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Andrade-Romo Z, La Hera-Fuentes G, Ochoa-Sánchez LE, Chavira-Razo L, Aramburo-Muro T, Castro-León L, Amaya-Tapia G, Andrade-Pérez JS, Bautista-Arredondo S. Effectiveness of an intervention to improve ART adherence among men who have sex with men living with HIV: a randomized controlled trial in three public HIV clinics in Mexico. AIDS Care 2024; 36:816-831. [PMID: 38422450 DOI: 10.1080/09540121.2023.2299322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024]
Abstract
We conducted a parallel-group randomized controlled trial in three HIV clinics in Mexico to evaluate a user-centred habit-formation intervention to improve ART adherence among MSM living with HIV. We randomized 74 participants to the intervention group and 77 to the control group. We measured adherence at one, four, and ten months through medication possession ratio and self-reported adherence. Additionally, we measured viral load, CD4 cell count, major depression disorder symptoms, and alcohol and substance use disorder at baseline, fourth and tenth months. We found no statistically significant effect on adherence between groups. However, the intervention demonstrated positive results in major depression disorder symptoms (21% vs. 6%, p = 0.008) and substance use disorder (11% vs. 1%, p = 0.018) in the fourth month. The latter is relevant because, in addition to its direct benefit, it might also improve the chances of maintaining adequate adherence in the long term. This trial was retrospectively registered at ClinicalTrials.gov (trial number NCT03410680) on 8 January 2018.Trial registration: ClinicalTrials.gov identifier: NCT03410680.
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Affiliation(s)
- Zafiro Andrade-Romo
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gina La Hera-Fuentes
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
- Newcastle Business School, The University of Newcastle, Callaghan, Australia
| | - Luz Edith Ochoa-Sánchez
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Laura Chavira-Razo
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Tania Aramburo-Muro
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
| | | | - Gerardo Amaya-Tapia
- Infectious Diseases Department, Hospital General de Occidente, Zapopan, México
| | | | - Sergio Bautista-Arredondo
- Health Economics and Health Systems Innovation Division, National Institute of Public Health of Mexico, Cuernavaca, México
- School of Public Health, UC Berkeley, Berkeley, USA
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2
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Robles G, Lee JJ, Yu M, Starks TJ. Multilevel Analysis of Sociopolitical Contexts, Social Support, Mental Health, and Alcohol Use Among Partnered Sexual Minority Latino Men in the U.S. J Racial Ethn Health Disparities 2024; 11:1618-1627. [PMID: 37222939 DOI: 10.1007/s40615-023-01637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective of this paper is to examine how state-level characteristics relate to social support and mental health outcomes among Latino sexual minority men in the U.S. METHODS Multilevel linear regression analyses were used to estimate the effect of social support and contextual-level characteristics on mental health and alcohol use among Latino sexual minority men (n = 612). Individual-level data were collected via a national, online survey between November 2018 and May 2019. State-level data were drawn from the 2019 American Community Survey and the Human Rights Campaign's 2018 State Equality Index score cards. RESULTS The interaction between friend support and supportive LGBTQ+ policies was associated with anxiety (B = 1.77; 95% CI 0.69, 2.85; p = 0.001) and depression (B = 2.25; 95% CI 0.99, 3.50; p<0.001). The interaction between friend support and Latino population size was associated with greater problematic alcohol use (B = 0.06; 95% CI 0.03, 0.10; p<0.001). The interaction between partner support and supportive LGBTQ+ policies were also associated problematic drinking (B = -1.72; 95% CI -3.05, -0.38; p<0.012). CONCLUSIONS Contextual factors can affect the everyday experiences of Latino sexual minority men. The effect of social support on mental health outcomes may depend on state-level factors. Public health efforts that seek to address the mental health and problematic drinking behaviors of Latino sexual minority men must consider the impact of macro-level policies on program and intervention development.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA.
| | - Jane J Lee
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Melanie Yu
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
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Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomed J 2024:100746. [PMID: 38734408 DOI: 10.1016/j.bj.2024.100746] [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: 11/20/2023] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
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Affiliation(s)
- Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Narendra Kumar
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kamal Singh
- Department of Veterinary Pathobiology, College of Veterinary Medicine, and Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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4
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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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Dai Z, Wu Y, Liu X, Fu J, Si M, Chen X, Wang H, Xiao W, Huang Y, Yu F, Mi G, Su X. Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model. Brain Behav 2024; 14:e3472. [PMID: 38549560 PMCID: PMC10979188 DOI: 10.1002/brb3.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis. METHODS A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma. RESULTS Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma. CONCLUSION The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.
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Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yijin Wu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xin Liu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jiaqi Fu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Mingyu Si
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xu Chen
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Hao Wang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Weijun Xiao
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yiman Huang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Fei Yu
- Danlan Public WelfareBeijingChina
| | | | - Xiaoyou Su
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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Rodríguez-Expósito B, Rieker JA, Uceda S, Beltrán-Velasco AI, Echeverry-Alzate V, Gómez-Ortega M, Positivo A, Reiriz M. Psychological characteristics associated with chemsex among men who have sex with men: Internalized homophobia, conscientiousness and serostatus as predictive factors. Int J Clin Health Psychol 2024; 24:100465. [PMID: 38737628 PMCID: PMC11088328 DOI: 10.1016/j.ijchp.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Background Although significant progress has been made in the rights of the LGBTQ+ community, even today this population still faces stigma and discrimination that impacts their mental health. In the case of men who have sex with men, it has been demonstrated that the use of drugs in a sexual context (chemsex) is one of the coping mechanisms and means of escape to deal with these situations. Method We assessed 284 native Spanish speakers' participants, 45,4 % were not engaged in sexualised drug use (n = 129) while 54,6 % were chemsex users (n = 155) using 18,7 % of them the injected via. The participants completed six questionnaires about life and sexual satisfaction, depression, anxiety, internalised homophobia and personality. Bivariate and multivariable logistic regression were performed to assess the associations between sexual behaviour-related and psychological variables. Kruskal-Wallis H test was used to analysed the impact on mental health of the administration via. Results Aged, unprotected sexual relationships, positive serostatus, homonegativity and conscientiousness predicted the chemsex engagement. Furthermore, we found differences regarding the administration via. Conclusions We conclude that mental health significantly correlates with the practice of chemsex, highlighting the importance of integrating mental health considerations into the prevention of risky sexual behaviors.
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Affiliation(s)
- Benjamín Rodríguez-Expósito
- Nebrija University, Facultad de Lenguas y Educación, Universidad Antonio de Nebrija, Madrid 28240, Spain
- Departament of Psychology, UNED, Seville, Spain
| | - Jennifer A. Rieker
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | - Sara Uceda
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | - Víctor Echeverry-Alzate
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
| | | | | | - Manuel Reiriz
- NBC Group, Psychology Department, School of Life and Nature Sciences, Nebrija University, Madrid, Spain
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Gibbs JJ, O'Shields J, DeVane R, Purcell A. Religious Identity Dissonance: Examining the Path of Religious Factors to Depression in Sexual Minority Men in the USA. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02025-4. [PMID: 38517583 DOI: 10.1007/s10943-024-02025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
Little is known about the religious factors that contribute to religious identity dissonance (ID) for sexual minority men. Our aim was to model the path of religious factors to depression symptoms through ID and internalized stigma (IS). US sexual minority men (N = 168) participated in a survey about religious factors and mental health. Serial mediation of religious factors through ID and IS to depression symptoms was assessed using Hayes PROCESS macro. Results indicate that two religious factors significantly increase depression through ID and IS. Negative parental religious messages about LGBTQ people play a meaningful role in ID and increasing depression.
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Affiliation(s)
- Jeremy J Gibbs
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA, 30602, USA.
| | - Jay O'Shields
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA, 30602, USA
| | - Ryan DeVane
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA, 30602, USA
| | - Anna Purcell
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA, 30602, USA
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Hernandez M, Guarino H, Kozlowski S, Srivastava A, Schenkel R, Tapia T, Seabrook TB, Nash D, Irvine MK. Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care. AIDS Patient Care STDS 2024; 38:107-114. [PMID: 38471091 DOI: 10.1089/apc.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.
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Affiliation(s)
- Miguel Hernandez
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Sarah Kozlowski
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Schenkel
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Thamara Tapia
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Tyeirra B Seabrook
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Mary K Irvine
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Mwaniki SW, Kaberia PM, Mugo PM, Palanee-Phillips T. "What if I get sick, where shall I go?": a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya. BMC Public Health 2024; 24:52. [PMID: 38166989 PMCID: PMC10763282 DOI: 10.1186/s12889-023-17555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Globally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM's healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM. METHODS In September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12. RESULTS Participants were 18-24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM's experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention. CONCLUSION During engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.
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Affiliation(s)
- Samuel Waweru Mwaniki
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Health Services, Administration and Campus Support Services, University of Nairobi, Nairobi, Kenya.
| | - Peter Mwenda Kaberia
- Department of Mathematics, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Peter Mwangi Mugo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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10
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Liu Y, Ramos SD, Hanna DB, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Friedman MR, Plankey M, Chichetto NE. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 2023; 27:4094-4105. [PMID: 37418062 PMCID: PMC10615787 DOI: 10.1007/s10461-023-04123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.
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Affiliation(s)
- Yiyang Liu
- University of Florida, Gainesville, FL, USA
| | - Stephen D Ramos
- University of California - San Diego, San Diego, La Jolla, CA, USA
| | | | - Deborah L Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Mardge H Cohen
- Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Jenni M Wise
- University of Alabama at Birmingham, Birmingham, AL, England
| | - Mackey R Friedman
- School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada
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11
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Berlin GW, Fulcher K, Taylor K, Nguyen T, Montiel A, Moore D, Hull M, Lachowsky NJ. Links Between Childhood Abuse, Insidious Trauma, and Methamphetamine Use Across the Lifespan Among Gay, Bisexual, and Other Men Who Have Sex with Men: A Qualitative Analysis. JOURNAL OF HOMOSEXUALITY 2023; 70:3192-3212. [PMID: 35759650 DOI: 10.1080/00918369.2022.2089075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Developmental and lifespan examinations of methamphetamine use among gay, bisexual, and other men who have sex with men (GBM) remain limited. We used a feminist trauma framework to examine potential links between childhood trauma, trauma-related stressors, and methamphetamine use among GBM. From June 2018 to October 2018, semi-structured interviews (N = 33) were conducted with GBM across British Columbia. Interviews focused on sexual experiences, support services, and methamphetamine use. Using thematic analysis, two overarching trauma-related themes were identified: developmental and insidious trauma and coping with trauma-related stressors. GBM's methamphetamine use co-occurred with childhood experiences of family- and peer-perpetrated heterosexism, childhood sexual abuse, and intersecting forms of oppression/marginalization. These experiences manifested as internalized shame, interpersonal anxiety, and low self-esteem. In adulthood, participants reported difficulty managing emotions, low self-confidence, and loneliness. GBM reported using methamphetamine to manage negative emotions, life stressors, and overcome barriers to interpersonal connection. Findings indicate a need for trauma-informed interventions that address underlying issues and help GBM cultivate supportive relationships.
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Affiliation(s)
- G W Berlin
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - K Fulcher
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - K Taylor
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Canadian Institute of Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - T Nguyen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Montiel
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - D Moore
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Hull
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - N J Lachowsky
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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12
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Gomillia CE, Burns PA, Xavier Hall CD, Beach LB. The Association of Depression, Social Determinants and PrEP Uptake Among Black Sexual Minority Men in the Deep South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01793-1. [PMID: 37702972 DOI: 10.1007/s40615-023-01793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
Despite its known efficacy in reducing HIV acquisition, pre-exposure prophylaxis (PrEP) uptake and utilization remains alarmingly low among key populations, including Black sexual minority men (SMM). Additionally, research has shown that SMM are at elevated risk of adverse mental health outcomes, including depression, anxiety, illegal drug use, and suicidality. However, there is limited data examining the impact of depression on PrEP uptake among Black SMM. This study analyzes survey data obtained from the ViiV ACCELERATE! Initiative between January 2016 and September 2017 to examine the association between depressive symptoms and uptake of PrEP among a sample of HIV-negative Black SMM ages 18-65 years (N=170) residing in Mississippi, the poorest state in the USA. We found that PrEP-eligible Black SMM reporting depressive symptoms were 60% less likely to take PrEP (aOR = 0.40, CI: 0.18-0.74, p = 0.05). Similarly, PrEP-eligible men lacking health insurance were 63% less likely to start PrEP (aOR = 0.37; CI: 0.17-0.94; p = 0.035). Given the low uptake of PrEP among Black SMM, there is an urgent need for the development and implementation of combination HIV prevention interventions that incorporate access to mental health services among this highly stigmatized and marginalized population.
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Affiliation(s)
- Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA.
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, TR202, Jackson, MS, 39216, USA
| | - Casey D Xavier Hall
- College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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13
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Lee F, Jain JP, Duthely LM, Ikeda J, Santos GM. Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study. JMIR Form Res 2023; 7:e45717. [PMID: 37590045 PMCID: PMC10472175 DOI: 10.2196/45717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. OBJECTIVE We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. METHODS Participants who were aged ≥18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. RESULTS Of 272 participants, 201 (73.9%) identified as male, 134 (49.2%) were MSM, 52 (19.1%) were from racial and ethnic minoritized communities, and 158 (58%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR] 4.61, 95% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95% CI 1.01-1.04), a higher depression score (aOR 1.06, 95% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95% CI 0.037-0.13). CONCLUSIONS Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations.
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Affiliation(s)
- Frank Lee
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Jennifer Payaal Jain
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lunthita M Duthely
- Obstetrics, Gynecology & Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
| | - Janet Ikeda
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Glenn-Milo Santos
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, CA, United States
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14
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Davis DA, Muessig KE, Matthews DD, Angeles G, McNaughton-Reyes L, Guzmán K, Northbrook S, Barrington C. 'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV. Health Promot Int 2023; 38:daab188. [PMID: 34849870 PMCID: PMC9233178 DOI: 10.1093/heapro/daab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.
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Affiliation(s)
- Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Karla Guzmán
- HIV Central America Regional Program, Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sanny Northbrook
- US Center for Disease Control and Prevention (CDC) Central America Region, 11 calle 15-79, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
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15
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Huang FF, Chen WT, Shiu C, Yang JP, Zhao H. Relationships between spirituality and mental stress in people living with HIV in China: A cross-sectional study. Ment Health Relig Cult 2023; 26:276-289. [PMID: 37974904 PMCID: PMC10651058 DOI: 10.1080/13674676.2023.2219620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 05/24/2023] [Indexed: 11/19/2023]
Abstract
There are limited reports on the relationship between spirituality and mental stress in PLWH in China, who may be subject to anti-religious pressures from the government. In this study, we aimed to understand whether spirituality influences Chinese PLWH's mental stress and, if so, at what level. We recruited 200 PLWHs from Beijing's Ditan Hospital to complete a cross-sectional survey inquiring about their practice of spirituality as well as their level of mental stress. The study found that PLWH who presented with a mid-level of spirituality have the highest mental stress when compared to those who have a low level of spiritual beliefs or a high level of spiritual beliefs. This study points to the utility of healthcare providers taking PLWH's potential spirituality into consideration, perhaps in particular for those with a moderate level of spirituality, in order to provide the most comprehensive care possible.
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Affiliation(s)
- Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Chengshi Shiu
- National Taiwan University, Department of Social Work, Taipei, Taiwan
| | - Joyce P. Yang
- Department of Psychology, University of San Francisco, San Francisco, CA, USA
| | - Hongxin Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
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16
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Xu Y, Huang Y, Peng J, Tang R, Luo B, Xia Z. Association between depression and HIV infection vulnerable populations in United States adults: a cross-sectional analysis of NHANES from 1999 to 2018. Front Public Health 2023; 11:1146318. [PMID: 37325316 PMCID: PMC10267355 DOI: 10.3389/fpubh.2023.1146318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Although the government has made a commitment to advance education on HIV disclosure, depression continues to play a significant role in whether people living with HIV (PLWH) choose to disclose their HIV status to families or friends. Vulnerable populations who are at risk of contracting HIV may also be more susceptible to mental illness. However, there is a limited understanding of the association between depression and vulnerable populations affects by HIV among United States adults. We aimed to explore the incidence of depression in the HIV infection vulnerable populations and assessed the association between the HIV infection vulnerable populations and depression. Methods We analyzed the most current statistics from the National Health and Nutrition Examination Survey (NHANES) that included 16,584 participants aged 18 years or older between 1999 and 2018. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate symptoms of depressive disorder. Demographic characteristics were compared between the HIV infection vulnerable groups and HIV infection low-risk groups. Multivariable logistic regression analysis was also carried out to evaluate the odds rate and association between the HIV infection vulnerable populations and depression. Results Based on the most recent statistics from NHANES, HIV infection vulnerable populations were male, younger, less married or living together, non-Hispanic White people, lower income, and lower body mass index (BMI), with higher levels of cigarette smoking, alcohol drinking, a higher prevalence of depression, lower prevalence of hypertension and diabetes mellitus (DM; p < 0.05). Additionally, individuals with severe depression had a higher prevalence of cardiovascular disease (CVD), hypertension, DM, chronic kidney disease (CKD), and a higher proportion of HIV infection vulnerable populations and less married or living together (p < 0.01). Finally, the odds of depression from the logistic regression were significantly increased in HIV infection vulnerable groups (p < 0.01). Conclusion Depression might be associated with HIV infection vulnerable populations in the United States adults. More research is needed to evaluate the association between HIV infection vulnerable populations and depression and explore their causal associations. In addition, prevention efforts focusing on HIV disclosure and HIV infection vulnerable populations in the United States should address common co-prevalent depression to reduce new HIV infections.
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Affiliation(s)
- Yan Xu
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Yuexin Huang
- Department of Urology, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Jie Peng
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Ruiti Tang
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Bin Luo
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Zhiwei Xia
- Department of Neurology, Hunan Aerospace Hospital, Changsha, Hunan, China
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17
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Stein O, Sang JM, Wang L, Cui Z, Zhu J, Lal A, Card KG, Lachowsky NJ, Hogg R, Moore DM. Factors associated with improvements in symptoms of anxiety and depression among gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada: A prospective cohort study. J Affect Disord 2023; 328:334-340. [PMID: 36806593 DOI: 10.1016/j.jad.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced among gay, bisexual and other men-who-have-sex-with-men (gbMSM). We explored factors associated with improvements in mental health symptoms among gbMSM with abnormal depression and anxiety scores over a period of four years, in Vancouver, Canada. METHODS Sexually active gbMSM ≥16 years of age were recruited using respondent-driven sampling from February 2012 to February 2015. Participants completed a computer-assisted questionnaire which included the Hospital Anxiety and Depression Scale (HADS), and psychometric scales to measure loneliness, self-esteem and social connectedness, every 6 months until July 2019. Generalized linear mixed models were used to assess factors associated with normal/borderline HADS scores (<11) following a previous abnormal score (≥11) for each of anxiety and depression subscales. RESULTS We recruited 694 participants, of whom 580 had at least one follow-up visit. Across all visits, 43.6 % of participants ever had abnormal anxiety scores and 16.2 % ever had abnormal depression scores. Among those with abnormal anxiety scores, 34.9 % of follow-up visits demonstrated reductions in anxiety scores. Among those with abnormal depression scores 51.0 % of follow-up visits demonstrated reductions in depression scores. Reductions in anxiety scores were associated with increased self-esteem, decreased loneliness and the number of gbMSM seen/spoken to in the previous month. Reductions in depression scores were associated with increased self-esteem, decreased loneliness and having a regular partner. CONCLUSION Improvements in mental health symptoms were frequently observed. Social connectedness was related with improved anxiety and depression symptoms. Interventions to improve social connectedness may help to improve mental health for gbMSM.
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Affiliation(s)
- Olivia Stein
- Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Faculty of Medicine, University of British Columbia, Canada
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Canada.
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18
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Is There a Reduction in Chemsex Practice in Men Who Have Sex With Men During COVID-19 Lockdown? Results of the CheRRLock Study. J Acquir Immune Defic Syndr 2023; 92:378-384. [PMID: 36562613 DOI: 10.1097/qai.0000000000003153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Chemsex is a growing concern among men who have sex with men (MSM). COVID-19 lockdowns have had consequences on social and sexual interactions. We aimed to assess changes in chemsex practices during COVID-19 lockdown in France among MSM and factors associated with maintaining or increasing chemsex practice. METHODS Repeated face-to-face questionnaires were conducted at "Le 190" Sexual Health Center, Paris, France, exploring lifestyle, sexual, and chemsex practices, COVID-19 concerns and mental health before and during second lockdown in France (30/10/2020-15/12/2020). Inclusion criteria were chemsex practices at least 3 times throughout lifetime and at least once in the 3 months before second lockdown. The primary end point was the proportion of participants who declared having stopped, decreased, maintained, or increased their chemsex practice during lockdown. Univariable and multivariable logistic regressions were used to analyze factors associated with evolutions of chemsex practice. RESULTS Ninety-three MSM were included: 66% HIV-positive and 30% taking PrEP. Drugs most used were cathinones (91%) and GHB/GBL (52%). Participants reported stopping, decreasing, maintaining, and increasing chemsex drugs use in 14%, 22%, 22%, and 42% of cases, respectively. Despite this overall increase in chemsex practice, MSM decreased their number of sexual partners. Factors significantly associated with maintaining or increasing chemsex drugs use were feeling lonely (OR = 3.24), craving (OR = 4.51), and working during lockdown (OR = 3.27), contrasting with fear of COVID-19 (OR = 0.31). CONCLUSION Restriction measures lead to changes in sexual behavior and seem to increase chemsex practice. Maintaining care for most isolated patients should be a priority in COVID-19 context.
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19
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Okafor CN, Brennan-Ing M, Ware D, Haberlen S, Egan JE, Brown AL, Meanley S, Stosor V, Shoptaw S, Friedman MR, Plankey M. Grit is associated with psychological health among older sexual minority men. Aging Ment Health 2023; 27:434-444. [PMID: 35138200 PMCID: PMC9360198 DOI: 10.1080/13607863.2022.2032594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/17/2022] [Indexed: 01/21/2023]
Abstract
Objectives: Studies have shown that grit-defined as perseverance and passion for achieving one's long-term goals-is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress.Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress.Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1.Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594.
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Affiliation(s)
- Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, NY, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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20
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Chan ASW, Leung LM, Li JSF, Ho JMC, Tam HL, Hsu WL, Iu ANOS, Tang PMK, Yan E. Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis. Front Public Health 2022; 10:912980. [PMID: 36523575 PMCID: PMC9746694 DOI: 10.3389/fpubh.2022.912980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing. Objective The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing. Methods This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse. Results The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1). Conclusion Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,*Correspondence: Alex Siu Wing Chan ;
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jane Siu Fan Li
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Mei Chi Ho
- Faculty of Health and Social Sciences, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hon Lon Tam
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Wing Leung Hsu
- Aceso Medical Centre, Hong Kong, Hong Kong SAR, China,Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, United Kingdom
| | - April Nicole On Sang Iu
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Elsie Yan
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China,Patrick Ming Kuen Tang
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21
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Marbaniang I, Rose E, Moodie EEM, Hart TA, Cox J. Mental health services use and depressive symptom scores among gay and bisexual men in Canada. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2333-2342. [PMID: 36121487 PMCID: PMC9636296 DOI: 10.1007/s00127-022-02362-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/02/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the association between mental health services (MHS) use and depressive symptom scores among gay and bisexual men (GBM) and compare with heterosexual men in Canada. METHODS We used data from the 2015-2016 cycles of the Canadian Community Health Survey. Depressive symptoms were assessed using the PHQ-9 questionnaire (prior two weeks). MHS consultations with any licensed mental health professional (prior year) were categorized as 0, 1, 2-11, ≥ 12. We fit linear regression models to quantify the associations between MHS use and PHQ-9 scores, with an interaction term for sexual identity (GBM and heterosexual men). Models were adjusted for socioeconomic and health-related indicators. RESULTS Among 21,383 men, 97.3% self-identified as heterosexual and 2.7% as GBM. Compared to heterosexual men, GBM used any MHS (21% vs. 10%, p < 0.05) and consulted ≥ 2 health professionals for their mental health (6% vs. 2%, p < 0.05) in the preceding year more frequently. Overall, mean PHQ-9 scores were higher among GBM compared to heterosexual men (3.9 vs. 2.3, p < 0.05). Relative to no consultations, higher MHS use (2-11, ≥ 12 consultations) was associated with higher PHQ-9 scores (1.4-4.9 points higher). Associations between MHS use and PHQ-9 scores did not differ statistically between GBM and heterosexual men. CONCLUSION Our findings were inconclusive in demonstrating a difference between heterosexual men and GBM for the association between MHS use and PHQ-9 scores. However, GBM consistently had higher average PHQ-9 scores for every category of consultations. Considering the higher use of MHS and higher burden of depressive symptoms among GBM, more research is needed.
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Affiliation(s)
- Ivan Marbaniang
- Department of Epidemiology, 2001 McGill University, Suite 1200, Montreal, QC, H3A 1G1, Canada.
| | - Eric Rose
- Department of Biostatistics, McGill University, Montreal, QC, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
- Clinical Outcomes Research and Evaluation, Research Institute-McGill University Health Centre, Montreal, QC, Canada
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22
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Kobrak P, Remien RH, Myers JE, Salcuni P, Edelstein Z, Tsoi B, Sandfort T. Motivations and Barriers to Routine HIV Testing Among Men Who Have Sex with Men in New York City. AIDS Behav 2022; 26:3563-3575. [PMID: 35536518 PMCID: PMC9550690 DOI: 10.1007/s10461-022-03679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
Abstract
In-depth qualitative interviews explored the experiences and understandings of men 18-39 years old who have sex with men that could facilitate or prevent HIV testing and routine HIV testing. For many men who tested frequently, testing and routine testing were motivated by awareness of the benefit of prompt treatment; public health and provider encouragement to test periodically; responsibility towards sexual partners; and wanting to share a recent HIV-negative test result when seeking sex online. For some men, any testing was impeded by anxiety around possible HIV diagnosis that made testing a stressful occasion that required time and energy to prepare for. This anxiety was often compounded by stigma related to sex between men, having condomless sex, or having HIV. Routine testing could be further stigmatized as some men felt judged by testing providers or partners if they asked for a test or said they tested frequently. We describe efforts to promote testing and routine testing by countering fear and stigma associated with HIV and testing.
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Affiliation(s)
- Paul Kobrak
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA.
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Paul Salcuni
- Relevant Healthcare Technologies, New York, NY, USA
| | - Zoe Edelstein
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Benjamin Tsoi
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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23
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Wang Y, Kinsler J, Cumberland WG, Young SD. Mental Health among African American and Latinx Men who have sex with men after the COVID-19 Lockdown in Los Angeles - Findings from the HOPE cohort. Community Ment Health J 2022; 58:1554-1562. [PMID: 35441965 PMCID: PMC9019533 DOI: 10.1007/s10597-022-00970-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to examine the depression and anxiety among men of color (primarily African American and Latinx) who have sex with men after the lockdown due to the COVID-19 pandemic. Outcomes included 21-item Beck Depression Inventory (BDI), 7-item Generalized Anxiety Disorder (GAD), and a 10-item COVID-related anxiety measure using a modified H1N1-related anxiety question. Independent variables were food insecurity and belief in government efficiency. Data were analyzed by Regression models with random cluster effects. Food insecurity experiences were significantly associated with higher depression (p < 0.001), higher anxiety (p < 0.001), and higher pandemic-related anxiety (p < 0.001). Higher levels of belief in government efficiency were significantly associated with lower depression (p < 0.05), less anxiety (p < 0.05), and less pandemic-related anxiety (p-value < 0.001). These findings emphasize the importance of establishing trust between government and at-risk communities when issuing public health policies, especially during unforeseen circumstances, as well as to ensure basic human rights, such as food security.
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Affiliation(s)
- Yan Wang
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte, 90095, Los Angeles, California, USA.
| | - Janni Kinsler
- Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles (UCLA), 10833 Le Conte, 90095, Los Angeles, California, USA
| | - William G Cumberland
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles (UCLA), 10833 Le Conte, 90095, Los Angeles, California, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, 92697, Irvine, CA, USA.,Department of Informatics, Institute for Prediction Technology, University of California, 6091 Bren Hall, Irvine, CA, USA
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24
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Hoff L, Scheidell JD, Mazumdar M, Feelemyer J, Dyer TV, Turpin RE, Cleland CM, Caniglia EC, Remch M, Brewer R, Hucks-Ortiz C, Irvine NM, Mayer KH, Khan MR. The associations of incarceration and depression with healthcare experiences and utilization among Black men who have sex with men in HPTN 061. AIDS Care 2022; 34:1169-1178. [PMID: 34384304 PMCID: PMC8837705 DOI: 10.1080/09540121.2021.1966695] [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] [Received: 03/30/2021] [Accepted: 08/03/2021] [Indexed: 01/26/2023]
Abstract
Associations of incarceration with healthcare access and utilization among Black sexual minority men (BSMM) and differences in association among those with and without pre-incarceration symptoms of depression were measured. Secondary analysis using survey data from the longitudinal cohort HIV Prevention Trials Network 061 study was conducted among 1553 BSMM from six major U.S. cities from 2009 to 2011. We used modified log-binomial regression with robust standard errors to estimate associations of incarceration (reported at 6 month follow-up) on next six-month healthcare utilization and access (reported at the 12 month follow-up). We tested the significance of baseline depressive symptoms by incarceration interaction and reported differences in associations when observed. Participants with a history of incarceration were more likely to have depressive symptoms at baseline compared to those without. Recent incarceration was associated with almost twice the risk of mistrust in healthcare providers and emergency room utilization. Among men reporting depressive symptoms, a history of incarceration was associated with almost tripled risk of reporting providers do not communicate understandably. Among those with depression, one in five reported a missed visit regardless of incarceration status.
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Affiliation(s)
- Lee Hoff
- SUNY Downstate Medical Center School of Public Health, New York, NY
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Joy D Scheidell
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Medha Mazumdar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Jonathan Feelemyer
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Typhanye V Dyer
- University of Maryland School of Public Health, Department of Epidemiology and Biostatistics, College Park, MD
| | - Rodman E Turpin
- University of Maryland School of Public Health, Department of Epidemiology and Biostatistics, College Park, MD
| | - Charles M Cleland
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Ellen C Caniglia
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Molly Remch
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
| | - Russell Brewer
- University of Chicago, Department of Medicine, Chicago, IL
| | | | - Natalia M Irvine
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | | | - Maria R Khan
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
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25
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Guimarães MD, McKinnon K, Dourado I, Veras MA, Magno L, Almeida M, Wainberg M, Kendall C, Kerr L, Cournos F. A potential syndemic effect associated with symptoms of depression among men who have sex with men. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:517-521. [PMID: 36423231 PMCID: PMC9561832 DOI: 10.47626/1516-4446-2022-2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors. METHODS Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none. RESULTS The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms. CONCLUSION The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.
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Affiliation(s)
- Mark D.C. Guimarães
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil,Correspondence: Mark Drew Crosland Guimarães, Av. Alfredo Balena, 190, Santa Efigênia, CEP 30130-100, Belo Horizonte, MG, Brazil. E-mail:
| | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Inês Dourado
- Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Laio Magno
- Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Milton Wainberg
- New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Carl Kendall
- Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA,Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Ligia Kerr
- Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute and Columbia University, New York, NY, USA
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26
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Liu Y, Brown L, Przybyla S, Bleasdale J, Mitchell J, Zhang C. Characterizing Racial Differences of Mental Health Burdens, Psychosocial Determinants, and Impacts on HIV Prevention Outcomes Among Young Men Who have Sex With Men: a Community-based Study in Two U.S. Cities. J Racial Ethn Health Disparities 2022; 9:1114-1124. [PMID: 33987809 DOI: 10.1007/s40615-021-01052-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
Few studies examine racial differences (e.g., Black vs. White) regarding the psychosocial pathways linking mental health burdens and various HIV-related outcomes among young men who have sex with men (MSM) in the U.S. We conducted a community-based study to examine the racial differences of mental health burdens (e.g., depression, anxiety, stress), the psychosocial determinants (e.g., HIV stigma, homonegativity, resilience, social support, loneliness, housing/food security) and impact on HIV-related outcomes (e.g., event-level alcohol/drug use before sex, condomless insertive/receptive anal sex, recent HIV testing, and PrEP awareness/willingness/use) among young Black MSM (YBMSM; n = 209) and young White MSM (YWMSM; n = 109) from two cities (Nashville, TN and Buffalo, NY) in the United States. Overall, we found YBMSM were more likely (p < 0.05) to experience anxiety and depression compared to YWMSM. Among YBMSM, we found structural inequities (housing instability, food insecurity, internalized homonegativity) were positively associated with anxiety/depression/stress (p < 0.001); we also found anxiety/depression was associated with increased alcohol/drug use before sex, and stress was associated with reduced recent HIV testing and pre-exposure prophylaxis awareness/willingness/use. Among YWMSM, we found psychological buffers (perceived social support, resilience) were associated with reduced anxiety/depression/stress (p < 0.001); anxiety was associated with increased condomless insertive/receptive anal sex and recent HIV testing among this subgroup. YBMSM and YWMSM differed in psychosocial determinants and HIV-related consequences regarding their mental health. Our findings provide important implications for developing culturally and contextually tailored interventions to address mental health burdens and HIV prevention outcomes among young MSM at highest risk for HIV acquisition.
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Affiliation(s)
- Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 256 Crittenden Blvd, Ste. 3305, Rochester, NY, 14642, USA.
| | - Lauren Brown
- Meharry Medical College, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, USA
| | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health, University at Buffalo, Buffalo, NY, USA
| | - Jason Mitchell
- Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY, USA
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27
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García M, Ramos SR, Aponte-Soto L, Ritchwood TD, Drabble LA. "Family before Anyone Else": A Qualitative Study on Family, Marginalization, and HIV among Hispanic or Latino/a/x Mexican Sexual Minority Males. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8899. [PMID: 35897270 PMCID: PMC9332740 DOI: 10.3390/ijerph19158899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
This study explored the influence family relationships have on HIV-related factors among Hispanic or Latino/a/x Mexican sexual minority cisgender males in San Antonio, TX, US. A total of 15 young adults (7 people living with HIV; PLWH) ages 21-30 completed a semi-structured interview. Data were transcribed verbatim and analyzed using thematic analysis. The following themes emerged: (1) family support; (2) mother-son relationships; (3) father-son relationships; (4) sibling support; (5) family marginalization of sexual minorities; and (6) internalized homophobia. People who reported being HIV negative were more likely to have a prominent mother-son relationship, strong sense of family, supportive siblings, and family acceptance as a sexual minority. PLWH were more likely to report a weak sense of family, being raised in a maternal-led household, and less likely to have a relationship with their father and siblings. Marginalization among participants regardless of HIV status included exposure to religious rhetoric stigmatizing sexual minorities and fathers' reinforcing Mexican traditional gender norms. In addition to encountering homophobia, PLWH were further marginalized by family members due to their HIV status. The findings suggest a need for greater attention to examining the impact of familial support of Hispanic or Latino/a/x Mexican sexual minority cisgender males as young adults with or at risk of HIV.
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Affiliation(s)
- Moctezuma García
- School of Social Work, San José State University, San Jose, CA 95112, USA;
| | | | - Lisa Aponte-Soto
- College of Science and Health, DePaul University, Chicago, IL 60604, USA;
| | - Tiarney D. Ritchwood
- Department of Family Medicine and Community Health, Duke University, Durham, NC 27710, USA;
| | - Laurie A. Drabble
- School of Social Work, San José State University, San Jose, CA 95112, USA;
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28
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Yu Y, Wang X, Wu Y, Weng W, Zhang M, Li J, Huang X, Gao Y. The benefits of psychosocial interventions for mental health in men who have sex with men living with HIV: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:440. [PMID: 35768860 PMCID: PMC9241196 DOI: 10.1186/s12888-022-04072-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Men who have sex with men (MSM) living with HIV are more likely to suffer from mental health problems. They should be given adequate attention to treat and improve their mental health disorders. This meta-analysis aimed to assess whether psychosocial interventions reliably improve psychological well-being among MSM living with HIV. METHOD Cochrane Library, EMBASE, PsycINFO, and PubMed were searched for psychosocial intervention randomized controlled trials evaluating mental health (e.g., depression, anxiety, self-efficacy). The effect size was pooled using the random-effects model, and continuous outcomes were reported using standardized mean difference (SMD) values . RESULTS A total of 12 studies including 1782 participants were included in the meta-analysis. Psychosocial interventions in contrast to control groups significantly reduced depression (SMD, - 0.28; 95% CI - 0.52 - - 0.03) at the follow-up assessment and improved quality of life (SMD 0.43, 95% CI 0.23-0.63) after treatment. Psychosocial interventions also had a significant effect on measures of self-efficacy (SMD 2.22, 95% CI 0.24-4.20), and this effect was sustained until long-term follow-up (SMD 0.55, 95% CI 0.02-1.08). Subgroup analyses revealed that improvements in depression were more significant when participants possessed higher education and treatment providers used cognitive behavioral therapy (CBT). CONCLUSIONS The findings of this study indicate that psychosocial interventions benefit the mental health of MSM living with HIV. It is necessary to conduct more research to explore characteristics that may affect treatment outcomes in the future. TRIAL REGISTRATION This research was prospectively registered in PROSPERO ( CRD42021262567 ).
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Affiliation(s)
- Yan Yu
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wu
- grid.24696.3f0000 0004 0369 153XCenter for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenjia Weng
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Juan Li
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China. .,Candidate Branch of National Clinical Research Center for Skin Diseases, Beijing, China.
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29
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Zelaya DG, Guy AA, Surace A, Mastroleo NR, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Modeling the Impact of Race, Socioeconomic Status, Discrimination and Cognitive Appraisal on Mental Health Concerns Among Heavy Drinking HIV+ Cisgender MSM. AIDS Behav 2022; 26:3925-3938. [PMID: 35687187 DOI: 10.1007/s10461-022-03719-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Prior research has attributed mental health disparities between marginalized and non-marginalized populations to socioeconomic differences (i.e., education, income, employment), stigma (e.g., HIV-related discrimination), and cognitive appraisal (i.e., optimism, hostility, satisfaction with life), but the relations among these variables have not been examined concomitantly. The current study utilized structural equation modeling to examine how race and socioeconomic status impact mental health outcomes through increased exposure to stigma and more negative cognitive appraisals. Data came from a randomized controlled trial of motivational interviewing to address heavy drinking in cisgender men with HIV who have sex with men (n = 180). We found that self-reported discrimination experiences related to race/ethnicity, sexual orientation, and HIV status significantly mediated the relation between socioeconomic status and mental health concerns, whereas cognitive appraisal did not. These findings suggest that, among heavy drinking men with HIV who have sex with men, having low socioeconomic resources may increase exposure to discrimination which, in turn, may worsen mental health. Interventions that address social determinants, like socioeconomic disadvantage, and that enhance coping resources related to stigma, may have positive effects on mental health.ClinicalTrials.gov Identifier NCT01328743. Date of Registration 09/09/2019.
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Affiliation(s)
- David G Zelaya
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Arryn A Guy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
| | - Anthony Surace
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | | | - David W Pantalone
- Fenway Health Boston, Boston, MA, USA
- University of Massachusetts, Boston, MA, USA
| | - Peter M Monti
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Kenneth H Mayer
- Fenway Health Boston, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher W Kahler
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
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Buffel V, Reyniers T, Masquillier C, Thunissen E, Nöstlinger C, Laga M, Wouters E, Berghe WV, Deblonde J, Vuylsteke B. Awareness of, Willingness to Take PrEP and Its Actual Use Among Belgian MSM at High Risk of HIV Infection: Secondary Analysis of the Belgian European MSM Internet Survey. AIDS Behav 2022; 26:1793-1807. [PMID: 34817766 DOI: 10.1007/s10461-021-03526-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
We examined PrEP awareness, willingness to take it and early PrEP use among men who have sex with men (MSM) at increased risk of HIV acquisition in Belgium. This analysis of the Belgian EMIS online data of 2017-2018 adopts a cascade approach, with the following steps quantified as conditional probabilities: being eligible for, aware of, willing to take PrEP, and PrEP use. One out of three MSM was eligible to use PrEP according to the operationalized Belgian reimbursement criteria. PrEP awareness was lower among socioeconomically vulnerable MSM, MSM living outside large cities, MSM who were less open about their sexuality and those who did not identify as gay or homosexual. A lack of PrEP knowledge, a higher self-efficacy regarding safe sex, having a steady partner and reporting more symptoms of depression were related to unwillingness to use PrEP. Among those willing to take PrEP, less than one third were actually using PrEP. Not using PrEP was associated with living in small cities and experiencing financial problems.
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31
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Coleman JN, Batchelder AW, Kirakosian N, Choi KW, Shipherd JC, Bedoya CA, Safren SA, Ironson G, O'Cleirigh C. Indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless sex among men who have sex with men with a history of childhood sexual abuse. J Trauma Dissociation 2022; 23:279-295. [PMID: 34678135 PMCID: PMC9023598 DOI: 10.1080/15299732.2021.1989118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms may interfere with gay, bisexual and other men who have sex with men's (MSM) ability to engage in safe sex practices. An indirect relationship with dissociation may help to elucidate the relationship between PTSD symptom severity and condomless sex among MSM with childhood sexual abuse (CSA) histories. These relationships have not previously been examined in this group, which has a unique vulnerability for HIV acquisition. A cross-sectional sample of MSM with histories of CSA (N=290) was recruited at study sites in Boston, MA, and Miami, FL. Participants had a mean age of 37.95 years (SD=11.68), 22% were African American and 29.4% identified as Latino. The sample reported a mean of 10.47 (SD=4.38) lifetime PTSD symptoms and 26.4% met the clinical threshold for dissociation. Logistic regression models (adjusted for age, education, and substance use disorder) were used to assess indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless anal/vaginal sex episodes with serodiscordant or unknown status partners in the past 3 months. Dissociation accounted for the association between lifetime PTSD symptom severity and condomless sex episodes. The Sobel test (Sobel = 2.04, p= .042; CI 95% bias-corrected bootstrap) suggested significant indirect effects for dissociation. Dissociation among MSM with CSA histories may compromise accurate appraisals of sexual risk and safety and increase vulnerability for HIV acquisition. Further research is warranted to address HIV prevention in the context of PTSD symptom severity to improve the mental health of MSM and increase the effectiveness of HIV prevention interventions.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States.,Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, United States
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States.,The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States
| | - Karmel W Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States.,Department of Epidemiology, Harvard T.h. Chan School of Public Health, Boston, Massachusetts, United States
| | - Jillian C Shipherd
- School of Medicine, Boston University, Boston, Massachusetts, United States.,Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, United States.,Office of Patient Care Services, LGBT Health Program, Veterans Health Administration, Washington, District of Columbia, United States
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, United States
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, Florida, United States
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States.,The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
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32
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Blair CS, Needleman J, Javanbakht M, Comulada WS, Ragsdale A, Bolan R, Shoptaw S, Gorbach PM. Risk Behaviors Associated with Patterns of Sexualized Stimulant and Alcohol Use among Men Who Have Sex with Men: a Latent Class Analysis. J Urban Health 2022; 99:293-304. [PMID: 35028876 PMCID: PMC9033896 DOI: 10.1007/s11524-021-00600-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
Substance use during sexual encounters (sexualized substance use) is an important driver of HIV and sexually transmitted infection (STI) disparities that are experienced by men who have sex with men (MSM). This analysis aimed to identify patterns of sexualized substance use and their associations with HIV risk behaviors. We utilized visit-level data from a longitudinal cohort of predominantly Black/Latinx MSM, half with HIV and half with substance use in Los Angeles, California. Every 6 months from 8/2014 to 3/2020, participants underwent STI testing and completed surveys on demographics, sexualized substance use (stimulant and/or alcohol intoxication during oral sex, receptive anal intercourse [RAI] and/or insertive anal intercourse [IAI]), transactional sex, biomedical HIV prevention (pre-/post-exposure prophylaxis use or undetectable viral load), and depressive symptoms. Latent class analysis was used to identify patterns of sexualized substance use. Multinomial logit models evaluated risk behaviors associated with latent classes. Among 2386 study visits from 540 participants, 5 classes were identified: no substance use, sexualized stimulant use, sexualized alcohol use, sexualized stimulant and alcohol use, and stimulant/alcohol use during oral sex and RAI. Compared to the no sexualized substance use class, sexualized stimulant use was associated with transactional sex, current diagnosis of STIs, not using HIV biomedical prevention, and depressive symptoms. Sexualized alcohol use had fewer associations with HIV risk behaviors. Patterns of sexual activities, and the substances that are used during those activities, confer different risk behavior profiles for HIV/STI transmission and demonstrate the potential utility of interventions that combine substance use treatment with HIV prevention.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA.
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amy Ragsdale
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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The shame spiral of addiction: Negative self-conscious emotion and substance use. PLoS One 2022; 17:e0265480. [PMID: 35303025 PMCID: PMC8932605 DOI: 10.1371/journal.pone.0265480] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The bidirectional associations between negative self-conscious emotions such as shame and guilt and substance use are poorly understood. Longitudinal research is needed to examine the causes, consequences, and moderators of negative self-conscious emotions in people who use substances.
Methods
Using parallel process latent growth curve modeling, we assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. Emotions were assessed using the Differential Emotions Scale. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. Participants self-reported emotions and recent substance use behaviors over six time points across 15 months.
Results
Higher initial levels of shame were associated with slower decreases in stimulant use over time (b = 0.23, p = .041) and guilt was positively associated with stimulant use over time (β = 0.85, p < .0001). Initial levels of guilt and alcohol use were positively related (b = 0.29, p = .040), but over time, they had a negative relationship (β = -0.99, p < .0001). Additionally, higher initial levels of other drug use were associated with slower decreases in shame over time (b = 0.02, p = .041). All results were independent of depression, highlighting the specific role of self-conscious emotions.
Conclusions
Shame and guilt are barriers to reducing stimulant use, and expanded efforts are needed to mitigate the deleterious effects of these self-conscious emotions in recovery from a stimulant use disorder.
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Blair CS, Needleman J, Javanbakht M, Comulada WS, Ragsdale A, Bolan R, Shoptaw S, Gorbach PM. Examining the Relative Contributions of Methamphetamine Use, Depression, and Sexual Risk Behavior on Rectal Gonorrhea/Chlamydia Among a Cohort of Men Who Have Sex With Men in Los Angeles, California. Sex Transm Dis 2022; 49:216-222. [PMID: 34654768 PMCID: PMC8821317 DOI: 10.1097/olq.0000000000001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methamphetamine use, sexual risk behaviors, and depression contribute to ongoing human immunodeficiency virus (HIV) and sexually transmitted infection (STI) disparities among men who have sex with men (MSM). The relative contributions of these effects longitudinally are not well understood. METHODS This analysis used visit-level data from a longitudinal cohort of MSM, half with HIV, in Los Angeles, CA. From August 2014 to March 2020, participants completed follow-up visits every 6 months and underwent testing for rectal gonorrhea/chlamydia (GC/CT) and completed questionnaires including depressive symptoms, number of receptive anal intercourse (RAI) partners, and methamphetamine use. Path analysis with structural equation modeling using concurrent and lagged covariates was used to identify relative contributions of methamphetamine use and depression on number of RAI partners and rectal GC/CT across time. RESULTS Five hundred fifty-seven MSM with up to 6 visits (3 years) were included for a total of 2437 observations. Methamphetamine use and depressive symptoms were positively associated with number of RAI partners (β = 0.28, P < 0.001; β = 0.33, P = 0.018, respectively), which was positively associated with rectal GC/CT (β = 0.02, P < 0.001). When stratified by HIV status, depressive symptoms were positively associated with RAI partners for HIV-negative MSM (β = 0.50, P = 0.007) but were not associated for MSM living with HIV (β = 0.12, P = 0.57). Methamphetamine use was positively associated with RAI partners in both strata. CONCLUSIONS Factors and patterns, which contribute to risk behaviors associated with rectal GC/CT, may differ by HIV status. Our findings demonstrate the importance of combined treatment and prevention efforts that link screening and treatment of stimulant use and depression with STI prevention and treatment.
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Affiliation(s)
- Cheríe S. Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - W. Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amy Ragsdale
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Robert Bolan
- Health and Mental Health Services, Los Angeles LGBT Center
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M. Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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35
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Davis DA, Rock A, Santa Luce R, McNaughton-Reyes L, Barrington C. Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1637-NP1657. [PMID: 32552467 PMCID: PMC7941092 DOI: 10.1177/0886260520928960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.
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Affiliation(s)
- Dirk A. Davis
- The University of North Carolina at Chapel Hill, USA
| | - Amelia Rock
- The University of North Carolina at Chapel Hill, USA
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36
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Chai PR, Mohamed Y, Bustamante MJ, Goodman GR, Najarro J, Castillo-Mancilla J, Baez A, Bronzi O, Sullivan MC, Pereira LM, Baumgartner SL, Carnes TC, Mayer KH, Rosen RK, Boyer EW, O'Cleirigh C. DigiPrEP: A Pilot Trial to Evaluate the Feasibility, Acceptability, and Accuracy of a Digital Pill System to Measure PrEP Adherence in Men Who Have Sex With Men Who Use Substances. J Acquir Immune Defic Syndr 2022; 89:e5-e15. [PMID: 34753871 PMCID: PMC8740604 DOI: 10.1097/qai.0000000000002854] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to once daily oral preexposure prophylaxis (PrEP) for HIV prevention can be challenging for men who have sex with men (MSM) with substance use. Digital pill systems (DPS) comprise a radiofrequency emitter integrated into a gelatin capsule containing PrEP, which transmits data to a wearable Reader following ingestion, thereby enabling direct, real-time adherence measurement. This study evaluated the feasibility, acceptability, and accuracy of a DPS to measure PrEP adherence. METHODS A 90-day, single-arm, open-label, pilot demonstration trial was conducted with adult, cisgender, HIV-negative MSM on PrEP with nonalcohol substance use. Feasibility was measured via DPS engagement and timeline followback. Acceptability was assessed via qualitative user experience interviews. Accuracy was evaluated via DPS performance metrics, pill counts, and DBS to quantify tenofovir diphosphate. RESULTS Sixteen MSM enrolled (median age, 32 years), and 15 completed the study. Engagement remained stable over time. Emergent nonadherence patterns included intercurrent substance use. The DPS was largely acceptable based on interviews; the predominant barrier to use was the Reader. DPS-recorded ingestions totaled 1099, including 83.9% were detected by Reader and 16.1% were reported manually. The DPS recorded 92.2% of 1192 total expected ingestions per pill counts. Point-biserial correlation (R = 0.58; 95% CI: 0.21 to 0.80; P = 0.047) and Pearson correlation (month 1: R = 0.85; 95% CI: 0.57 to 0.95; P = 0.0002; month 3: R = 0.75; 95% CI: 0.17 to 0.94; P = 0.0197) showed strong correlations between DPS-recorded adherence and tenofovir diphosphate in dried blood spots. CONCLUSION DPS are a feasible, acceptable, and accurate method of measuring PrEP adherence in MSM with substance use. Future investigations should incorporate DPS into behavioral interventions targeting nonadherence.
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Affiliation(s)
- Peter R. Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Georgia R. Goodman
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Jose Castillo-Mancilla
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, CO
| | | | | | - Matthew C. Sullivan
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Luis M. Pereira
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA
| | | | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical, Boston, MA
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI; and
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Edward W. Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Conall O'Cleirigh
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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37
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Association of positive psychobehavioral factors and structural disadvantage with condomless sex in men who have sex men with childhood sexual abuse histories. J Behav Med 2022; 45:90-102. [PMID: 34431031 PMCID: PMC8821327 DOI: 10.1007/s10865-021-00251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
Previous research has highlighted both psychological and structural risk factors as correlates of condomless anal sex, a key pathway to HIV acquisition in men who have sex with men (MSM). Fewer studies have focused on positive psychobehavioral factors, which may be associated with more consistent condom use. This study hypothesized that positive psychobehavioral factors would be associated with more frequent condom use over and above psychological and structural risk factors. MSM with histories of childhood sexual abuse in Boston, MA and Miami, FL (N = 108) completed cross-sectional assessments of psychosocial, structural, and positive psychobehavioral factors. These factors were entered simultaneously in a linear regression model to examine their association with frequency of condomless sex. More recent seroadaptive behavior (B = 0.323, 95% CI = 0.055-0.590, p = .019) and receipt of government benefits to supplement income (B = 0.892, 95% CI = 0.171-1.612, p = .016) were independently associated with higher frequency of condomless sex over and above all other psychosocial, structural, and positive psychobehavioral factors. R2 for the final model was 0.270. Ancillary analyses including participants taking and adherent to biomedical HIV prevention suggested an association between higher distress tolerance and lower frequency of condomless sex. Positive psychobehavioral factors may potentially lower risk for HIV in high-risk MSM; however, left unaddressed, structural disadvantage is a potent influence which may limit potential benefits.
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38
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Brown AL, Matthews DD, Meanley S, Brennan-Ing M, Haberlen S, D’Souza G, Ware D, Egan J, Shoptaw S, Teplin LA, Friedman M, Plankey M. The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men. STIGMA AND HEALTH 2022; 7:113-121. [PMID: 35935592 PMCID: PMC9355118 DOI: 10.1037/sah0000327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.
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Affiliation(s)
- Andre L. Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | | | - Mark Brennan-Ing
- Roosevelt House Public Policy Institute at Hunter College, City University of New York
| | | | | | - Deanna Ware
- Department of Epidemiology, Georgetown University
| | - James Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | - Steve Shoptaw
- Department of Family Medicine, University of California Los Angeles
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh
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Batchelder AW, Burgess C, Perlson J, O’Cleirigh C. Age and Year of HIV Diagnosis are Associated with Perceptions of Discrimination and Internalized Stigma Among Sexual Minority Men Who Use Substances. AIDS Behav 2022; 26:125-137. [PMID: 34117966 PMCID: PMC8665940 DOI: 10.1007/s10461-021-03333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
Discrimination and internalized stigma are barriers to engagement in HIV self-care among men who have sex with men (MSM) living with HIV. However, differences in perceptions of discrimination and internalized stigmas by age, year of HIV-diagnosis, and race are poorly understood. We assessed differences in reported discrimination related to HIV, race, sexual orientation, and substance use and internalized stigmas among 202 MSM living with HIV who use substances. Younger participants reported higher levels of all types of discrimination and internalized stigmas (p-values < 0.001-0.030). Those diagnosed after the advent of antiretrovirals reported higher levels of discrimination related to HIV, sexual orientation, and substance use, as well as internalized stigma related to HIV and substance use (p-values 0.001-0.049). We explored perceived community HIV stigma, which accounted for associations involving age and year of diagnosis. Age, year of diagnosis, and race should be considered when assessing and intervening with stigma.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA,Corresponding Author: Abigail Batchelder, Ph.D., M.P.H., One Bowdoin Square, 7th Floor, Boston, MA 02114; Phone: 617-643-0387; Fax: 617-536-8602;
| | - Claire Burgess
- Department of Psychiatry, Harvard Medical School, Boston, MA,VA Boston Healthcare System, Boston, MA
| | - Jacob Perlson
- The Fenway Health Institute, Fenway Health, Boston, MA,Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA
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40
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Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model. AIDS Behav 2022; 26:138-148. [PMID: 34741690 PMCID: PMC8900724 DOI: 10.1007/s10461-021-03517-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 01/03/2023]
Abstract
Sexual minority men (SMM) with HIV are disproportionately impacted by stigma and mental health disorders. Guided by the Stigma and Substance Use Process Model, we evaluated how HIV stigma impacts mental health outcomes among SMM with HIV. Data were drawn from Thrive With Me, an RCT of an mHealth intervention targeting ART adherence among SMM with HIV. Path analyses tested the relationships between HIV stigma, depression, stress, and recent stimulant use. Overall, 49.1% (194/401) had depression symptoms, 68.8% (276/401) had moderate-to-high stress, and 28.1% (111/401) had detectable stimulant use in urine samples at baseline. In path analyses, baseline internalized HIV stigma was associated with depression and stress 5-months post-baseline and enacted stigma was associated with recent stimulant use 11-months post-baseline. We identified internalized and enacted HIV stigma, but not anticipated stigma, as potentially important intervention targets for stimulant use, depression, and stress among SMM with HIV.
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41
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Arends RM, Grintjes KJT, van den Heuvel TJ, Foeken-Verwoert EGJ, Schene AH, van der Ven AJAM, Schellekens AFA. Effectiveness of a group intervention to reduce sexual transmission risk behavior among MSM living with HIV: a non-randomized controlled pilot study. AIDS Care 2021; 34:515-526. [PMID: 34851810 DOI: 10.1080/09540121.2021.2002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ABSTRACTWith an annual incidence of about 1.5 million new infections, HIV is an ongoing public health concern. Sexual transmission risk behavior (STRB) is a main driver of the HIV epidemic in most Western countries, particularly among specific populations such as men who have sex with men (MSM). This quasi-experimental pilot study examined the effectiveness of a ten-session group intervention, aiming to reduce STRB among a high-risk subpopulation of MSM living with HIV. Self-reported STRB, impulsivity, mental health symptoms, and functional impairment were compared between the intervention group (n = 12) and a control group (n = 16). At baseline, participants in the intervention group had higher levels of STRB, impulsivity, mental health problems, and functional impairment, compared to the control group. A significant time-by-group interaction effect revealed that after the intervention, STRB, impulsivity, and functional impairment reduced in the intervention group to levels comparable to the control group. These findings suggest that a targeted behavioral intervention might be an effective strategy to reduce persistent STRB and related factors in MSM living with HIV. Future studies should confirm these findings in larger samples, using randomized designs.
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Affiliation(s)
- Rachel M Arends
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin J T Grintjes
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thom J van den Heuvel
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,GGNet, Scelta, Nijmegen, Netherlands
| | | | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behavior, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, Netherlands
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42
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Gagliano N, Black S, Mniszak C, Morgan J, Lachowsky N, Knight R. Exchanging a "Gnawing Thought for "Taking a Pill Once a Day": Examining Sexual Minority Men's Experiences With PrEP and Mental Health in a Universal PrEP Access Context. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:411-423. [PMID: 34596431 DOI: 10.1521/aeap.2021.33.5.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study explores how universal access to and taking no-cost preexposure prophylaxis (PrEP), which effectively prevents HIV acquisition, may impact the mental health-related experiences of sexual minority men, including HIV-related anxiety. We employed community-based and participatory methods to conduct and analyze 27 interviews with sexual minority men in British Columbia, Canada. Before starting PrEP, participants' experiences with sex were highly associated with HIV-related anxiety. Participants stated they did not explicitly initiate PrEP to reduce HIV-related anxiety, yet many described significant reductions of HIV-related anxiety after starting PrEP. Participants described feeling that the sex they were having was safer following their initiation of PrEP, which resulted in increased ability to access heightened experiences of pleasure, desire, and intimacy. PrEP's capacity to impact HIV stigma and health broadly should continue to be explored, particularly given the mental health inequities faced by those who may acquire HIV.
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Affiliation(s)
| | | | - Caroline Mniszak
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey Morgan
- Community-Based Research Centre, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Nathan Lachowsky
- Community-Based Research Centre, Vancouver, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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43
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Chai PR, Mohamed Y, Goodman G, Bustamante MJ, Sullivan MC, Najarro J, Mendez L, Mayer KH, Boyer EW, O'Cleirigh C, Rosen RK. Development of a digital pill and respondent behavioral intervention (PrEPSteps) for HIV pre-exposure prophylaxis adherence among stimulant using men who have sex with men. Transl Behav Med 2021; 12:6359129. [PMID: 34453536 DOI: 10.1093/tbm/ibab117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention in men who have sex with men (MSM) is contingent upon consistent adherence. Digital pill systems (DPS) provide real-time, objective measurement of ingestions and can inform behavioral adherence interventions. Qualitative feedback was solicited from MSM who use stimulants to optimize a cognitive behavioral therapy (CBT)-based intervention (LifeSteps), used in conjunction with a DPS, to promote PrEP adherence (PrEPSteps). Seven focus groups and one individual qualitative interview were conducted in Boston, MA with cisgender, HIV-negative MSM who reported stimulant use and current PrEP use or interest. Focus groups and interviews explored reactions to the DPS and PrEPSteps messaging components: contingent reinforcement (CR), corrective feedback (CF), LifeSteps, and substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Quantitative assessments were administered. Qualitative data were analyzed using applied thematic analysis. Twenty MSM participated. Most were White (N = 12), identified as homosexual or gay (N = 15), and college-educated (N = 15). Ages ranged from 24 to 68 years (median 35.5). Participants were willing to engage with the DPS and viewed it as beneficial for promoting adherence. Confirmatory CR messages were deemed acceptable, and a neutral tone was preferred. CF messages were viewed as most helpful and as promoting individual responsibility. LifeSteps was perceived as useful for contextualizing nonadherence. However, SBIRT was a barrier to DPS use; concerns around potential substance use stigma were reported. MSM who use stimulants were accepting of the DPS and PrEPSteps intervention. CR, CF, and LifeSteps messages were viewed as helpful, with modifications pertaining to tone and content; SBIRT messages were not preferred.
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Affiliation(s)
- Peter R Chai
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Georgia Goodman
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Matthew C Sullivan
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse Najarro
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Edward W Boyer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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44
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Meanley SP, Plankey MW, Matthews DD, Hawk ME, Egan JE, Teplin LA, Shoptaw SJ, Surkan PJ, Stall RD. Lifetime Prevalence and Sociodemographic Correlates of Multifactorial Discrimination Among Middle-Aged and Older Adult Men Who Have Sex with Men. JOURNAL OF HOMOSEXUALITY 2021; 68:1591-1608. [PMID: 31860386 PMCID: PMC7305044 DOI: 10.1080/00918369.2019.1702353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study describes multifactorial discrimination (discrimination attributed to multiple social identities) among middle-aged and older adult MSM. MSM aged 40+ years (N = 1,193) enrolled in the Multicenter AIDS Cohort Study completed behavioral surveys ascertaining experiences of discrimination and their social identity attributions. Non-proportional odds regressions assessed multifactorial discrimination by age, race/ethnicity, HIV status, and covariates. Twenty-seven percent of participants reported multifactorial discrimination. Adjusted models indicated that middle-aged men were more likely to report multifactorial discrimination compared to older adult men. Racial/ethnic minorities were more likely to report multifactorial discrimination compared to non-Hispanic white participants. These same patterns emerged among the sub-sample of participants living with HIV. To our knowledge, this is the first assessment of multifactorial discrimination in middle-aged and older MSM. Our findings support the deleterious association between multiple-marginalization and multifactorial discrimination. Multilevel interventions targeting interconnected experiences of stigma may improve the health of MSM in transition to older age.
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Affiliation(s)
- Steven P. Meanley
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA
| | - Michael W. Plankey
- Georgetown University Department of Medicine, Division of Infectious Diseases, Washington, DC
| | - Derrick D. Matthews
- University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, Pittsburgh, PA
| | - Mary E. Hawk
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - James E. Egan
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Linda A. Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Steven J. Shoptaw
- University of California – Los Angeles, Department of Family Medicine and Psychiatry and Biobehavioral Sciences, Los Angeles, CA
| | - Pamela J. Surkan
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | - Ron D. Stall
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
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45
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Clark V, Kim SJ. Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review. J Med Internet Res 2021; 23:e27751. [PMID: 34342585 PMCID: PMC8371491 DOI: 10.2196/27751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is a research design that allows for the measurement of nearly instantaneous experiences within the participant's natural environment. Using EMA can help improve recall bias, ecological validity, and patient engagement while enhancing personalization and the ubiquity of interventions. People that can benefit from the use of EMA are men who have sex with men (MSM). Previous EMA studies have been successful in capturing patterns of depression, anxiety, substance use, and risky sexual behavior. These findings are directly relevant to MSM, who have high rates of each of these psychological and behavioral outcomes. Although there is a driving force behind the growing literature surrounding EMAs among MSM, no synthesizing reviews yet exist. OBJECTIVE The aims of this study were to (1) synthesize the literature across fields on how EMA methods have been used among MSM, (2) better understand the feasibility and acceptability of EMA interventions among MSM, and (3) inform designs for future research studies on best evidence-based practices for EMA interventions. METHODS Based on 4 library databases, we conducted a scoping review of EMAs used within interventions among MSM. The eligibility criteria included peer-reviewed studies conducted in the United States and the use of EMA methodology in an intervention for MSM. Modeling after the Centers for Disease Control and Prevention's Compendium of Evidence-Based Interventions as the framework, we applied a typology that used 8 distinct review criteria, for example, sample size, design of the intervention, random assignment, design of the follow-up investigation, rate of retention, and rate of engagement. RESULTS Our results (k=15, N=952) indicated a range of sample sizes; the smallest sample size was 12, while the largest sample size was 120. Of the 15 studies, 7 (47%) focused on outcomes related to substance use or outcomes related to psychological experiences. Of the 15 studies, 5 (33%) implemented an EMA intervention across 30 days. Of the 15 studies, 2 studies (13%) used random assignment, and 2 studies (13%) had quasi-experimental designs. Of the 15 studies, 10 studies (67%) reported acceptable retention rates greater than 70%. The outcomes that had event-contingent prompts (ie, prompts after engaging in substance use) were not as effective in engaging participants, with overall engagement rates as low as 37%. CONCLUSIONS Our systematic scoping review indicates strong evidence that the EMA methodology is both feasible and acceptable at high rates among MSM, especially, when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior, or substance use. Further research on optimal designs of EMA interventions for MSM is warranted.
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Affiliation(s)
- Viktor Clark
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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46
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Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158031. [PMID: 34360326 PMCID: PMC8345572 DOI: 10.3390/ijerph18158031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.
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47
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Clark K, Pachankis J, Khoshnood K, Bränström R, Seal D, Khoury D, Fouad FM, Barbour R, Heimer R. Stigma, displacement stressors and psychiatric morbidity among displaced Syrian men who have sex with men (MSM) and transgender women: a cross-sectional study in Lebanon. BMJ Open 2021; 11:e046996. [PMID: 33986065 PMCID: PMC8126317 DOI: 10.1136/bmjopen-2020-046996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Displaced Syrians face psychiatric morbidity often resulting from displacement-related stressors (eg, resource scarcity). Both men who have sex with men (MSM) and transgender women among the displaced Syrians are particularly vulnerable to mental health challenges given that they also often face stigma-related stressors (eg, discrimination). METHODS Between January and December 2019 in greater Beirut, 258 Lebanese-born MSM and transgender women and 230 displaced Syrian MSM and transgender women were recruited via respondent-driven sampling to complete an in-person survey assessing displacement-related stressors, stigma-related stressors, depression, anxiety and post-traumatic stress disorder. In the total sample, we first documented the prevalence of psychiatric morbidity among the displaced Syrians; we then assessed associations among displacement-related and stigma-related stressors and each psychiatric outcome. RESULTS Sixty-three per cent of Syrian participants met criteria for depression compared with 43.8% of Lebanese participants (p<0.001); 21.3% of Syrians met criteria for severe anxiety compared with 13.1% of Lebanese participants (p<0.05) and 33.0% of Syrians met criteria for post-traumatic stress disorder compared with 18.4% of Lebanese participants (p<0.001). Among Syrian MSM and transgender women, sociodemographic characteristics, displacement-related stressors and stigma-related stressors were uniquely associated with psychiatric morbidity. CONCLUSION Displaced Syrian MSM and transgender women experience higher levels of psychiatric comorbidities than Lebanese MSM and transgender women in part due to compounding exposure to displacement-related stressors and stigma-related stressors. Informed by tenets of minority stress theory and intersectionality theory, we discuss mental health intervention implications and future directions.
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Affiliation(s)
- Kirsty Clark
- Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - John Pachankis
- Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Kaveh Khoshnood
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | | | - David Seal
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Russell Barbour
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Robert Heimer
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
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48
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Liu J, Deng R, Lin B, Pan H, Gao Y, Dai J, Liang H, Huang A, Zhong X. Risk Management on Pre-Exposure Prophylaxis Adherence of Men Who Have Sex with Multiple Men: A Multicenter Prospective Cohort Study. Risk Manag Healthc Policy 2021; 14:1749-1761. [PMID: 33953624 PMCID: PMC8092636 DOI: 10.2147/rmhp.s295114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Men who have sex with multiple men (MSMM) belong to a high-risk group for HIV infection, and pre-exposure prophylaxis (PrEP) is an effective measure to prevent the infection. However, few studies on PrEP adherence by MSMM in China exist. We aimed to explore the protective motivation-related factors for PrEP adherence in an HIV-negative MSMM population in Western China and to provide a reference for future risk management and effective prevention strategies. Methods Data were collected from a 2-year follow-up cohort study of PrEP in MSM in China. Rogers’ protective motivation theory (PMT) was used to study the PrEP adherence of MSMM, and logistic regression was performed to analyze the influencing factors of PrEP adherence. Results A total of 496 MSMM were included in the study: 299 (60.28%) of them in the good adherence group and 197 (39.72%) in the poor adherence group. The threat assessment scores of the good and poor adherence groups were 2.15 ± 0.59 and 2.06 ± 0.47, respectively, and the response assessment scores were 2.81 ± 0.62 and 2.74 ±0.62, respectively. Poor PrEP adherence was associated with on-demand PrEP medication (OR=0.670), students at school (OR=1.837), occasional condom use (OR=1.621), and good HIV knowledge (OR= 0.659). The higher the threat assessment score, the higher the susceptibility; and the lower the response cost, the stronger the protection motivation and the less likely MSMM were to have poor adherence. Conclusion On-demand PrEP medication is more conducive to adherence. Preventive management should focus on MSMMs who are students at school, those who occasionally use condoms, and those with poor HIV knowledge. Improving threat perception and susceptibility, and controlling and reducing the response cost can effectively improve PrEP adherence, and the subsequent application of PMT during intervention research can provide a reference for HIV prevention in MSMM.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China.,School of Medical Information, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ruibin Deng
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Hong Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yuwen Gao
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, People's Republic of China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning, People's Republic of China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
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49
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Lund EM, Burgess CM. Sexual and Gender Minority Health Care Disparities: Barriers to Care and Strategies to Bridge the Gap. Prim Care 2021; 48:179-189. [PMID: 33985698 DOI: 10.1016/j.pop.2021.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gender and sexual minority individuals face considerable physical and mental health disparities, health risk factors, and barriers to care. These disparities are rooted in systemic and interpersonal prejudice, discrimination, and violence toward lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) individuals and communities that place LGBTQ+ individuals at increased risk for negative social determinants of health. While also advocating for systemic change, individual providers and clinics have an ethical duty to promote an openly affirming, culturally competent health care environment that can help to address these disparities on an individual patient level.
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Affiliation(s)
- Emily M Lund
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, PO Box 870231, Tuscaloosa, AL 35487, USA.
| | - Claire M Burgess
- VA Boston Healthcare System, Harvard Medical School, 940 Belmont Street, Brockton, MA 02310, USA
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50
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Davis DA, Angeles G, McNaughton-Reyes L, Matthews DD, Muessig KE, Northbrook S, Barrington C. Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala. AIDS Patient Care STDS 2021; 35:126-133. [PMID: 33835850 DOI: 10.1089/apc.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps.
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Affiliation(s)
- Dirk A. Davis
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Derrick D. Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sanny Northbrook
- United States Center for Disease Control and Prevention Central America Region, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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