruited via community and other sources. Men completed a questionnaire about their sexual behaviors and were screened for gonorrhea, chlamydia, syphilis, and HIV. RESULTS Two hundred men were included. The median age was 19 years. The median age at first insertive or receptive anal intercourse was 17 years. Half of men reported sex with mainly older men: these men were more likely to engage in receptive anal intercourse (48% vs. 25%, p < .001) than other men. Most men had engaged in insertive (87%) and receptive (85%) anal intercourse in the prior 12 months with 60% and 53% reporting inconsistent condom use with insertive and receptive anal intercourse partners, respectively. The median number of insertive anal intercourse partners was 3 and 1.5 (p < .001) among men reporting inconsistent and consistent condom use with insertive anal intercourse over the prior 12 months. The median number of receptive anal intercourse partners was 3 and 2 (p = .006) among men reporting inconsistent and consistent condom use with receptive anal intercourse over the prior 12 months. Pharyngeal gonorrhea, rectal gonorrhea, urethral chlamydia, rectal chlamydia, and syphilis were detected in 3.0%, 5.5%, 3.0%, 4%, and 2.0% of men, respectively. All men were HIV negative. CONCLUSION Many of the teenage MSM in this study were at risk for STI. Preventative messages and STI screening interventions that are age appropriate need to be developed to reduce HIV and STI risk in this under-recognized group.
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Affiliation(s)
- Huachun Zou
- School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Garrett Prestage
- Kirby Institute, University of New South Wales, Sydney, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Christopher K Fairley
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Jane S Hocking
- Centre for Women's Health, Gender and Society, University of Melbourne, Melbourne, Australia
| | - Catriona S Bradshaw
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrea Morrow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Marcus Y Chen
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
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