1
|
Mo PKH, Xin M, Wang Z, Lau JTF, Ye X, Hui KH, Yu FY, Lee HH. Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study. PLoS One 2024; 19:e0300988. [PMID: 38573984 PMCID: PMC10994335 DOI: 10.1371/journal.pone.0300988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless anal intercourse during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong. METHODS A cross-sectional study was conducted among MSM in Hong Kong. A total of 463 MSM completed a cross-sectional telephone survey between March 2021 and January 2022. RESULTS Among all participants, the mean number of regular sex partners, non-regular sex partners, and casual sex partners during the COVID-19 period were 1.24, 2.09, and 0.08 respectively. Among those who had sex with regular, non-regular, and casual sex partner during the COVID-19 period, respectively 52.4%, 31.8% and 46.7% reported condomless anal intercourse. Compared to the pre-COVID-19 period, participants reported significantly fewer number of regular and non-regular sex partners during the COVID-19 period. However, a higher level of condomless anal intercourse with all types of sex partners during the COVID-19 period was also observed. Adjusted for significant socio-demographic variables, results from logistic regression analyses revealed that perceived severity of COVID-19 (aOR = 0.72, 95% CI = 0.58, 0.88), COVID-19 risk reduction behaviors in general (aOR = 0.68, 95% CI = 0.48, 0.96), COVID-19 risk reduction behaviors during sex encounters (aOR = 0.45, 95% CI = 0.30, 0.66), condom negotiation (aOR = 0.61, 95% CI = 0.44, 0.86), and collective efficacy (aOR = 0.79, 95% CI = 0.64, 0.98) were protective factors of condomless anal intercourse with any type of sex partners during the COVID-19 period. CONCLUSION The COVID-19 control measures have caused a dramatic impact on the sexual behavior of MSM in Hong Kong. Interventions that promote condom use during the COVID-19 pandemic are still needed and such interventions could emphasize prevention of both COVID-19 and HIV.
Collapse
Affiliation(s)
- Phoenix K. H. Mo
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zixin Wang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joseph T. F. Lau
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Xinchen Ye
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kam Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fuk Yuen Yu
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Hin Lee
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Lauckner C, Lambert D, Truszczynski N, Jann JT, Hansen N. A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south. AIDS Care 2023; 35:1563-1569. [PMID: 35914115 DOI: 10.1080/09540121.2022.2105798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.
Collapse
Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Danielle Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA
| |
Collapse
|
3
|
Huyst V, Dewinter J, Noens I, Platteau T, Tsoumanis A. Measuring the prevalence of autistic traits in a cohort of adults living with HIV or taking HIV pre-exposure prophylaxis and mapping safer-sex barriers and facilitators: a study protocol. BMJ Open 2023; 13:e075667. [PMID: 37775292 PMCID: PMC10546106 DOI: 10.1136/bmjopen-2023-075667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Autistic individuals identify with a wider range of sexual orientations than non-autistic individuals, including higher rates of bisexual orientation in autistic men. Gay, bisexual and other men who have sex with men are at greater risk for HIV. Prevalence data of autistic traits in people living with HIV or using Pre-Exposure Prophylaxis (PrEP) for HIV are lacking so far. Such data, combined with insights in barriers and facilitators for safer sex in autistic people living with HIV or using PrEP, are a first step to improve health support for autistic people in HIV clinics. This support is crucial since autistic individuals have worse physical and mental health outcomes. The objective of this research is to determine the prevalence of autistic traits within the group of people living with HIV or using PrEP in Belgium and to describe specific facilitators and barriers for sexual safer behaviour in people living with HIV and PrEP users with autistic traits. METHODS AND ANALYSIS The research is a cross-sectional, observational and multicentre study with recruitment of individual participants. The research consists of two phases. In phase 1, adults coming for HIV/AIDS care or HIV PrEP in participating Belgian HIV Reference Centres will be invited to fill in the validated Autism Spectrum Quotient questionnaire. In phase 2, participants with a score above the predefined cut-off for autistic traits (>26), who agreed to be informed about this score, will be invited to complete an additional survey, inquiring facilitators and barriers for sexual safer behaviour. ETHICS AND DISSEMINATION OF RESULTS Institutional Review Board Institute of Tropical Medicine Antwerp, 25 July 2022, REF 1601/22 and University Hospital of Antwerp, 12 September 2022, Project ID 3679: BUN B3002022000111. Study results will be published in peer-reviewed journals and presented to Belgian HIV Reference Centres and at conferences.
Collapse
Affiliation(s)
- Veerle Huyst
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jeroen Dewinter
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ilse Noens
- Parenting and Special Education Research Unit, University of Leuven, Leuven, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
4
|
Malaeb D, Hallit S, Obeid S. Pornography Use among Lebanese Adults: Association with Loneliness and Fear of Commitment. Healthcare (Basel) 2023; 11:healthcare11060795. [PMID: 36981451 PMCID: PMC10048288 DOI: 10.3390/healthcare11060795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 03/10/2023] Open
Abstract
(1) Background: Sexuality is a prohibited topic about which knowledge is highly lacking among Arabs compared to Westerners, due to religious restrictions. A majority of people believes that any use of pornography is a toxic conduct that will have negative repercussions; these beliefs only shame those who engage in this behavior. Consumption of pornography can be attributed to self-reported reasons such as loneliness and fear of commitment. To date, there has been a dearth of research in Lebanon concerning pornography use. Hence, this study aims to assess the correlation between loneliness, fear of commitment, and internet pornography use among Lebanese adults. (2) Methods: This cross-sectional study conducted between October and November 2020 assessed pornography use through the Cyber-Pornography Use Inventory, Jong Gierveld Loneliness Scale, and Fear of commitment scale. It enrolled 653 adults from all Lebanese geographic areas. (3) Results: Women compared to men and Muslims compared to Christians were significantly associated with lower pornography addictive patterns scores, whereas more fear of commitment was significantly associated with higher pornography addictive patterns scores. More fear of commitment and more loneliness were significantly associated with higher having guilt regarding online porn use scores. Muslims compared to Christians had significantly lower online sexual behaviors scores. (4) Conclusions: Further research is recommended to properly assess internet pornography use and develop appropriate treatment options.
Collapse
Affiliation(s)
- Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- Correspondence: (D.M.); (S.H.)
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib P.O. Box 60096, Lebanon
- Correspondence: (D.M.); (S.H.)
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Byblos 4504, Lebanon
| |
Collapse
|
5
|
Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
Collapse
Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
6
|
Xia D, Chen Y, Chang R, Xu C, Yu X, Liu Y, Chen H, Wang R, Liu S, Ge X, Wang Y, Liang A, Hu F, Cai Y, Wang Y. Psychosocial Problems and Condomless Anal Sex among Transgender Women in Two Cities of China: Study Based on the Syndemic Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16161. [PMID: 36498232 PMCID: PMC9737078 DOI: 10.3390/ijerph192316161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Studies examining the association between psychosocial problems and condomless anal sex (CAS) among transgender women (TGW) are rare. In this study, close attention was paid to the effect of co-occurring psychosocial problems on sexual risk behaviors. A cross-sectional study, including 247 TGW, was conducted in Kunming and Shenyang, China. The prevalence of condomless anal sex among TGW in the previous 6 months was 30.8%. Most of the psychosocial factors were associated with one another in bivariate logistic regression models. Low self-esteem (ORm = 2.99, 95% CI = 1.25-7.18), sexual compulsivity (ORm = 2.13, 95% CI = 1.13-4.00), and intimate partner violence (ORm = 2.21, 95% CI = 1.19-4.11) were discovered to be related to condomless anal sex in the multivariate regression model. No significant interactive effects of the syndemic factors on condomless anal sex were detected. More programmatic and effective HIV prevention interventions targeting psychosocial problems are required to reduce HIV infection within the population.
Collapse
Affiliation(s)
- Danni Xia
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Yingjie Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Ruijie Chang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Chen Xu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Xiaoyue Yu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Yujie Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Hui Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Rongxi Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Shangbin Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Xin Ge
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Yuxuan Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Ajuan Liang
- Reproductive Medical Center, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Fan Hu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Yong Cai
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No. 227, South Chongqing Road, Shanghai 200025, China
| |
Collapse
|
7
|
Sarno EL, Swann G, Xavier Hall CD, Newcomb ME, Mustanski B. Minority Stress, Identity Conflict, and HIV-Related Outcomes Among Men Who Have Sex with Men, Transgender Women, and Gender Nonbinary People of Color. LGBT Health 2022; 9:411-417. [PMID: 35594255 PMCID: PMC9499444 DOI: 10.1089/lgbt.2021.0401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study investigated conflict between sexual orientation and racial/ethnic identities as a mechanism linking minority stress to HIV-related outcomes among men who have sex with men (MSM), transgender women and gender nonbinary (TGN) people of color (POC). Methods: We tested longitudinal mediation models with sexual orientation microaggressions, internalized heterosexism (IH), and sexual orientation concealment at Time 1, and pre-exposure prophylaxis (PrEP) use and number of condomless anal sex (CAS) partners at Time 3, mediated by identity conflict at Time 2. Participants were 337 MSM and TGN POC. Data were collected in Chicago, Illinois, from September 2018 to February 2021. Results: Indirect associations of IH and sexual orientation concealment, respectively, at Time 1 with CAS partners at Time 3 through identity conflict at Time 2 were significant. Mediation models with sexual orientation microaggressions as the predictor and PrEP use as the outcome were not significant. Conclusion: Minority stress may contribute to identity conflict and increase CAS by isolating MSM and TGN POC from sexual and gender minority communities, thus restricting access to safer sex resources, and by increasing psychological distress and decreasing self-care (e.g., condom use).
Collapse
Affiliation(s)
- Elissa L. Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
8
|
Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
Collapse
Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
| |
Collapse
|
9
|
Hussain MA, Sun-Suslow N, Montoya JL, Iudicello JE, Heaton RK, Grant I, Morgan EE. Loneliness, Risky Beliefs and Intentions about Practicing Safer Sex among Methamphetamine Dependent Individuals. Subst Use Misuse 2021; 57:295-307. [PMID: 34889707 PMCID: PMC8922988 DOI: 10.1080/10826084.2021.2003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Methamphetamine use is a known predictor of riskier sexual behaviors, which can have important public health implications (e.g., HIV-transmission risk). Loneliness also is associated with riskier sexual behaviors, though the relationship between loneliness and beliefs and/or intentions to practice safer sex has not been examined among people dependent on methamphetamine. MATERIALS AND METHODS Individuals who met DSM-IV criteria for lifetime methamphetamine dependence and current (≤ 18-months) methamphetamine abuse or dependence (METH+ n = 56) were compared to those without severity and recency of methamphetamine use (METH- n = 59). These groups did not differ on social network size or proportion of people with HIV (∼58% HIV+). Participants completed the NIH Toolbox Loneliness Scale and the Sexual Risks Scale's "Norms" and "Intentions" subscales. RESULTS METH+ individuals were significantly lonelier than METH- controls (t(113) = 2.45, p = .02). Methamphetamine dependence remained significantly associated with greater loneliness, after controlling for HIV status and other relevant covariates (e.g., neurocognitive impairment, history of mood disorder, social network size; F = 3.70, Adjusted R2 = 0.18, p = .0009). Loneliness, above and beyond the aforementioned covariates, was significantly associated with riskier beliefs and intentions to practice safer sex among METH+, but not METH-, individuals (β = 2.92, p = .02). CONCLUSIONS Loneliness is prevalent among individuals dependent on methamphetamine, and is uniquely associated with riskier beliefs and intentions regarding practicing safer sex. Findings may aid in identifying individuals at-risk of engaging in riskier sexual behaviors and guide risk prevention strategies.
Collapse
Affiliation(s)
- Mariam A. Hussain
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Jessica L. Montoya
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Jennifer E. Iudicello
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Robert K. Heaton
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Igor Grant
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Erin E. Morgan
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - TMARC Group
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| |
Collapse
|
10
|
Hubach RD, O'Neil A, Stowe M, Giano Z, Curtis B, Fisher CB. Perceived Confidentiality Risks of Mobile Technology-Based Ecologic Momentary Assessment to Assess High-Risk Behaviors Among Rural Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1641-1650. [PMID: 32078710 PMCID: PMC7438245 DOI: 10.1007/s10508-019-01612-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection.
Collapse
Affiliation(s)
- Randolph D Hubach
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA.
| | - Andrew O'Neil
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Mollie Stowe
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Zachary Giano
- Sexual Health Research Lab, Center for Rural Health, Oklahoma State University-Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Brenda Curtis
- National Institute on Drug Abuse, Baltimore, MD, USA
| | - Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Bronx, NY, USA
| |
Collapse
|
11
|
Sarno EL, Bettin E, Jozsa K, Newcomb ME. Sexual Health of Rural and Urban Young Male Couples in the United States: Differences in HIV Testing, Pre-exposure Prophylaxis Use, and Condom Use. AIDS Behav 2021; 25:191-202. [PMID: 32607917 DOI: 10.1007/s10461-020-02961-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Young men who have sex with men (YMSM) are disproportionally affected by HIV, and main partnerships account for a large proportion of new HIV infections. HIV prevention is largely focused on urban YMSM, and less is known about sexual health of rural male couples. The present study used data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV/STI testing, PrEP use, number of sexual partners, and condomless anal sex (CAS) acts. Participants were 430 YMSM in relationships. Rural YMSM were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Although higher rurality was associated with fewer CAS acts, CAS was not infrequent among rural YMSM, highlighting the need for increased HIV prevention geared toward young male couples living in rural, less resourced areas.
Collapse
Affiliation(s)
- Elissa L Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Emily Bettin
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kyle Jozsa
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
12
|
Glon B, Giano Z, Hubach R, Hammer T. Rurality, gay-related rejection sensitivity, and mental health outcomes for gay and bisexual men. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1850595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Brendon Glon
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Zachary Giano
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Randolph Hubach
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Tonya Hammer
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| |
Collapse
|
13
|
Giano Z, Kavanaugh KE, Durham AR, Currin JM, Wheeler DL, Croff JM, Hubach RD. Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma. JOURNAL OF HOMOSEXUALITY 2020; 67:1881-1901. [PMID: 31125299 DOI: 10.1080/00918369.2019.1616430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.
Collapse
Affiliation(s)
- Zachary Giano
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Katherine E Kavanaugh
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - André R Durham
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Joseph M Currin
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Julie M Croff
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Randolph D Hubach
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| |
Collapse
|
14
|
Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [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: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
Collapse
Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
| |
Collapse
|
15
|
Owens C, Hubach RD, Williams D, Voorheis E, Lester J, Reece M, Dodge B. Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2179-2191. [PMID: 32219687 DOI: 10.1007/s10508-020-01654-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 05/24/2023]
Abstract
Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective.
Collapse
Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Room 116, 1025 E 7th St., Bloomington, IN, 47403, USA.
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| |
Collapse
|
16
|
Quinn KG, Murphy MK, Nigogosyan Z, Petroll AE. Stigma, isolation, and depression among older adults living with HIV in rural areas. AGEING & SOCIETY 2020; 40:1352-1370. [PMID: 38764491 PMCID: PMC11101162 DOI: 10.1017/s0144686x18001782] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is a growing population of ageing individuals living with acquired immunodeficiency syndrome (HIV). Older adults living with HIV often contend with intersecting stigmas including HIV stigma, ageism, and for some, homonegativity and/or racism. Although the HIV stigma literature is quite robust, research on the relationship between HIV stigma, social support, and mental well-being among older adults living with HIV is limited. This study begins to address this gap by examining how intersectional stigma affects social support and mental wellbeing among rural-dwelling older adults living with HIV. Qualitative interviews were conducted by phone with 29 older adults living with HIV, over the age of 50, living in rural areas of the United States. Interviews were transcribed verbatim and analyzed using thematic content analysis in MAXQDA qualitative analysis software. Analysis revealed three primary themes. The first had to do with gossip and non-disclosure of HIV status, which intersected with ageism and homonegativity to exacerbate experiences that fell within the remaining themes of experiences of physical and psychological isolation and loneliness, and shame and silence surrounding depression. The prevalence of social isolation and the effects of limited social support among older adults living with HIV are prominent and indicate a need for tailored interventions within the HIV care continuum for older adults living with HIV.
Collapse
Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, WI
| | - Molly K Murphy
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, WI
| | - Zack Nigogosyan
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, WI
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
17
|
Giano Z, Currin JM, Wheeler DL, Hubach RD. Outness amplifies the negative effect of gay related rejection in rural, but not urban sexual minority men. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1765411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
18
|
Stroumpouki T, Perrett S, Kasdovasilis P, Papatheodorou P, Paparizos V, Stavropoulou A. "A journey towards acceptance": The process of adapting to life with HIV in Greece. A Qualitative study. Appl Nurs Res 2020; 53:151249. [PMID: 32451004 DOI: 10.1016/j.apnr.2020.151249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Aim To identify the experiences related to adaptation for people living with HIV in Greece and to explore different adaptation stages as well as their individual reactions. BACKGROUND Receiving an HIV positive diagnosis leads to major changes in an individual's life and it can trigger an array of emotions including fear, despair and loss of control. As the profile of the disease has changed due to its transition into a chronic disease and extended life expectancy, adaptation to life and coping with uncertain events is of paramount importance. METHOD Interpretative phenomenological research design was used to guide data collection and analysis. A purposive sampling technique was used. Ethical procedures were taken into account and nine individuals who were diagnosed with HIV took part in the study using semi-structured interviews. RESULTS Data analysis revealed the different stages of adaptation that the participants experienced after an HIV positive diagnosis. A superordinate theme identified as 'a journey towards acceptance' while five subthemes were formed, namely, 'Communicating the bad news, Conscious loneliness, Getting information, Receiving Support, and Moving on with hope'. CONCLUSION An HIV positive diagnosis can affect the very core of the individual as the essence of -self- is targeted and in need of reform. Education, empathy, family and social support can help the individual make small steps towards a greater journey, that of acceptance.
Collapse
Affiliation(s)
- Theodora Stroumpouki
- Acute Adult Nursing, Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, Kingston Hill Campus, Kingston upon Thames KT2 7LB, United Kingdom.
| | - Stephanie Perrett
- Health and Justice, Health Protection Team, Public Health Wales, 4th Floor, Number 2 Capital Quarter, Tyndall Way, Cardiff CF10 4BZ, United Kingdom.
| | - Pavlos Kasdovasilis
- Health Psychology, Business Improvement and Research Manager, Rehability UK, 25 Hatton Place, 118 Midland Rd, Luton, LU2 0FB, United Kingdom
| | | | - Vasilios Paparizos
- HIV/AIDS Unit, 'A. Syggros' Hospital, 5 I. Dragoumi Str., Kessariani 161 21, Athens, Greece
| | - Areti Stavropoulou
- Department of Nursing, University of West Attica, Ag. Spiridonos 28, 12243 Aegaleo, Greece.
| |
Collapse
|
19
|
Currin JM, Giano Z, Hubach RD. Interface of Internalized Homophobia and Community Connectedness on Frequency of Doctor's Visits for Rural and Urban MSM in Oklahoma. J Rural Health 2020; 36:416-422. [PMID: 32057137 DOI: 10.1111/jrh.12416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Men who have sex with men (MSM) face persistent risk of stigma, with past studies showing unequal treatments of MSM in health care settings. Contextual factors, such as internalized homophobia and connectedness to one's community, have shown to serve as a barrier or facilitator (respectively) with regard to MSM's decisions to seek preventative treatment. These studies, however, predominately feature urban populations, with less consideration given to rural MSM. The current study comparatively investigates these contextual factors between rural and urban MSM to detect differences in the frequency of doctor's visits. METHODS A 2-by-2 (rural/urban × doctor visit yes/no) multivariate analysis of variance (MANOVA) was conducted to investigate if significant differences and/or interactions existed for internalized homophobia and community connectedness. FINDINGS Results show a significant interaction between rurality and doctor's visits in our sample of predominantly white, self-identified gay men. Higher levels of internalized homophobia and lower levels of community connectedness were seen in rural individuals who had visited a doctor in the past 12 months and in urban individuals who had not seen a doctor in the past 12 months. CONCLUSIONS Study findings have implications for future public health research and for health promotion interventions, practices, and policies for MSM in rural areas. Social exclusion reinforces the invisibility of lesbian, gay, bisexual, and transgender (LGBT) populations, particularly in rural areas. Stigma and marginalization of MSM promote structural barriers inhibiting care. Our results give evidentiary support for programs which inform the work of clinicians on mechanisms to create LGBT-inclusive practice settings.
Collapse
Affiliation(s)
- Joseph M Currin
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Zachary Giano
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Randolph D Hubach
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| |
Collapse
|
20
|
Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:51-66. [PMID: 32073310 DOI: 10.1521/aeap.2020.32.1.51] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non-primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
Collapse
Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio State University, Athens, Ohio
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| |
Collapse
|
21
|
Willingness of MSM Living with HIV to Take Part in Video-Groups: Application of the Technology Readiness and Acceptance Model. AIDS Behav 2019; 23:3165-3174. [PMID: 31123856 DOI: 10.1007/s10461-019-02534-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Group-based programs are important for the psychosocial care of people living with HIV; however, programs are often limited by geography and availability. Video-groups, conducted via group-based video-conferencing on video-phones or computer, offer the benefits of group-based programs while overcoming barriers to attendance. This study sought to explore if, and how, the Technology Readiness and Acceptance Model (TRAM) could be used to explain the willingness of men to take part in video-groups. The TRAM was used as the guiding framework for thematic qualitative analysis. Among 106 participants, there was a general willingness to participate in video-groups. TRAM constructs were present in the data-with perceived usefulness (extent that participating in a technology-based program would facilitate group intervention behaviors) and insecurity (distrust/skepticism of technology) emerging as the most salient themes. The TRAM alone did not account for concerns related to group settings or the level of privacy needed when talking about HIV.
Collapse
|
22
|
Frieson Bonaparte KS, Graves CC, Farber EW, Gillespie SE, Hussen SA, Thomas-Seaton L, Chakraborty R, Camacho-Gonzalez AF. Metropolitan Atlanta Community Adolescent Rapid Testing Initiative: The impact of motivational interviewing and intensive case management on the psychosocial and clinical care outcomes of adolescents and young adults with HIV. ACTA ACUST UNITED AC 2019; 57:97-106. [PMID: 31647261 DOI: 10.1037/pst0000256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Early diagnosis and treatment are critical to preventing HIV-related complications and transmission for adolescents and young adults with HIV. The Metropolitan Atlanta Community Adolescent Rapid Testing Initiative (MACARTI) was a single-center, prospective, nonrandomized, interventional control group study incorporating motivational interviewing psychotherapy strategies with community outreach, HIV testing, and intensive case management. This substudy of MACARTI examined how the motivational interviewing and case management components influenced psychological distress, proactive coping, HIV/AIDS stress, and HIV stigma in association with HIV disease markers (HIV viral load and CD4+ T-cell counts). Ninety-eight adolescents and young adults with HIV (Mage = 21.5 ± 1.8, range 18-24) were allocated to either the standard of care (n = 49) or MACARTI (n = 49) arms, and results were compared between these two groups. Baseline and follow-up surveys measured psychological distress, proactive coping, HIV/AIDS stress, and HIV stigma. MACARTI arm assignment was associated with statistically significant reductions in psychological distress (p = .016), HIV/AIDS stress (p = .023), and the use of more reflective coping (p = .016) and strategic planning strategies (p = .001) during the first 6 months. These results did not remain significant at 1-year follow-up but may still provide support for the integration of psychotherapy strategies into HIV identification, linkage, and retention efforts in the future. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
|
23
|
Currin JM, Hubach RD, Meyers HJ, DeBoy K, Giano Z, Wheeler DL. Navigating disclosure of sexual minority identity for men in socio-politically conservative areas. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1655511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, Texas, USA
| | - Randolph D. Hubach
- Center for Rural Health, Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Hunter J. Meyers
- Center for Rural Health, Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Kyle DeBoy
- Center for Rural Health, Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Zachary Giano
- Center for Rural Health, Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Denna L. Wheeler
- Center for Rural Health, Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
24
|
Hubach RD, Currin JM, Giano Z, Meyers HJ, DeBoy KR, Wheeler DL, Croff JM. Experiences of Stigma by Gay and Bisexual Men in Rural Oklahoma. Health Equity 2019; 3:231-237. [PMID: 31289783 PMCID: PMC6608693 DOI: 10.1089/heq.2018.0095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: The unique experiences of men who have sex with men (MSM) residing in culturally conservative rural areas are not well represented in the scientific literature. The human immunodeficiency virus (HIV) epidemic in the United States has shifted toward rural areas where populations are dispersed and health care resources are limited. Methods: We recruited 40 sexual minority men, ages 22-66, residing in rural Oklahoma for in-depth, qualitative sexual health interviews that sought to understand how cultural and social environments impacted health behaviors. Findings: Participants described a stigmatizing social environment and less access to quality, sexual minority medical care within rural communities and perceived these as substantial barriers to enhancing health. Structural issues, including lack of sexual minority-affirming policies, institutional practices, and hostile cultural norms, were noted. Conclusions: Results indicate the need to develop greater awareness of stigma as an etiologic factor that contributes to the health of rural sexual minority populations, specifically when it relates to provision of culturally appropriate care.
Collapse
Affiliation(s)
- Randolph D. Hubach
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | | | - Zachary Giano
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Hunter J. Meyers
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Kyle R. DeBoy
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| | - Julie M. Croff
- Center for Wellness and Recovery, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma
| |
Collapse
|
25
|
Giano Z, Hubach RD, Deboy K, Meyers H, Currin JM, Wheeler DL. A comparative analysis of rural and urban MSM depressive symptomology: the mediating effects of loneliness. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2019.1593885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zachary Giano
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Randolph D. Hubach
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Kyle Deboy
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Hunter Meyers
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| | - Joseph M. Currin
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Denna L. Wheeler
- Center for Rural Health, Oklahoma State University–Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
26
|
Shen Q, Wang Y, Wang Z, Wang Y, Luo M, Wang S, Jiang X, Yang Y, Cai Y, Shang M. Understanding condom use among unmarried female migrants: a psychological and personality factors modified information-motivation-behavioral skills model. BMC Public Health 2019; 19:223. [PMID: 30791897 PMCID: PMC6385431 DOI: 10.1186/s12889-019-6541-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 02/13/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In China, unmarried female migrants are vulnerable to sexual and reproductive health risks. One effective protection strategy is promoting consistent condom use (CCU). METHODS We conducted a cross-sectional study to apply the information-motivation-behavioral skills (IMB) model and modified it by addition of psychological and personal factors to examine the related factors of CCU and provide suggestions for intervention among unmarried female migrants. RESULTS Of all 903 eligible participants, only 13.8% of participants reported CCU in the past six months. Both the IMB model and the modified IMB model provided acceptable fit to the data. In both models, information had no direct or indirect influence on CCU (p > 0.05). However, behavioral skills had a positive effect on CCU (β = 0.344, p < 0.001 and β = 0.330, p < 0.001). Moreover, motivation contributed to CCU indirectly by affecting behavioral skills (β = 0.800, p < 0.001) and had no direct influence (p > 0.05). In the modified model, psychological and personality factors influenced CCU directly (β = - 0.100, p = 0.005). CONCLUSIONS Our results highlight the importance of conducting CCU promotion among unmarried female migrants. Future intervention strategies should focus on both the traditional IMB model constructs and the added psychological and personality factors.
Collapse
Affiliation(s)
- Qiuming Shen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Yichen Wang
- Department of Hospital Infection Control, Ruijin Hospital, affiliated with the School of Medicine Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Zezhou Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Mengyun Luo
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Suping Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Xueqin Jiang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Yinghua Yang
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, 200336, People's Republic of China
| | - Yong Cai
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.
| | - Meili Shang
- Sanlin Community Health Service Center, No.375, Sanlin Road, Shanghai, 200126, People's Republic of China.
| |
Collapse
|
27
|
Social Support, Loneliness, Depressive Symptoms, and High-Risk Sexual Behaviors of Middle-Aged Hispanic Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2019; 30:98-110. [DOI: 10.1097/jnc.0000000000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Su X, Zhou AN, Li J, Shi LE, Huan X, Yan H, Wei C. Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1959-1968. [PMID: 29147806 PMCID: PMC5955768 DOI: 10.1007/s10508-017-1061-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/20/2017] [Accepted: 08/11/2017] [Indexed: 05/09/2023]
Abstract
Research conducted among men who have sex with men (MSM) in high-income countries has demonstrated that negative mental health is one of the significant drivers of HIV infection, and few studies have examined the status of mental health among MSM in China. We sought to describe depression and loneliness and identify their correlates among Chinese MSM. A cross-sectional study was conducted among HIV-negative or unknown status MSM in 2014. Time-location sampling and online convenience sampling methods were employed. Depression was measured via a short version of CES-D (CES-D 10). Loneliness was measured from a single item in CES-D 10. Multivariable logistic regressions were conducted to identify independent correlates of depression and loneliness. A total of 507 individuals participated in the study. Of them, 26.8 and 35.5% reported moderate-to-severe symptoms of depression and feeling lonely, respectively. Depressed participants were more likely to have a sense of hopelessness for the future (AOR 3.20, 95% CI 1.90, 5.20) and report higher levels of internalized homophobia (AOR 2.32, 95% CI 1.47, 3.67). Participants who reported feeling lonely were more likely to have had condomless receptive anal intercourse in the past 6 months (AOR 1.67, 95% CI 1.08, 2.58) and feel hopeless for the future (AOR 2.40, 95% CI 1.60, 3.70). MSM in China have significant rates of depression and loneliness. HIV prevention efforts should address the mental health needs of Chinese MSM such as providing safe environments for social support and role models.
Collapse
Affiliation(s)
- Xiaoyou Su
- School of Public Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - A Ning Zhou
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jianjun Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ling-En Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hongjing Yan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, 50 Beale St., Suite 1300, San Francisco, CA, 94105, USA.
| |
Collapse
|
29
|
Wang Z, Zhao X, Zhang Z, Luo M, Shen Q, Dong Y, Wang Y, Cai Y. Co-Occurring Psychosocial Problems and Multiple Sexual Partners among Men Who Have Sex with Men in Shanghai, China: A Syndemic Approach. JOURNAL OF SEX RESEARCH 2018; 55:892-901. [PMID: 29220586 DOI: 10.1080/00224499.2017.1399333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We aimed to apply syndemic theory to verify the association and reinforcing effects between psychosocial problems and multiple sexual partners (MSP) of men who have sex with men (MSM) in Shanghai, China. A cross-sectional study was conducted among 547 MSM in Shanghai, China using a face-to-face survey. Sociodemographic and psychosocial data were collected, as well as information on MSP and condomless anal sex. In the 6 months prior to the survey, 54.3% of the MSM sample had had MSP. Univariate analysis showed that self-esteem, depression, loneliness, sexual compulsivity, and involuntary subordination (IS) were associated with MSP. Sexual compulsivity (multivariate odds ratio [ORm] = 2.94, 95% CI = 1.76-4.91) and IS (ORm = 1.79, 95% CI = 1.14-2.81) remained significant in multivariate analysis. MSM with five or more psychosocial problems had greater odds of (adjusted odds ratios = 3.06, 95% CI = 1.49-6.25) having MSP in the previous 6 months than the non-syndemic group. Our findings provide preliminary confirmation of the additive relationship of syndemic psychosocial health conditions and MSP among MSM in Shanghai, China. An integrated intervention with special focus on sexual compulsivity and IS is needed.
Collapse
Affiliation(s)
- Zezhou Wang
- a School of Public Health , Shanghai Jiao Tong University , School of Medicine
| | - Xu Zhao
- b Antibiotic Institute , Huashan Hospital, Fudan University
| | - Zhan Zhang
- c Shanghai Changning District Center for Disease Control and Prevention
| | - Mengyun Luo
- d School of Public Health , Shanghai Jiao Tong University , School of Medicine and
| | - Qiuming Shen
- d School of Public Health , Shanghai Jiao Tong University , School of Medicine and
| | - Yuanyuan Dong
- d School of Public Health , Shanghai Jiao Tong University , School of Medicine and
| | - Ying Wang
- d School of Public Health , Shanghai Jiao Tong University , School of Medicine and
| | - Yong Cai
- e Shanghai Jiao Tong University Institute of Social Cognitive and Behavioral Sciences
| |
Collapse
|
30
|
Mauck DE, Sheehan DM, Fennie KP, Maddox LM, Trepka MJ. Role of Gay Neighborhood Status and Other Neighborhood Factors in Racial/Ethnic Disparities in Retention in Care and Viral Load Suppression Among Men Who Have Sex with Men, Florida, 2015. AIDS Behav 2018; 22:2978-2993. [PMID: 29372456 PMCID: PMC6060015 DOI: 10.1007/s10461-018-2032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study's objective was to examine the role of gay neighborhood residence and other neighborhood factors in racial/ethnic disparities in retention in HIV care and viral load suppression during 2015. Florida residents diagnosed 2000-2014 with HIV infection and with transmission mode of men who have sex with men (MSM) were included in multi-level logistic regression models. Of 29,156 MSM, 29.4% were not retained and 34.2% were not virally suppressed. Non-Hispanic Blacks (NHB) had a higher likelihood of not being retained (adjusted prevalence ratio [aPR] 1.31, 95% confidence interval [CI] 1.24-1.38, p value < 0.0001) and not being virally suppressed (aPR 1.82, 95% CI 1.67-1.98, p value < 0.0001) compared with non-Hispanic Whites. Among NHBs, rural residence was protective for both outcomes. Although gay neighborhood residence was not associated with either outcome, the role of other neighborhood factors suggests that individual and neighborhood barriers to HIV care and treatment should be addressed among MSM.
Collapse
Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 487, Miami, FL, 33199, USA.
| |
Collapse
|
31
|
Carrasco MA, Barrington C, Perez M, Donastorg Y, Kerrigan D. Social cohesion, condom use, and sexually transmitted infections among female sex workers living with HIV in the Dominican Republic. Int J STD AIDS 2018; 30:64-71. [PMID: 30170526 DOI: 10.1177/0956462418792100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross-sectional study examines the relationship between social cohesion with consistent condom use (CCU) and sexually transmitted infections (STIs) among the Abriendo Puertas (Opening Doors) cohort of female sex workers (FSWs) living with human immunodeficiency virus (HIV) in the Dominican Republic (n = 228). Using data from the follow-up survey of the cohort, we conducted multivariate logistic regression to explore these dynamics. Social cohesion was significantly associated with CCU between FSWs living with HIV and their clients in the last month (adjusted odds ratio [AOR] = 1.65, 95% confidence interval [CI]: 1.11-2.45) and STI prevalence among FSWs (AOR: 3.76, CI: 1.159-12.162). Social cohesion was not associated with CCU between FSWs living with HIV and their steady partners. However, both illicit drug use in the past six months (AOR = 0.11, CI: 0.023-0.57) and pregnancy intentions (AOR = 0.11; CI: 0.02-0.42) were significantly associated with CCU with steady partners. Findings highlight the differential role of social cohesion on condom use outcomes between FSWs living with HIV and their paying clients versus steady partners. Research on the pathways via which cohesion influences condom use among sex workers and their clients is merited, as is research regarding the role of drug use and pregnancy intentions on condom use with steady partners.
Collapse
Affiliation(s)
- M A Carrasco
- 1 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Office of HIV/AIDS United States Agency for International Development, Washington, DC, USA
| | - C Barrington
- 3 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - M Perez
- 4 HIV Vaccine Research Unit, Instituto Dermatalogico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic
| | - Y Donastorg
- 4 HIV Vaccine Research Unit, Instituto Dermatalogico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic
| | - D Kerrigan
- 1 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,5 Department of Sociology, Center on Health, Risk and Society, American University, Washington, DC, USA
| |
Collapse
|
32
|
Abstract
We conducted a cross-sectional study among HIV-positive adults age ≥ 50 in San Francisco to evaluate the frequency of loneliness, characteristics of those who reported loneliness, and the association of loneliness with functional impairment and health-related quality of life (HRQoL). Participants (N = 356) were predominately male (85%); 57% were white; median age was 56. 58% reported any loneliness symptoms with 24% reporting mild, 22% moderate and 12% severe loneliness. Lonely participants were more likely to report depression, alcohol and tobacco use, and have fewer relationships. In unadjusted models, loneliness was associated with functional impairment and poor HRQoL. In adjusted models, low income and depression remained associated with poor HRQoL, while low income, higher VACS index and depression were associated with functional impairment. A comprehensive care approach, incorporating mental health and psychosocial assessments with more traditional clinical assessments, will be needed to improve health outcomes for the aging HIV-positive population.
Collapse
|
33
|
Social Support and HIV Risks Among Migrant and Non-Migrant Market Workers in Almaty, Kazakhstan. J Immigr Minor Health 2018; 19:809-817. [PMID: 27832474 DOI: 10.1007/s10903-016-0529-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Migration processes are listed within the primary factors facilitating the heterosexual spread of HIV. The study examines the relationship between social support, sexual HIV risk behaviors and sexually transmitted infections (STIs) among 1342 male migrant and non-migrant market workers from Barakholka Market in Almaty, Kazakhstan. RESULTS (1) higher level of perceived social support [Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument (ESSI score)] was associated with a lower likelihood of having sex with a female sex worker (FSW) [OR = 0.952 (0.927, 0.978) p < .001]; (2) higher availability of friends was associated with a higher likelihood of having STIs [OR = 1.244 (1.007, 1.537), p < .05]; (3) larger network size was associated with a higher likelihood of having STIs [OR = 1.201 (1.026, 1.407), p < .05]; (4) loneliness was associated with an increased likelihood of having unprotected sex with any female partner [RR = 1.102 (1.027, 1.182), p < .05]. Results suggest that social support factors should be considered as a component of HIV and STI prevention programs for male migrant workers from Central Asia in Kazakhstan.
Collapse
|
34
|
Matsutaka Y, Koyano J, Hidaka Y. Perceptions of Reducing HIV-Preventive Behaviors among Men Who Have Sex with Men Living with HIV in Japan. Health (London) 2018. [DOI: 10.4236/health.2018.1012130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
35
|
Pereira H, Caldeira D, Monteiro S. Perceptions of HIV-Related Stigma in Portugal Among MSM With HIV Infection and an Undetectable Viral Load. J Assoc Nurses AIDS Care 2017; 29:439-453. [PMID: 29292083 DOI: 10.1016/j.jana.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
We explored perceptions of HIV-related stigma using a qualitative approach based on the findings of in-depth e-mail asynchronous interviews with 37 self-identified Portuguese men who have sex with men (MSM) with HIV infection and undetectable viral loads. Participants were asked to answer an online interview. Major findings concerned external perceptions of HIV-related stigma, HIV status disclosure, the impact of HIV on everyday life, the presence of double discrimination, and general perceptions of HIV-related stigma. Results revealed (a) stigmatizing and discriminatory behaviors and practices in psychosocial and inter-relational events, but not in accessing and receiving health care; (b) double exposure to stigma associated with being gay and having HIV; and (c) undetectability as an autonomous identity with important connections to social and interpersonal interactions. An important implication was related to multilevel risk perceptions and the psychosocial complexity and challenges of HIV infection. In Portugal, HIV is still a socially disabling disease.
Collapse
|
36
|
Halkitis PN, Cook SH, Ristuccia A, Despotoulis J, Levy MD, Bates FC, Kapadia F. Psychometric analysis of the Life Worries Scale for a new generation of sexual minority men: The P18 Cohort Study. Health Psychol 2017; 37:89-101. [PMID: 28967772 DOI: 10.1037/hea0000537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. METHOD Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. RESULTS Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. CONCLUSIONS The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations. (PsycINFO Database Record
Collapse
Affiliation(s)
- Perry N Halkitis
- Department of Biostatistics, School of Public Health, Rutgers University
| | - Stephanie H Cook
- Department of Biostatistics, College of Global Public Health, New York University
| | - Annie Ristuccia
- Center for Health, Identity, Behavior, & Prevention Studies, College of Global Public Health, New York University
| | - James Despotoulis
- Center for Health, Identity, Behavior, & Prevention Studies, College of Global Public Health, New York University
| | - Michael D Levy
- Center for Health, Identity, Behavior, & Prevention Studies, College of Global Public Health, New York University
| | - Francesca C Bates
- Center for Health, Identity, Behavior, & Prevention Studies, College of Global Public Health, New York University
| | - Farzana Kapadia
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University
| |
Collapse
|
37
|
Shame and blame and its influence on male gay (chaay rak chaay) quality of life in Bangkok Thailand: a health promotion community nursing perspective. JOURNAL OF PUBLIC MENTAL HEALTH 2017. [DOI: 10.1108/jpmh-12-2016-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore gay male informant experiences of discrimination and stigma in Bangkok from a health promotion community nursing perspective.
Design/methodology/approach
Semi-structured in-depth interviews were conducted with 30 informants and included field work observations at eight entertainment venues. Data analysis utilised an inductive thematic approach.
Findings
Key themes that emerged from the data were related to communication, particularly the use of smart phone applications; lack of privacy in health services; sexual exploitation by entertainment venues; and concerns about coming out safely to protect self-esteem and mental health.
Originality/value
Development of key mental health promotion messages based on a greater understanding and knowledge of discrimination and stigma may help to reduce negative behaviour and stigmatisation towards Thai gay men in Bangkok.
Collapse
|
38
|
Fekete EM, Williams SL, Skinta MD. Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV. Psychol Health 2017; 33:398-415. [PMID: 28749185 DOI: 10.1080/08870446.2017.1357816] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms. DESIGN 181 PLWH from across the United States completed an online survey. Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms. CONCLUSIONS PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.
Collapse
Affiliation(s)
- Erin M Fekete
- a School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Stacey L Williams
- b Department of Psychology , East Tennessee State University , Johnson City , TN , USA
| | - Matthew D Skinta
- c Pacific Graduate School of Psychology , Palo Alto University , Palo Alto , CA , USA
| |
Collapse
|
39
|
Wang Y, Wang Z, Jia M, Liang A, Yuan D, Sun Z, Gan F, Wang Y, Cai Y, Zhang Z. Association between a syndemic of psychosocial problems and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis 2017; 17:46. [PMID: 28061819 PMCID: PMC5219803 DOI: 10.1186/s12879-016-2132-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/15/2016] [Indexed: 11/12/2022] Open
Abstract
Background Previous studies have discussed the overlapping and reinforcing effects (defined as a syndemic) of psychosocial problems on high-risk sexual behaviors among men who have sex with men (MSM). The present study aimed to apply the syndemic theory to verify the reinforcing effects of psychosocial problems on unprotected anal intercourse (UAI) among MSM in Shanghai, and determine if other important psychosocial factors fit into the syndemic theory. Methods Data were collected from 547 MSM in Shanghai, China, through face-to-face interviews. The measures for psychosocial problems included the Rosenberg Self-Esteem Scale; the Generalized Anxiety Disorder-7; the Center for Epidemiological Studies Depression Scale; the University of California, Los Angeles Loneliness Scale; and the Sexual Compulsivity Scale. We used multivariate analysis and binary logistic regression to investigate the associations between psychosocial problems and high-risk sexual behaviors. Results The prevalence of UAI among MSM in the past 6 months was 54.5%. Education (graduate from college vs. high school) served as a protective factor against UAI (OR 0.59, 95% CI: 0.38–0.94). There was a high prevalence of psychosocial problems, and at least one-third of participants reported experiencing more than two psychosocial symptoms. Of these psychosocial factors that we investigated, lower self-esteem was associated with UAI in both univariate and multivariate regression model (P = 0.009). Result suggests that overlapping and reinforcing effects of psychosocial problems may increase high risk sexual behaviors among MSM in Shanghai, China (OR 1.65, 95% CI: 1.09–2.50; P = 0.018). Conclusions We found further evidence for a syndemic of psychosocial problems among MSM in Shanghai, China. This syndemic may also increase high risk sexual behaviors among MSM. Most HIV prevention interventions are focused on behavior change and only have moderate effects; our findings suggest that a shift from behavior-focused interventions to a more comprehensive strategy that addresses psychosocial factors may be necessary.
Collapse
Affiliation(s)
- Ying Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zezhou Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Mengmeng Jia
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ajuan Liang
- Renji Hospital, affiliated with School of Medicine Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Zhe Sun
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Feng Gan
- School of Continuing Education, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yichen Wang
- Ruijin Hospital, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Yong Cai
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Zhiruo Zhang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| |
Collapse
|
40
|
Batey DS, Whitfield S, Mulla M, Stringer KL, Durojaiye M, McCormick L, Turan B, Nyblade L, Kempf MC, Turan JM. Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop. AIDS Patient Care STDS 2016; 30:519-527. [PMID: 27849373 DOI: 10.1089/apc.2016.0223] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre-post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop "excellent" and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, well-organized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH (p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.
Collapse
Affiliation(s)
- D. Scott Batey
- Department of Social Work, College of Arts & Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samantha Whitfield
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mazheruddin Mulla
- Department of Psychology, College of Arts & Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Kristi L. Stringer
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Modupeoluwa Durojaiye
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa McCormick
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bulent Turan
- Department of Psychology, College of Arts & Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Nyblade
- Division of Global Health, International Development Group and HP+, RTI International, Washington, District of Columbia
| | - Mirjam-Colette Kempf
- Nursing Family, Community & Health Systems, College of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M. Turan
- Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
41
|
Li Z, Hsieh E, Morano JP, Sheng Y. Exploring HIV-related stigma among HIV-infected men who have sex with men in Beijing, China: a correlation study. AIDS Care 2016; 28:1394-401. [PMID: 27137205 DOI: 10.1080/09540121.2016.1179713] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Human immunodeficiency virus (HIV)-related stigma among HIV-infected men who have sex with men (MSM) has been associated with adverse health outcomes, including poor adherence to antiretroviral therapy and care, and increased participation in behaviors linked to higher rates of HIV transmission. In China, the incidence of HIV is growing more rapidly among MSM than among other subgroups. This study characterizes and quantifies HIV stigma among HIV-infected MSM in Beijing, China, which arguably may be driving this epidemic. A cross-sectional survey study was performed among 266 HIV-positive MSM in Beijing, China, in 2014. The Berger HIV Stigma Scale was used to measure levels of HIV-related stigma. Participants additionally answered questions regarding socio-demographic characteristics and HIV-associated risk factors; previously validated Mandarin-language scales assessed depression, coping style, and social support networks. Multivariable linear regression models were used to identify variables significantly associated with HIV stigma. The mean overall HIV stigma score among the study population was 112.78 ± 18.11 (score range: 40-160). Higher HIV stigma scores were positively associated with depression (β = 7.99, 95% CI:3.69, 12.29, p < .001) and negative coping skills (β = 0.64, 95% CI:0.21,1.08, p < .01), and was negatively associated with disclosed HIV status (β = -6.45, 95%CI:-11.80, -1.11, p < .05), and availability of social support networks (β = -0.12, 95%CI:-0.22, -0.02, p < .05). Other variables such as poor self-rated health status and presence of opportunistic infections were positively associated with individual dimensions of HIV-related stigma. The results of this study can inform the development of culturally sensitive interventions to reduce HIV-related stigma among MSM with HIV in China, with the overarching goal of reducing HIV transmission in this vulnerable population.
Collapse
Affiliation(s)
- Zhen Li
- a School of Nursing , Peking Union Medical College , Beijing , People's Republic of China
| | - Evelyn Hsieh
- b Department of Internal Medicine , Yale School of Medicine , New Haven , CT , USA
| | - Jamie P Morano
- c Division of Infectious Diseases and International Medicine , University of South Florida, Morsani College of Medicine and College of Public Health , Tampa , FL , USA.,d Yale University Center for Interdisciplinary Research on AIDS (CIRA) , New Haven , CT , USA
| | - Yu Sheng
- e Department of Basic Nursing, School of Nursing , Peking Union Medical College , Beijing , People's Republic of China
| |
Collapse
|
42
|
Hart TA, Stratton N, Coleman TA, Wilson HA, Simpson SH, Julien RE, Hoe D, Leahy B, Maxwell J, Adam BD. A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms. PLoS One 2016; 11:e0152762. [PMID: 27054341 PMCID: PMC4824469 DOI: 10.1371/journal.pone.0152762] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/18/2016] [Indexed: 01/01/2023] Open
Abstract
Background Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. Method HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. Results There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. Conclusions The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. Trial Registration ClinicalTrials.gov NCT02546271
Collapse
Affiliation(s)
- Trevor A. Hart
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Natalie Stratton
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Todd A. Coleman
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Holly A. Wilson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | | | - David Hoe
- Poz Prevention Working Group, Gay Men’s Sexual Health Alliance, Toronto, Ontario, Canada
| | - Bob Leahy
- Poz Prevention Working Group, Gay Men’s Sexual Health Alliance, Toronto, Ontario, Canada
| | - John Maxwell
- AIDS Committee of Toronto, Toronto, Ontario, Canada
| | - Barry D. Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Holtzman S, Landis L, Walsh Z, Puterman E, Roberts D, Saya-Moore K. Predictors of HIV testing among men who have sex with men: a focus on men living outside major urban centres in Canada. AIDS Care 2016; 28:705-11. [PMID: 27043184 DOI: 10.1080/09540121.2016.1164288] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Men who have sex with men (MSM) represent almost half of new HIV infections in Canada each year. However, the vast majority of research on HIV testing among MSM has been conducted in major urban centres. The present study addressed this gap by investigating HIV testing behaviour and predictors of HIV testing among MSM living outside major urban centres, in the Interior of British Columbia. An anonymous online survey of 153 MSM assessed HIV testing behaviour and psychosocial factors that may impact HIV testing (internalized homophobia, disclosure to healthcare providers (HCPs) of same sex attraction, and gay community involvement). Almost one-quarter (24%) had never been tested and over one-third (35%) had not disclosed same sex attraction to HCPs. Internalized homophobia was associated with a lower likelihood of HIV testing, and this relationship was partially explained by the fact that those high in internalized homophobia were less likely to disclose same sex attraction to their HCPs. Neither formal nor informal involvement in the gay community was related to HIV testing, and both types of involvement were relatively low in our sample. Further research is needed to better understand the distinctive health issues facing MSM living outside major urban centres.
Collapse
Affiliation(s)
- Susan Holtzman
- a Department of Psychology , University of British Columbia , Kelowna , BC , Canada
| | | | - Zachary Walsh
- a Department of Psychology , University of British Columbia , Kelowna , BC , Canada
| | - Eli Puterman
- c School of Kinesiology , University of British Columbia , Vancouver , BC , Canada
| | - Daryle Roberts
- d Kelowna Community Development Society , Kelowna , BC , Canada
| | | |
Collapse
|
44
|
Yi S, Tuot S, Chhoun P, Pal K, Tith K, Brody C. Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in Cambodia. PLoS One 2015; 10:e0136114. [PMID: 26287731 PMCID: PMC4546109 DOI: 10.1371/journal.pone.0136114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022] Open
Abstract
Background Compared to the general population, men who have sex with men (MSM) are at greater risk for HIV and less understood due to their more hidden and stigmatized nature. Moreover, the discrepancy in findings in the literature merits further investigations in MSM populations from different cultures and settings. We therefore conducted this study to explore factors associated with inconsistent condom use among high-risk MSM in Cambodia. Methods This cross-sectional study was conducted in 2014 among 367 MSM randomly selected from Battembang and Siem Reap using a two-stage cluster sampling method. A structured questionnaire was used for face-to-face interviews to collect information on characteristics of respondents, HIV testing history, self-perception of HIV risk, substance use, sexual behaviors, mental disorders, and HIV knowledge. Multivariable logistic regression analysis was performed to identify factors independently associated with inconsistent condom use. Results On average, 62.3% of respondents reported that they always used condoms over the past three months. The rates varied with types of sexual partners; the proportion of respondents who reported always using condoms was 55.1%, 64.2%, 75.9%, 73.0%, 78.1%, and 70.3%, for sexual partners who were girlfriends, boyfriends, female sex workers, male sex workers, female clients, or male clients, respectively. After adjustment, inconsistent condom use was significantly associated with age of ≥25 (AOR = 1.77, 95% CI = 1.09–2.86), self-rated quality of life as good or very good (AOR = 4.37, 95% CI = 1.79–5.67), self-perception of higher HIV risk compared to the general population (AOR = 2.37, 95% CI = 1.35–4.17), illicit drug use in the past three months (AOR = 5.76, 95% CI = 1.65–10.09), and reported consistent lubricant use when selling anal sex to men in the past three months (AOR = 2.85, 95% CI = 1.07–8.12). Conclusions We found risky sexual behaviors to be considerably high among MSM in this study, especially among those who used illicit drugs or were older than 25. HIV education and social marketing should be expanded and specifically designed for MSM to better educate on the increased risk of HIV with unprotected anal sex and illicit drug use as risk factors, and the importance of the use of both condoms and lubricant during anal intercourse.
Collapse
Affiliation(s)
- Siyan Yi
- Research Center, KHANA, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, California, United States of America
- * E-mail:
| | | | | | | | - Khimuy Tith
- Research Center, KHANA, Phnom Penh, Cambodia
| | - Carinne Brody
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, California, United States of America
| |
Collapse
|