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Abstract
ABSTRACTSyndemic theory hypothesises that observed clusters of diseases are the result of harmful social conditions. Critiques of syndemics present the theory as ambiguous and lacking empirical evidence. Syndemics are evidenced through qualitative assessments drawing on observations, epidemiology, and biomedical evidence to explain bio-bio and bio-social interactions. Quantitative syndemic studies commonly apply a summative approach, whereby the outcome is a result of the cumulative effect of the individual elements. More recently, quantitative studies apply analyses to assess mechanical interactions among conditions. This paper applies a synergy factor analysis to measure synergy - the enhancement of the effect of one element on the effect of the others. Data from the canonical quantitative syndemic analysis study was reanalysed to assess synergy among the elements of the SAVA syndemic (substance ab/use, violence, HIV/AIDS). Contrary to original study findings, which applied a summative approach, no synergy was measured. Synergistic interactions were confirmed among a subset of the study population; the effects of substance ab/use and violence on HIV were more than two times greater in White MSM than the predicted joint effect (SF = 2·32, 95%CI 1·02-5·11, p = 0·044), indicating synergy. Synergy factor analysis presents an accessible tool to measure syndemic interactions and facilitate timely global health responses.
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Affiliation(s)
- Nicola Bulled
- University of Connecticut, Institute for Collaboration on Health, Intervention and Policy, Storrs, CT, USA
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2
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Zhou Z, Ma P, Feng Y, Ou W, Wei M, Shao Y. The inference of HIV-1 transmission direction between a man who has sex with men and his heterosexual wife based on the sequences of HIV-1 quasi-species. Emerg Microbes Infect 2021; 10:1209-1216. [PMID: 34077305 PMCID: PMC8676586 DOI: 10.1080/22221751.2021.1938693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently, homosexual transmission has become one of the main routes of HIV-1 spread in China. Furthermore, about 80% Chinese men, who have sex with men (MSM), feel forced to enter eventually into heterosexual marriages due to the Chinese traditional marriage culture, which may cause HIV-1 infection in families. In this study, we identified HIV-1 transmission in a family and the direction of HIV-1 transmission from a MSM to his wife and infant, which indicated Chinese MSM may have become a potential bridge of HIV-1 transmission to their wives and children. Therefore, we need to develop more effective defence measures to prevent the spread of HIV-1 in MSM families in China.
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Affiliation(s)
- Zehua Zhou
- School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Ping Ma
- Nankai University Second People's Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Yi Feng
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Weidong Ou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Min Wei
- School of Medicine, Nankai University, Tianjin, People's Republic of China.,Nankai University Second People's Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Yiming Shao
- School of Medicine, Nankai University, Tianjin, People's Republic of China.,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
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3
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Pagkas-Bather J, Ozik J, Millett G, Schneider JA. The last Black man with HIV in San Francisco: the potential role of gentrification on HIV getting to zero achievements. Lancet HIV 2021; 7:e853-e856. [PMID: 33275918 DOI: 10.1016/s2352-3018(20)30250-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 01/02/2023]
Abstract
San Francisco was the first city in the USA to develop a Getting to Zero HIV elimination strategy. The cause of decreased HIV incidence has been attributed to the use of biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). These strategies have benefitted White men who have sex with men (MSM), whose population has increased over the past decade. However, Black MSM in San Francisco continue to have higher HIV incidence and outmigration rates. We posit that the declining overall HIV incidence, including among White MSM, is not only explained by the use of TaSP and PrEP, but is also due to the declining Black population and rising HIV incidence among Black MSM, who have historically been more likely to acquire HIV due to structural, racial, and criminal justice-related factors than have White MSM.
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Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA; Argonne National Laboratory, Lemont, IL, USA
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA; Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
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4
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Williams LD, Stall R, Tempalski B, Jefferson K, Smith J, Ibragimov U, Hall HI, Satcher Johnson A, Wang G, Purcell DW, Cooper HLF, Friedman SR. Trajectories of and disparities in HIV prevalence among Black, white, and Hispanic/Latino men who have sex with men in 86 large U.S. metropolitan statistical areas, 1992-2013. Ann Epidemiol 2021; 54:52-63. [PMID: 32950653 DOI: 10.1016/j.annepidem.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas. METHODS This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States. RESULTS Our estimates indicate that HIV prevalence among MSM increased, from an across-metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions. CONCLUSIONS The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.
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5
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Macapagal K, Li DH, Clifford A, Madkins K, Mustanski B. The CAN-DO-IT Model: a Process for Developing and Refining Online Recruitment in HIV/AIDS and Sexual Health Research. Curr HIV/AIDS Rep 2020; 17:190-202. [PMID: 32444929 PMCID: PMC7380648 DOI: 10.1007/s11904-020-00491-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW HIV/AIDS and sexual health research has increasingly relied on online recruitment in recent years. However, as potential online recruitment avenues (e.g., dating and sexual networking applications, websites, social media) have proliferated, navigating this process has become increasingly complex. This paper presents a practical model to guide researchers through online recruitment irrespective of platform. RECENT FINDINGS The CAN-DO-IT model reflects 7 iterative steps based on work by the authors and other investigators: conceptualize scope of recruitment campaign, acquire necessary expertise, navigate online platforms, develop advertisements, optimize recruitment-to-enrollment workflow, implement advertising campaign, and track performance of campaigns and respond accordingly. Online recruitment can accelerate HIV/AIDS research, yet relatively limited guidance exists to facilitate this process across platforms. The CAN-DO-IT model presents one approach to demystify online recruitment and reduce enrollment barriers.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 14-057, Chicago, IL, 60611, USA.
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL, 60611, USA.
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 14-057, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL, 60611, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL, 60611, USA
| | - Antonia Clifford
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 14-057, Chicago, IL, 60611, USA
| | - Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 14-057, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 14-057, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL, 60611, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL, 60611, USA
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6
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Shin S, Liu Y, Cole SR, Fine JP. Ensemble estimation and variable selection with semiparametric regression models. Biometrika 2020; 107:433-448. [PMID: 32454529 DOI: 10.1093/biomet/asaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Indexed: 11/14/2022] Open
Abstract
We consider scenarios in which the likelihood function for a semiparametric regression model factors into separate components, with an efficient estimator of the regression parameter available for each component. An optimal weighted combination of the component estimators, named an ensemble estimator, may be employed as an overall estimate of the regression parameter, and may be fully efficient under uncorrelatedness conditions. This approach is useful when the full likelihood function may be difficult to maximize, but the components are easy to maximize. It covers settings where the nuisance parameter may be estimated at different rates in the component likelihoods. As a motivating example we consider proportional hazards regression with prospective doubly censored data, in which the likelihood factors into a current status data likelihood and a left-truncated right-censored data likelihood. Variable selection is important in such regression modelling, but the applicability of existing techniques is unclear in the ensemble approach. We propose ensemble variable selection using the least squares approximation technique on the unpenalized ensemble estimator, followed by ensemble re-estimation under the selected model. The resulting estimator has the oracle property such that the set of nonzero parameters is successfully recovered and the semiparametric efficiency bound is achieved for this parameter set. Simulations show that the proposed method performs well relative to alternative approaches. Analysis of an AIDS cohort study illustrates the practical utility of the method.
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Affiliation(s)
- Sunyoung Shin
- Department of Mathematical Sciences, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, Texas 75080, U.S.A
| | - Yufeng Liu
- Department of Statistics and Operations Research, CB# 3260, University of North Carolina, Chapel Hill, North Carolina 27599, U.S.A
| | - Stephen R Cole
- Department of Epidemiology, CB# 7435, University of North Carolina, Chapel Hill, North Carolina 27599, U.S.A
| | - Jason P Fine
- Department of Biostatistics, CB# 7420, University of North Carolina, Chapel Hill, North Carolina 27599, U.S.A
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7
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Yang Z, Li S, Zhang R, Na J, Li Y, Mu H, Yu L, Liu L, Sun W, Pan G, Yan L. Current heterosexual marriage is associated with significantly decreased levels of anxiety symptoms among Chinese men who have sex with men. BMC Psychiatry 2020; 20:151. [PMID: 32252706 DOI: 10.1186/s12888-020-02563-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/23/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The high heterosexual marriage rate could be a 'double-edge' sword for the emotional health of Chinese men who have sex with men (MSM). The aim of this study was to determine if current marriage and breakdown of marriage (divorce) have different effects on the mental health of Chinese MSM. METHODS Eight hundred seven MSM were recruited using respondent-driven sampling from four cities in northeastern China. Gay-related stressful events (GRSE) were measured using the Gay Related Stressful Life Events Scale; social support was measured by the Social Support Rating Scale (SSRS); and depressive and anxiety symptoms were assessed using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), respectively. RESULTS Of the study participants, 13.4% were married to women and 4.5% were divorced. The rates of marriage or divorce were 35.3 and 75.8% for participants 30-39 and > 40 years of age, respectively. The current married MSM had the highest SDS (50.0 ± 10.9) and SSRS (35.8 ± 8.6) levels, but the lowest SAS (38.7 ± 12.1) levels. Divorced MSM had the highest SAS (44.4 ± 9.6) and lowest SSRS (30.8 ± 8.1) levels. Age, GESE number, and HIV infection were predictors for SDS and SAS, and current marriage was associated with significantly decreased level of SAS (β = - 0.136, P = 0.001) based on multiple linear analysis. CONCLUSIONS Current marriage is associated with significantly decreased levels of anxiety symptoms among Chinese MSM. More studies are needed to understand the mechanisms underlying the effects of different marriage status on the emotional distress of Chinese MSM.
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Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A Mobile-Based App (MyChoices) to Increase Uptake of HIV Testing and Pre-Exposure Prophylaxis by Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10694. [PMID: 30617042 PMCID: PMC6329428 DOI: 10.2196/10694] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/16/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background HIV incidence is growing most rapidly in the United States among young men who have sex with men (YMSM). Overwhelming evidence demonstrates that routine testing and expanded use of pre-exposure prophylaxis (PrEP) would dramatically reduce the population burden of HIV; however, uptake of both interventions is suboptimal among young adults. The use of mobile phone apps by YMSM is ubiquitous and may offer unique opportunities for public health interventions. MyChoices is a theory-driven app to increase HIV testing and PrEP uptake. It was developed by an interdisciplinary team based on feedback from a diverse sample of YMSM. Objective The aim of this paper is to describe the protocol for the refinement, beta testing, and pilot randomized controlled trial (RCT) to examine the acceptability and feasibility of the MyChoices app. Methods This 3-phase study includes 4 theater testing groups for app refinement with a total of approximately 30 YMSM; for beta testing, including quantitative assessments and exit interviews, with approximately 15 YMSM over a 2-month period; and for a pilot RCT with 60 YMSM. The pilot will assess feasibility, acceptability, and preliminary efficacy of the MyChoices app, compared with referrals only, in increasing HIV testing and PrEP uptake. All participants will be recruited at iTech clinical research sites in Boston, MA, and Bronx, NY. Results App refinement is underway. Enrollment for the pilot RCT began in October 2018. Conclusions MyChoices is one of the first comprehensive, theory-driven HIV prevention apps designed specifically for YMSM. If MyChoices demonstrates acceptability and feasibility in this pilot RCT, a multicity, 3-arm randomized controlled efficacy trial of this app and another youth-optimized app (LYNX) versus standard of care is planned within iTech. If shown to be efficacious, the app will be scalable, with the ability to reach YMSM across the United States as well as be geographically individualized, with app content integrated with local prevention and testing activities. International Registered Report Identifier (IRRID) PRR1-10.2196/10694
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Affiliation(s)
- Katie B Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.,Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Elliot Marrow
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.,Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Hightow-Weidman
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States
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Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
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Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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10
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Khan MR, McGinnis KA, Grov C, Scheidell JD, Hawks L, Edelman EJ, Fiellin DA, McInnes DK, Braithwaite RS, Justice AC, Wang EA. Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US .. AIDS Care 2018; 31:349-356. [PMID: 30064277 DOI: 10.1080/09540121.2018.1499861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.
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Affiliation(s)
- Maria R Khan
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | | | - Christian Grov
- c CUNY Graduate School of Public Health and Health Policy & The CUNY Institute for Implementation Science and Population Health , New York , NY , USA
| | - Joy D Scheidell
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Laura Hawks
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - E Jennifer Edelman
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA.,e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - David A Fiellin
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA.,e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - D Keith McInnes
- f Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center , Bedford , MA , USA.,g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA
| | - R Scott Braithwaite
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Amy C Justice
- b VA Connecticut Healthcare System , West Haven , CT , USA.,d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA.,e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - Emily A Wang
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
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11
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Morabia A. AJPH Dossier on the Erasure of the Sexual Orientation Question From the National Survey of Older Americans Act Participants. Am J Public Health 2017; 107:1203-1204. [DOI: 10.2105/ajph.2017.303926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Shen M, Xiao Y, Rong L, Meyers LA, Bellan SE. Early antiretroviral therapy and potent second-line drugs could decrease HIV incidence of drug resistance. Proc Biol Sci 2017; 284:20170525. [PMID: 28659449 PMCID: PMC5489726 DOI: 10.1098/rspb.2017.0525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/26/2017] [Indexed: 11/12/2022] Open
Abstract
Early initiation of antiretroviral therapy (ART) reduces the risk of drug-sensitive HIV transmission but may increase the transmission of drug-resistant HIV. We used a mathematical model to estimate the long-term population-level benefits of ART and determine the scenarios under which earlier ART (treatment at 1 year post-infection, on average) could decrease simultaneously both total and drug-resistant HIV incidence (new infections). We constructed an infection-age-structured mathematical model that tracked the transmission rates over the course of infection and modelled the patients' life expectancy as a function of ART initiation timing. We fitted this model to the annual AIDS incidence and death data directly, and to resistance data and demographic data indirectly among men who have sex with men (MSM) in San Francisco. Using counterfactual scenarios, we assessed the impact on total and drug-resistant HIV incidence of ART initiation timing, frequency of acquired drug resistance, and second-line drug effectiveness (defined as the combination of resistance monitoring, biomedical drug efficacy and adherence). Earlier ART initiation could decrease the number of both total and drug-resistant HIV incidence when second-line drug effectiveness is sufficiently high (greater than 80%), but increase the proportion of new infections that are drug resistant. Thus, resistance may paradoxically appear to be increasing while actually decreasing.
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Affiliation(s)
- Mingwang Shen
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712, USA
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, People's Republic of China
| | - Libin Rong
- Department of Mathematics and Statistics, Oakland University, Rochester, MI 48309, USA
- Department of Mathematics, University of Florida, Gainesville, FL 32611, USA
| | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712, USA
- The Santa Fe Institute, Santa Fe, NM 87501, USA
| | - Steven E Bellan
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA 30602, USA
- Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
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13
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Hughes AJ, Chen YH, Scheer S, Raymond HF. A Novel Modeling Approach for Estimating Patterns of Migration into and out of San Francisco by HIV Status and Race among Men Who Have Sex with Men. J Urban Health 2017; 94:350-363. [PMID: 28337575 PMCID: PMC5481213 DOI: 10.1007/s11524-017-0145-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the early 1980s, men who have sex with men (MSM) in San Francisco were one of the first populations to be affected by the human immunodeficiency virus (HIV) epidemic, and they continue to bear a heavy HIV burden. Once a rapidly fatal disease, survival with HIV improved drastically following the introduction of combination antiretroviral therapy in 1996. As a result, the ability of HIV-positive persons to move into and out of San Francisco has increased due to lengthened survival. Although there is a high level of migration among the general US population and among HIV-positive persons in San Francisco, in- and out-migration patterns of MSM in San Francisco have, to our knowledge, never been described. Understanding migration patterns by HIV serostatus is crucial in determining how migration could influence both HIV transmission dynamics and estimates of the HIV prevalence and incidence. In this article, we describe methods, results, and implications of a novel approach for indirect estimation of in- and out-migration patterns, and consequently population size, of MSM by HIV serostatus and race in San Francisco. The results suggest that the overall MSM population and all the MSM subpopulations studied decreased in size from 2006 to 2014. Further, there were differences in migration patterns by race and by HIV serostatus. The modeling methods outlined can be applied by others to determine how migration patterns contribute to HIV-positive population size and output from these models can be used in a transmission model to better understand how migration can impact HIV transmission.
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Affiliation(s)
- Alison J Hughes
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.
| | - Yea-Hung Chen
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA
| | - H Fisher Raymond
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Pathela P, Jamison K, Braunstein SL, Schillinger JA, Varma JK, Blank S. Incidence and Predictors of HIV Infection Among Men Who Have Sex with Men Attending Public Sexually Transmitted Disease Clinics, New York City, 2007-2012. AIDS Behav 2017; 21:1444-1451. [PMID: 27448826 DOI: 10.1007/s10461-016-1499-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1 year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1 year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged <20 years (5.7/100 person-years). Characteristics associated with all 648 new HIV diagnoses included: black race (aHR 2.2; 95 % CI 1.6-3.1), condomless receptive anal sex (aHR 2.1; 95 % CI 1.5-2.8), condomless insertive anal sex (aHR 1.3; 95 % CI 1.1-1.8), and incident STD diagnosis (aHR 1.6; 95 % CI 1.3-1.9). MSM attending STD clinics have substantial HIV incidence and report risk behaviors that are highly associated with HIV acquisition. Increased uptake of effective interventions, e.g., pre- and post-exposure prophylaxis, is needed.
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Shayo EH, Kalinga AA, Senkoro KP, Msovela J, Mgina EJ, Shija AE, Materu G, Kilima SP, Mboera LEG, Massaga JJ. Prevalence and risk factors associated with female anal sex in the context of HIV/AIDS in the selected districts of Tanzania. BMC Res Notes 2017; 10:140. [PMID: 28347357 PMCID: PMC5368909 DOI: 10.1186/s13104-017-2452-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female anal sex is a receptive type of sexual practice among heterosexual couples where the penis is inserted into the anus of a female partner. In the Western world, a number of studies and interventions have been carried out on anal sex among men due to its potential risks to HIV transmission. In African countries, including Tanzania, there is dearth of information on the risks inherent in practices associated with female anal sex in the general population. The objective of this study was to determine the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in selected districts of Tanzania. METHODS This study was conducted in four districts of Tanzania of Kinondoni, Tanga Urban, Makete and Siha. Both quantitative and qualitative methods i.e. household interviews and focus group discussions were employed in data collection. Study participants included community members of aged 15 and above such as heads of the household, adolescents, bar workers and commercial sex workers. FINDINGS A total of 903 individuals were interviewed, 60.6% of whom were females. When respondents were asked to indicate whether they had ever been tempted to practise FAS, 167 (18.5%) reported to have been tempted in the past 12 months. Of these, 44 (26.3%) respondents had at least practised FAS. Risky practices associated with FAS were forced sex, multiple partners, frequency of engaging in FAS, low use of condoms during FAS, low rates of HIV testing among partakers, poor perception of the risks to acquire HIV through FAS and use of lubricants. CONCLUSIONS In this population, the frequency of FAS practice was rather low. And yet, FAS practice attendant risk factors are likely to exacerbate HIV transmission. As such, there is a need for further exploratory studies to determine and document drivers of FAS. In addition, public health education should be provided with regard to the risks of contracting HIV associated with FAS practices.
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Affiliation(s)
- Elizabeth H. Shayo
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | | | - Kesheni P. Senkoro
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Judith Msovela
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Erick J. Mgina
- Tukuyu Medical Research Centre, P.O. Box 538, Tukuyu, Tanzania
| | - Angela E. Shija
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | | | - Stella P. Kilima
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Leonard E. G. Mboera
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Julius J. Massaga
- National Institute for Medical Research Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
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Li X, Zhang B, Wang J, Li Y, Li X, Yu P, Liu M, Liu X. Sexual health status of women who have regular sexual relations with men who have sex with men in mainland China. BMC Public Health 2017; 17:168. [PMID: 28166759 PMCID: PMC5294694 DOI: 10.1186/s12889-017-4096-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/01/2017] [Indexed: 11/28/2022] Open
Abstract
Background Men who have sex with men (MSM) are a high-risk group for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection. In China, the vast majority of MSM feel forced to marry or plan to marry women, according to traditional Chinese culture. Women who have regular sexual relations with MSM, called tongqi in mainland China, live with a high risk of STDs or HIV infection, but these risks are often ignored. Our investigation of this group of the women is a preliminary study that aims to understand the sexual health problems of tongqi and related factors. Methods This study relied on website mobilization and was funded by tongqi. Participants were limited to women who had sex with MSM to whom they were married (in-GWs), whom they had divorced (ex-GWs), or with whom they were friends (GGFs). The data were collected using questionnaire software. Results A total 144 valid surveys were returned from 100 in-GWs, 33 ex-GWs, and 11 GGFs. Average respondent age was 32.8 ± 6.4 years (range 22 to 58 years). Among in-GWs and ex-GWs, over 95% learned that their husbands were MSM after marriage. More than half of respondents had had sex before marriage, and one-third of those women had sex partners other than their husbands. In addition, 35.3% of tongqi had STDs symptoms. About 50% participants had had oral sex with sex partners of MSM and 10% had had passive anal sex, with low condom use during both oral (9.7%) and anal sex (23.1%). Most tongqi had misunderstandings about STDs and HIV and less than 30% had undergone HIV screening. Among participants tested, 5.6% were HIV positive. A total 93.5% of respondents believed that laws should be established to protect the sexual rights of women. Conclusions Women who have regular sexual relations with MSM face adverse sexual health issues and are susceptible to STDs and HIV infection. Measures must be taken to protect the rights and interests of tongqi in mainland China. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4096-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiufang Li
- Department of Sex Health Center, Affiliated Hospital of Qingdao University, 16 Jiangsu Street, Qingdao, Shandong, 266003, China.
| | - Beichuan Zhang
- Department of Sex Health Center, Affiliated Hospital of Qingdao University, 16 Jiangsu Street, Qingdao, Shandong, 266003, China
| | - Juan Wang
- Department of Dermatology, Jiaozhou Central Hospital of Qingdao, 29 Xuzhou Street, Jiaozhou, Shandong, 266300, China
| | - Yang Li
- Department of Dermatology, National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, 210042, China
| | - Xianhong Li
- School of Law Central South University, Xiang Ya Nursing School of Central South University, Changsha, Hunan, 410013, China
| | - Peiheng Yu
- Research Projects of Gay Men's Wives, Qingdao, Shandong, 266012, China
| | - Minghua Liu
- Centers for Disease Control and Prevention of Qingdao, Qingdao, Shandong, 266033, China
| | - Xinqiao Liu
- Department of Sex Health Center, Affiliated Hospital of Qingdao University, 16 Jiangsu Street, Qingdao, Shandong, 266003, China
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Abstract
Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
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Affiliation(s)
- Martin Plöderl
- a Department of Suicide Prevention , University Clinic of Psychiatry and Psychotherapy, University Institute of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University , Salzburg , Austria
| | - Pierre Tremblay
- b Faculty of Social Work, University of Calgary , Calgary, Alberta , Canada
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Ramirez-Valles J, Fergus S, Reisen CA, Poppen PJ, Zea MC. Confronting Stigma: Community Involvement and Psychological Well-Being Among HIV-Positive Latino Gay Men. Hispanic Journal of Behavioral Sciences 2016. [DOI: 10.1177/0739986304270232] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Theories of social integration and stress process posit that community involvement may buffer or may compensate the adverse effects of stigma on psychological well-being. In this article, the authors explore this thesis in a stigmatized and seldom studied group of HIV-positive Latino gay men. Specifically, they examine the effects of community involvement in AIDS and gay-related organizations (e.g., volunteerism and activism) and experienced homosexual stigma on three psychological well-being indicators (i.e., self-esteem, depression, and loneliness). The cross-sectional sample includes 155 HIV-positive men living in New York City and Washington, DC. Results suggest that experienced stigma attributed to homosexuality is associated with psychological well-being. Community involvement, however, seems to compensate the association between stigma and depression and loneliness, while buffering the association with self-esteem. Furthermore, community involvement appears to also heighten the perception of stigma.
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Abstract
This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.
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Affiliation(s)
- Stevenson Fergus
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109, USA.
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Grov C, Cain D, Whitfield THF, Rendina HJ, Pawson M, Ventuneac A, Parsons JT. Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and Opportunities. Sex Res Social Policy 2016; 13:1-21. [PMID: 26858776 PMCID: PMC4743043 DOI: 10.1007/s13178-015-0212-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups.
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21
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Abstract
Among men who have sex with men (MSM), sexual compulsivity is associated with overlapping psychosocial and behavioral health problems. Because difficulties with emotion regulation are thought to be one important feature, this study examined whether affective states and traumatic stress symptoms were independently associated with key dimensions of sexual compulsivity. Data were collected in San Francisco for the Urban Men's Health Study-2002 from May 24, 2002 to January 19, 2003. In total, 711 MSM recruited via probability-based sampling completed a mail-in questionnaire that assessed psychological factors and substance use. Dissociation related to traumatic stress and any stimulant use in the past 6 months were independently associated with more frequent sexual thoughts or urges. Increased anger and HIV-positive serostatus were independently associated with a greater perception that sexual behavior is difficult to control. Clinical research is needed to examine if interventions targeting emotion regulation and traumatic stress can boost the effectiveness of HIV prevention efforts among MSM who experience difficulties related to managing sexual behaviors.
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Affiliation(s)
- Roy C Jerome
- Psychologist in private practice, Brooklyn, New York, USA
| | - William J Woods
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Adam W Carrico
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA.
- School of Nursing, University of California San Francisco, 2 Koret Way, N511 M, San Francisco, CA, 94143-0608, USA.
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Monteiro JF, Escudero DJ, Weinreb C, Flanigan T, Galea S, Friedman SR, Marshall BD. Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs. Epidemiol Infect 2016; 144:1683-700. [PMID: 26753627 DOI: 10.1017/S0950268815003180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events ('risk acts'), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
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Abstract
Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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Affiliation(s)
- Sean D Young
- UCLA Department of Family Medicine, University of California Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800, Los Angeles, CA, 90049, USA.
| | - Dallas Swendeman
- UCLA Department of Psychiatry and Biobehavioral Sciences, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., David Geffen School of Medicine, Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Uyen Kao
- UCLA Department of Family Medicine, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
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Kelly JA, St Lawrence JS, Tarima SS, DiFranceisco WJ, Amirkhanian YA. Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men. Am J Public Health 2015; 106:96-102. [PMID: 26562130 DOI: 10.2105/ajph.2015.302945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). METHODS We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. RESULTS Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. CONCLUSIONS Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.
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Affiliation(s)
- Jeffrey A Kelly
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Janet S St Lawrence
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Sergey S Tarima
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Wayne J DiFranceisco
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
| | - Yuri A Amirkhanian
- Jeffrey A. Kelly, Sergey S. Tarima, Wayne J. DiFranceisco, and Yuri A. Amirkhanian are with Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee. Janet S. St Lawrence was with the College of Arts and Sciences, Mississippi State University, Meridian, when the study was conducted
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25
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Herrmann ES, Johnson PS, Johnson MW. Examining Delay Discounting of Condom-Protected Sex Among Men Who Have Sex with Men Using Crowdsourcing Technology. AIDS Behav 2015; 19:1655-65. [PMID: 26066395 DOI: 10.1007/s10461-015-1107-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Some men who have sex with men (MSM) have unprotected anal intercourse (UAI) in situations that put them at risk for HIV infection despite having the knowledge and skills to avoid these risks. The present study examined the potential role of delay discounting in sexual HIV risk behavior among MSM. Participants (n = 108) completed the Sexual Discounting Task and a questionnaire regarding UAI and other variables associated with HIV risk (e.g., age, socioeconomic status, substance use, psychiatric problems). MSM discounted the value of condom-protected anal intercourse in a manner that was orderly, hyperbolic, and sensitive to partner characteristics that likely influence realworld decisions about using condoms. Steeper discounting was associated with UAI, and other factors related to sexual HIV risk among MSM, including young age, socioeconomic disadvantage, substance use, sex under the influence of substances, and depression). Delay discounting is likely a critical, but underappreciated facet of HIV risk among MSM.
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Paik A. Surveying Sexualities: Minimizing Survey Error in Study of Sexuality. In: Delamater J, Plante RF, editors. Handbook of the Sociology of Sexualities. Cham: Springer International Publishing; 2015. pp. 93-107. [DOI: 10.1007/978-3-319-17341-2_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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St. Lawrence JS, Kelly JA, Dickson-Gomez J, Owczarzak J, Amirkhanian YA, Sitzler C. Attitudes Toward HIV Voluntary Counseling and Testing (VCT) Among African American Men Who Have Sex With Men: Concerns Underlying Reluctance to Test. AIDS Educ Prev 2015; 27:195-211. [PMID: 26010312 PMCID: PMC4547358 DOI: 10.1521/aeap.2015.27.3.195] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Contemporary antiretroviral therapy (ART) can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing (VCT) followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression. In the United States, African American men who have sex with men (MSM) bear a disproportionate burden of HIV and have high rates of undetected and untreated HIV infection. However, little research has examined racial minority MSM's views about HIV testing. In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as 100 African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust. Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as a consequence of testing, nor the benefits of testing to get early medical care for HIV infection. There is a gap between the public health field's perception of testing benefits and the beliefs about testing held by racial minority MSM in this sample. To increase the desired outcomes from VCT for minority MSM, VCT promotion should address the concerns of African American MSM and underscore the benefits of early entry into medical care.
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Affiliation(s)
| | - Jeffrey A. Kelly
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
| | - Julia Dickson-Gomez
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
- Johns Hopkins University School of Public Health, Baltimore, MD
| | - Jill Owczarzak
- Johns Hopkins University School of Public Health, Baltimore, MD
| | - Yuri A. Amirkhanian
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
| | - Cheryl Sitzler
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
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Abstract
With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.
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Affiliation(s)
- Joseph A Catania
- a Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences , Oregon State University
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Li YZ, Xu JJ, Qian HZ, You BX, Zhang J, Zhang JM, Hu QH, Chu ZX, Liu SY, Jiang YJ, Geng WQ, Shang H. High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis. BMC Infect Dis 2014; 14:531. [PMID: 25287717 PMCID: PMC4287343 DOI: 10.1186/1471-2334-14-531] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND China has the largest number of the elderly in the world. As the proportion of elderly is rapidly increasing among national reported HIV/AIDS cases, it is a concern about HIV epidemic among older MSM in China. However, studies on HIV prevalence and unprotected anal intercourse (UAI) among Chinese older MSM were relatively few or generally had small sample sizes. METHODS English and Chinese articles published in peer-reviewed journals were identified by systematically searching 5 electronic databases including PubMed and through cross-referencing. Summary prevalence rates of HIV infection and UAI with male sexual partners were calculated, and analyses were performed using the software Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Subgroup analyses were performed separately by sample size, study year, study location, recruitment settings and sampling method. RESULTS Twenty eligible cross-sectional studies (3 in English and 17 in Chinese), published between 2005 and 2013, with a total of 2812 older MSM participants, were identified. Our meta-analyses showed that the prevalence of HIV, syphilis and UAI in the last 6 months were 11.6% (95% confidence interval [CI]: 8.0%-16.6%), 23.0% (95% CI: 15.8%-32.3%) and 79.5% (95% CI: 72.7%-84.9%), respectively. HIV prevalence increased over the study period (6.3% in 2003-2007; 8.6% in 2008-2009, and 11.5% in 2010-2011, trend test Chi-square = 7.02, p = 0.008). The pooled prevalence of HIV (11.6% vs. 5.2%, Chi-square value = 36.2, p < 0.001) and UAI (79.5% vs. 52.6%, Chi-square value = 440.04, p < 0.001) among older MSM were both significantly higher than among younger age group (age < 50 years). CONCLUSIONS Older Chinese MSM have high prevalence of HIV and syphilis. Unprotected anal sex is common and further puts them at high risks of acquiring and transmitting HIV, which was one of reasons for the rapid increasing of national reported older male HIV/AIDS cases. Prevention intervention programs should be specially tailored for this high risk MSM subgroup.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
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Cao Z, Xu J, Zhang H, Song D, She M, Wang J, Wang J, Fan Y, Sun Y, Zhang C. Risk factors for syphilis among married men who have sex with men in China. Sex Transm Dis 2014; 41:98-102. [PMID: 24413488 DOI: 10.1097/OLQ.0000000000000074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study aimed to estimate the prevalence of syphilis among men who have sex with men (MSM) currently married with women in cities of China and examine the related factors for syphilis among them. METHODS "Snowballing" sampling was used to recruit participants in 4 cities from April 2008 to August 2009. Information of participants was collected anonymously and remained confidential. Blood samples were collected from all eligible participants for HIV and syphilis tests. RESULTS A total of 858 men participated in the study, and their average age was 38.3 years (ranged from 21 to 75 years). Fifty-three percent did not have residence cards, 37% accepted junior high school education or less, and 41% identified themselves as gay. The prevalence of HIV and syphilis was 8.0% and 17.9%, respectively. Older age, less education, homosexual orientation, the sex of the first sexual partner, residential places, and HIV infection were significantly associated with syphilis infection. Gay had higher proportions of some risk sexual behaviors than did non-gay-identified participants, including the first insert sex before 18 years (17.9% vs. 13.0%), the first male sex partner (49.0% vs. 34.3%) anal sex in the last 6 months (88.0% vs. 83.0%), noncondom use in the last anal sex (35.9% vs. 28.0%), and never use condom in anal sex in the last 6 months (14.8% vs. 9.1%). Non-gay-identified participants had a higher proportion of having opposite sex than did gay participants (70.8% vs. 43.0%). CONCLUSIONS Currently married MSM had a high prevalence of syphilis, and preventive interventions should be developed to control syphilis transmissions among currently married MSM via extromarital sex and intromarital opposite sex.
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Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquir Immune Defic Syndr 2014; 66:213-20. [PMID: 24662298 DOI: 10.1097/QAI.0000000000000143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. METHODS Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. RESULTS MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). DISCUSSION Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.
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Scott HM, Fuqua V, Raymond HF. Utilization of HIV prevention services across racial/ethnic groups among men who have sex with men in San Francisco, California, 2008. AIDS Behav 2014; 18 Suppl 3:316-23. [PMID: 23712733 DOI: 10.1007/s10461-013-0526-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection in the US is disproportionally higher among Black and Latino men who have sex with men (MSM), compared to other racial/ethnic groups. The 2008 US National HIV Behavioral Surveillance (NHBS) survey of MSM was analyzed to compare utilization of HIV testing, receiving condoms, and individual and group HIV prevention programs among racial/ethnic groups in San Francisco, CA. Using a weighted analysis of the time-location sampling method, racial/ethnic subpopulation estimates were obtained for utilization of these services in the prior 12 months. There was no significant difference in utilization of HIV prevention services among Black (N=37), Latino (N=128), and White (N=275) MSM in San Francisco, CA. Overall 60-70 % of MSM reported their last HIV test within the past 12 months and more than 75 % reported receiving condoms in the last 12 months. However, less than 15 % of MSM reported utilizing individual or group HIV prevention counseling sessions. The NHBS survey demonstrate that the majority of MSM in San Francisco, CA have utilized one or more HIV prevention service in the past 12 months and that there were no racial/ethnic disparities in utilization of these services. However, the utilization of individual or group HIV prevention programs is low and HIV testing is below current recommendations for MSM.
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Koo FK, Chow EPF, Gao L, Fu X, Jing J, Chen L, Zhang L. Socio-cultural influences on the transmission of HIV among gay men in rural China. Cult Health Sex 2014; 16:302-315. [PMID: 24555479 DOI: 10.1080/13691058.2014.883643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive sampling. Face-to-face in-depth interviews were conducted to explore participants' views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants' efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their individualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China.
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Affiliation(s)
- Fung Kuen Koo
- a Sydney Nursing School, University of Sydney , Sydney , Australia
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Friedman MR, Wei C, Klem ML, Silvestre AJ, Markovic N, Stall R. HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis. PLoS One 2014; 9:e87139. [PMID: 24498030 PMCID: PMC3907399 DOI: 10.1371/journal.pone.0087139] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. RESULTS We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. CONCLUSIONS This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population's HIV burden.
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Affiliation(s)
- M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mary Lou Klem
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Anthony J. Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nina Markovic
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ron Stall
- Center for Lesbian, Gay, Bisexual, and Transgender Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Kelly JA, DiFranceisco WJ, St Lawrence JS, Amirkhanian YA, Anderson-Lamb M. Situational, partner, and contextual factors associated with level of risk at most recent intercourse among Black men who have sex with men. AIDS Behav 2014; 18:26-35. [PMID: 23868691 DOI: 10.1007/s10461-013-0532-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
African American men who have sex with men (MSM) in the United States bear a disproportionate burden of HIV infection and disease incidence. 178 Black MSM provided detailed situational information concerning their most recent act of anal intercourse (AI) with a male partner including condom use, partner characteristics, serostatus disclosure, and substance use. Participants completed scales assessing AIDS-related as well as broader contextual domains. Most recent AI acts occurred with same-race partners outside of main relationships. Over one-third of AI acts were unprotected, and almost half of the unprotected acts were not between known HIV-concordant partners. Nearly half of men reported substance use before sex. In a multiple regression analysis, unprotected AI with a partner not known to be concordant was predicted by low risk reduction intentions and indicators of a casual relationship. The findings highlight issues and partner contexts associated with risk for contracting HIV infection among Black MSM.
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Affiliation(s)
- Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA,
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Tobin KE, Latkin CA, Curriero FC. An examination of places where African American men who have sex with men (MSM) use drugs/drink alcohol: a focus on social and spatial characteristics. Int J Drug Policy 2013; 25:591-7. [PMID: 24484732 DOI: 10.1016/j.drugpo.2013.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/13/2013] [Accepted: 12/06/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Drug and alcohol use are risk factors for HIV transmission. Much of the HIV behavioural research has focused on risk without consideration of the social and spatial context of the behaviour. Yet, risk may be specific or unique to place. The purpose of this study was to examine the social and spatial characteristics of places where African American men who have sex with men (AA MSM) use drugs and/or alcohol. Specifically, we examined spatial intensity and clustering of drug/alcohol places and characteristics of their social networks at these places. METHODS Participants were recruited using outreach, on-line advertisements and word-of-mouth referrals. Inclusion criteria were: age 18 or older and sex with a man in the prior 90 days. Participants (n=51) completed a socio-spatial inventory in which they provided addresses of n=187 places where they most recently used drugs and/or drank alcohol. Participants described characteristics of people who were at these places. RESULTS The mean age of participants was 36.5 years (SD=10.9). Half (51%) identified as gay, 31% bisexual, 4% heterosexual and 10% as not sure/questioning and 27% self-reported HIV positive status. Drug/alcohol places were spatially concentrated in the inner part of the city and evidence of clustering by participant characteristics was present. Of n=187 places named where the participant drank alcohol or used drugs, 68% were described as a residence (participants or "someone one else's house"), 20% were bars/clubs or restaurants, 8% were outside places and 4% were miscellaneous (e.g. on the bus/car). There were differences in the characteristics of social network members by place-type. At residential places, a greater proportion of networks listed were sex partners or kin, compared to other place-types. A greater proportion of networks listed at bars/clubs/restaurants were gay, knew that the participant had sex with men, and were younger compared to other place-types. CONCLUSION AA MSM drink alcohol and use drugs in a variety of place-types and with various social network members. Little research has been done on factors that shape the geography of AA MSM substance use. Future research is needed to explore these complex associations.
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Affiliation(s)
- Karin E Tobin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, Second Floor, Baltimore, MD 21205, USA.
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 2213 McElderry Street, Second Floor, Baltimore, MD 21205, USA.
| | - Frank C Curriero
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltmore, MD 21205, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltmore, MD 21205, USA.
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Woolf-King SE, Rice TM, Truong HHM, Woods WJ, Jerome RC, Carrico AW. Substance use and HIV risk behavior among men who have sex with men: the role of sexual compulsivity. J Urban Health 2013; 90:948-52. [PMID: 23974946 PMCID: PMC3795185 DOI: 10.1007/s11524-013-9820-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between substance use, sexual compulsivity and sexual risk behavior was assessed with a probability-based sample of men who have sex with men (MSM). Stimulant, poppers, erectile dysfunction medication (EDM), alcohol use, and sexual compulsivity were independently associated with higher odds of engaging in any serodiscordant unprotected anal intercourse (SDUAI). The association of sexual compulsivity with SDUAI was moderated by poppers and EDM use. Behavioral interventions are needed to optimize biomedical prevention of HIV among substance using MSM.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale St., Suite 1300, San Francisco, CA, 94105, USA,
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Tao J, Ruan Y, Yin L, Vermund SH, Shepherd BE, Shao Y, Qian HZ. Sex with women among men who have sex with men in China: prevalence and sexual practices. AIDS Patient Care STDS 2013; 27:524-8. [PMID: 23931683 DOI: 10.1089/apc.2013.0161] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men who have sex with men and women (MSMW) are a potential bridge population for transmitting HIV to heterosexual women. This study assessed key characteristics of this subgroup of men who have sex with men (MSM) in China. Of 1141 eligible MSM, 45.6% reported bisexual behaviors. Besides marriage as a strong predictor (odds ratio: 23.90, 95% confidence interval: 14.29-39.98), older age (1.12, 1.10-1.15) and lower education (or no college education) (1.98, 1.52-2.59) were also independently associated with having ever had sex with women. MSMW reported higher proportions of alcohol drinking, heterosexual/bisexual orientation, and preference for an insertive role in anal sex than men who had sex with men only; but there was no statistically significant difference between two groups in prevalence of HIV and syphilis infections and in history of sexually transmitted infections. HIV prevention intervention programs should break the bridging role of HIV transmission in MSMW population.
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Affiliation(s)
- Jun Tao
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Bryan E. Shepherd
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
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Gustafson P, Gilbert M, Xia M, Michelow W, Robert W, Trussler T, McGuire M, Paquette D, Moore DM, Gustafson R. Impact of statistical adjustment for frequency of venue attendance in a venue-based survey of men who have sex with men. Am J Epidemiol 2013; 177:1157-64. [PMID: 23639936 DOI: 10.1093/aje/kws358] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.
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Affiliation(s)
- Paul Gustafson
- Department of Statistics, Faculty of Science, University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC V6T 1Z4, Canada.
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Brady SS, Iantaffi A, Galos DL, Rosser BRS. Open, closed, or in between: relationship configuration and condom use among men who use the internet to seek sex with men. AIDS Behav 2013; 17:1499-514. [PMID: 23008123 PMCID: PMC3577942 DOI: 10.1007/s10461-012-0316-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nearly 70 % of HIV+ men who have sex with men (MSM) are estimated to have contracted HIV from a main partner. We examine whether condom use varies by relationship configuration, including open relationships with and without cheating. 656 MSM in committed relationships were recruited through a sexually explicit social networking website. Of the 55 % of MSM who had anal sex with a non-main partner in the past 90 days, two-thirds did not use a condom. Adjusting for covariates, MSM in relationships characterized as open with cheating versus monogamous were more likely to have unprotected anal sex with both main and non-main partners. MSM who perceived that their partner played around or cheated were more likely to have unprotected anal sex with a non-main partner. Prevention messages should attempt to reduce cheating and increase personal responsibility for protecting partners from HIV. Messages should be tailored to reflect open and monogamous relationships.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN 55454, USA.
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Herrick AL, Stall R, Chmiel JS, Guadamuz TE, Penniman T, Shoptaw S, Ostrow D, Plankey MW. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav 2013; 17:1423-30. [PMID: 23283578 DOI: 10.1007/s10461-012-0392-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.
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Owusu-Edusei K, Chesson HW, Leichliter JS, Kent CK, Aral SO. The association between racial disparity in income and reported sexually transmitted infections. Am J Public Health 2013; 103:910-6. [PMID: 23488482 DOI: 10.2105/ajph.2012.301015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. METHODS Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. RESULTS Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. CONCLUSIONS Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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van Griensven F, Thienkrua W, McNicholl J, Wimonsate W, Chaikummao S, Chonwattana W, Varangrat A, Sirivongrangson P, Mock PA, Akarasewi P, Tappero JW. Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Thailand. AIDS 2013; 27:825-32. [PMID: 23169330 DOI: 10.1097/QAD.0b013e32835c546e] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess HIV-prevalence, incidence and risk factors in a cohort of men who have sex with men (MSM) in Bangkok. DESIGN : Cohort study with 4-monthly follow-up visits conducted between April 2006 and July 2012 at a dedicated study clinic in a central Bangkok hospital. Participants were 1744 homosexually active Thai men, at least 18 years old and residents of Bangkok. METHODS Men were tested for HIV-infection at every study visit and for sexually transmitted infections at baseline. Demographic and behavioural data were collected by audio-computer-assisted self-interview. Logistic regression analysis was used to evaluate risk factors for HIV-prevalence and Cox proportional hazard analysis to evaluate risk factors for HIV-incidence. RESULTS Baseline HIV-prevalence was 21.3% (n = 372) and 60 months cumulative HIV-incidence was 23.9% (n = 222). Overall HIV-incidence density was 5.9 per 100 person-years. Multivariate risk factors for HIV-prevalence were older age, secondary/vocational education (vs. university or higher), employed or unemployed (vs. studying), nitrate inhalation, drug use for sexual pleasure, receptive anal intercourse, history of sexual coercion, no prior HIV-testing, and anti-HSV-1 and 2 and Treponema pallidum positivity at baseline. Multivariate risk factors for HIV-incidence were younger age, living alone or with roommate (vs. with a partner or family), drug use for sexual pleasure, inconsistent condom use, receptive anal intercourse, group sex, and anti-HSV-1 and 2 and T. pallidum positivity at baseline. Having no anal intercourse partners was inversely associated with HIV-incidence. CONCLUSION The high HIV prevalence and incidence in this cohort of Bangkok MSM documents an explosive epidemic. Additional preventive interventions for MSM are urgently needed.
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Pearson CR, Walters KL, Simoni JM, Beltran R, Nelson KM. A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. AIDS Educ Prev 2013; 25:25-37. [PMID: 23387949 PMCID: PMC3951888 DOI: 10.1521/aeap.2013.25.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.
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Affiliation(s)
- Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA 98105, USA.
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Kelly JA, St Lawrence JS, Amirkhanian YA, DiFranceisco WJ, Anderson-Lamb M, Garcia LI, Nguyen MT. Levels and predictors of HIV risk behavior among Black men who have sex with men. AIDS Educ Prev 2013; 25:49-61. [PMID: 23387951 PMCID: PMC4067001 DOI: 10.1521/aeap.2013.25.1.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Black men who have sex with men (MSM) contract HIV at disproportionately high rates, and National HIV/AIDS Strategy goals to reduce HIV incidence cannot be successful without improved HIV prevention among racial minority MSM. A total of 210 Black MSM from three cities (Cleveland, Miami, and Milwaukee) completed measures assessing their sexual behavior and demographic characteristics, as well as AIDS-specific psychosocial scales, broader contextual domains, and substance use. Nearly 50% of men reported recent unprotected anal intercourse (UAI), often with non-main partners, with partners not known to be HIV seroconcordant, or with multiple partners. Thirty-seven percent of men reported being HIV positive. In multiple regression analyses, higher levels of unprotected behavior were predicted by weaker perceived peer norms for condom use, weaker risk reduction behavioral intentions, being HIV negative, and recent use of marijuana, cocaine/crack, and poppers. Greater number of UAI partners was associated with weaker perceived peer condom use norms, lower risk reduction intentions, illicit use of prescribed opiates, and fewer AIDS conspiracy beliefs. These findings suggest important factors that should be targeted in HIV prevention programs for Black MSM.
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Affiliation(s)
- Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA.
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Chow EPF, Gao L, Koo FK, Chen L, Fu X, Jing J, Wilson DP, Zhang L. Qualitative exploration of HIV-related sexual behaviours and multiple partnerships among Chinese men who have sex with men living in a rural area of Yunnan Province, China. Sex Health 2013; 10:533-40. [DOI: 10.1071/sh13097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
Abstract
BackgroundThe HIV epidemic has been spreading rapidly among men who have sex with men (MSM) in China. The present study explored the pattern of HIV-related high-risk sexual practices among MSM in a rural Chinese setting. Methods: Data were collected by semistructured in-depth interviews conducted among 15 MSM in Yuxi Prefecture, Yunnan Province, China. Fifteen respondents were recruited through a local non-governmental organisation via purposive sampling. Thematic analysis was used. Results: Technological changes, risk behaviours, social stigma and high migration rates have played a significant role in the spread of HIV among MSM in rural China. The Internet has become the primary channel for soliciting casual sex partners in the MSM community. Bisexuality and having concurrent and multiple sexual partners were common among rural MSM. A large number of sexual partners and low condom use in all MSM partnership types were noted. Due to Chinese cultural traditions and social stigma, Chinese rural MSM were reluctant to disclose their homosexuality. Rural-to-urban migrant MSM were often engaged in the commercial sex trade. Conclusions: Rural MSM is a distinctive and complex population with multiple identities in China. Concurrent multiple sexual partnerships, high mobility and low disclosure rate are the major challenges for HIV prevention and intervention programs in MSM.
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Herrick AL, Lim SH, Plankey MW, Chmiel JS, Guadamuz TE, Guadamuz TT, Kao U, Shoptaw S, Carrico A, Ostrow D, Stall R. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health 2012; 103:79-85. [PMID: 23153154 DOI: 10.2105/ajph.2012.300810] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. METHODS Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. RESULTS Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ(2) = 247.94; P < .001; df = 22). CONCLUSIONS We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.
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Affiliation(s)
- Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Tobin K, Kuramoto SJ, German D, Fields E, Spikes PS, Patterson J, Latkin C. Unity in diversity: results of a randomized clinical culturally tailored pilot HIV prevention intervention trial in Baltimore, Maryland, for African American men who have sex with men. Health Educ Behav 2012; 40:286-95. [PMID: 22984216 DOI: 10.1177/1090198112452125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/Black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days, and willing to test for HIV. Retention exceeded 95% at 3-month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status, and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV-negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (adjusted odds ratio [AOR] = 3.03, 95% confidence interval [CI] = 1.26-7.28), condom use with male partners (AOR = 2.64, 95% CI = 0.95-7.36), and HIV-negative/unknown status partners (AOR = 3.19, 95% CI = 0.98-10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV.
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Affiliation(s)
- Karin Tobin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Marshall BDL, Paczkowski MM, Seemann L, Tempalski B, Pouget ER, Galea S, Friedman SR. A complex systems approach to evaluate HIV prevention in metropolitan areas: preliminary implications for combination intervention strategies. PLoS One 2012; 7:e44833. [PMID: 23028637 PMCID: PMC3441492 DOI: 10.1371/journal.pone.0044833] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV transmission among injecting and non-injecting drug users (IDU, NIDU) is a significant public health problem. Continuing propagation in endemic settings and emerging regional outbreaks have indicated the need for comprehensive and coordinated HIV prevention. We describe the development of a conceptual framework and calibration of an agent-based model (ABM) to examine how combinations of interventions may reduce and potentially eliminate HIV transmission among drug-using populations. METHODOLOGY/PRINCIPAL FINDINGS A multidisciplinary team of researchers from epidemiology, sociology, geography, and mathematics developed a conceptual framework based on prior ethnographic and epidemiologic research. An ABM was constructed and calibrated through an iterative design and verification process. In the model, "agents" represent IDU, NIDU, and non-drug users who interact with each other and within risk networks, engaging in sexual and, for IDUs, injection-related risk behavior over time. Agents also interact with simulated HIV prevention interventions (e.g., syringe exchange programs, substance abuse treatment, HIV testing) and initiate antiretroviral treatment (ART) in a stochastic manner. The model was constructed to represent the New York metropolitan statistical area (MSA) population, and calibrated by comparing output trajectories for various outcomes (e.g., IDU/NIDU prevalence, HIV prevalence and incidence) against previously validated MSA-level data. The model closely approximated HIV trajectories in IDU and NIDU observed in New York City between 1992 and 2002, including a linear decrease in HIV prevalence among IDUs. Exploratory results are consistent with empirical studies demonstrating that the effectiveness of a combination of interventions, including syringe exchange expansion and ART provision, dramatically reduced HIV prevalence among IDUs during this time period. CONCLUSIONS/SIGNIFICANCE Complex systems models of adaptive HIV transmission dynamics can be used to identify potential collective benefits of hypothetical combination prevention interventions. Future work will seek to inform novel strategies that may lead to more effective and equitable HIV prevention strategies for drug-using populations.
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Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
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Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, Chmiel JS, Herrick A, Stall R. Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health 2012; 89:697-708. [PMID: 22383094 PMCID: PMC3535137 DOI: 10.1007/s11524-012-9674-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.
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Affiliation(s)
- Typhanye Penniman Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.
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