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Li C, Xiong Y, Liu H, Luo D, Tucker JD, Maman S, Matthews DD, Fisher EB, Tang W, Muessig KE. Multifaceted Barriers to Rapid Roll-out of HIV Pre-exposure Prophylaxis in China: A Qualitative Study Among Men Who Have Sex with Men. Int J Behav Med 2024; 31:252-262. [PMID: 37156941 PMCID: PMC10166630 DOI: 10.1007/s12529-023-10177-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Oral pre-exposure prophylaxis (PrEP) as a safe and effective antiretroviral medicine-based prevention against HIV has not been widely adopted by gay, bisexual, and other men who have sex with men (MSM) in China. A deeper understanding of barriers and facilitators to PrEP uptake is needed to inform the development of effective interventions. METHOD During July-August 2020, we conducted one-on-one semi-structured interviews with 31 Chinese MSM with varied PrEP use experiences (PrEP-naïve, former, and current PrEP users). Interviews were digitally recorded and transcribed in Chinese. Informed by the Information-Motivation-Behavioral Skills Model (IMB), we analyzed the data using a thematic analysis approach to identify the barriers and facilitators to PrEP uptake among Chinese MSM. RESULTS Major barriers to PrEP uptake among MSM in the sample included uncertainty about PrEP efficacy and lack of PrEP education (information), concerns over potential side effects and cost (motivation), and difficulties in identifying authentic PrEP medications and managing PrEP care (behavioral skills). Facilitators include the perceived benefit of PrEP in improving the quality of sex life and control over health. At the contextual level, we also identified barriers to PrEP access from a thriving informal PrEP market and stressors related to being MSM. CONCLUSION Our findings identified a need to invest in non-discriminatory public health messaging of PrEP, explore options for MSM-friendly provision of PrEP outside of traditional HIV care settings, and be attentive to the unique context of an established informal PrEP market in future PrEP initiatives.
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Affiliation(s)
- Chunyan Li
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US.
- Tokyo College, the University of Tokyo, Tokyo, Japan.
| | - Yuan Xiong
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- University of North Carolina Project China, Guangzhou, China
| | - Honglin Liu
- Shenzhen Aitongxing Health Center, Shenzhen, China
| | - Danyang Luo
- University of North Carolina Project China, Guangzhou, China
| | - Joseph D Tucker
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Clinical Research, The London School of Hygiene & Tropical Medicine, London, UK
- University of North Carolina Project China, Guangzhou, China
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | - Weiming Tang
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project China, Guangzhou, China
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US
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Dawes HC, Eden TM, Hall WJ, Srivastava A, Williams DY, Matthews DD. Which types of social support matter for Black sexual minority men coping with internalized homophobia? Findings from a mediation analysis. Front Psychol 2024; 15:1235920. [PMID: 38379621 PMCID: PMC10876838 DOI: 10.3389/fpsyg.2024.1235920] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
Background Minority stress theory views social support as a protective factor against the effects of minority-specific stressors like internalized homophobia (IH) on mental health in sexual minority populations. However, much of the empirical validation of this theory has been conducted within predominantly White samples, resulting in a limited understanding of how the theory applies to Black sexual minority individuals. Current examinations of social support fail to capture the nuances of how Black sexual minority men may access support systems differently, resulting in a need to investigate how social support, IH, and mental health operate for Black sexual minority men. This study examined relationships between IH, depression, and different types of social support (i.e., family, friends, Black community, gay community) using a mediation model. Methods We used data from the POWER (Promoting Our Worth Equity and Resilience) Study, which recruited Black sexual minority men at Black Pride events across six cities in the United States from 2014 to 2017, to test four mediation pathways concurrently in Stata 17. Participants (N = 4,430) completed a questionnaire assessing a variety of health and life domains, including depression symptoms, internalized homophobia, and social support. Results IH was positively associated with depression. Lower levels of family, friend, and Black community support were all positively associated with depression symptoms. Additionally, IH was positively associated with all types of support. Finally, family, friend, and Black community support partially mediated the relationship between IH and depression. Conclusions and implications Results suggest that the relationship between social support and depression is complex for Black sexual minority men. Findings suggest family support is an important factor for clinical intervention efforts targeting depression, and that gay community support systems should assess how their environments can better support Black sexual minority men. Overall, findings demonstrate the necessity of future examination of how social support functions differently within Black sexual minority communities.
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Affiliation(s)
- Hayden C. Dawes
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tiffany M. Eden
- Department of Public Mental Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, United States
| | - William J. Hall
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ankur Srivastava
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Denise Yookong Williams
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Derrick D. Matthews
- Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Qian Y, Matthews DD, Fisher EB, Muessig KE, Song L, Kent EE. Associations Among Family Caregivers' Perceptions of Loneliness, Choice, and Purpose: a Comparative Analysis Between Non-Hispanic Black Caregivers and Non-Hispanic White Caregivers in a Population-Based Sample. Int J Behav Med 2024:10.1007/s12529-023-10246-2. [PMID: 38261233 DOI: 10.1007/s12529-023-10246-2] [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] [Accepted: 12/04/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Loneliness is a frequent experience among family members engaging in caregiving responsibilities and may vary across racial and ethnic groups. This study aimed to examine (a) the difference in loneliness between non-Hispanic Black and non-Hispanic White caregivers, (b) the associations between loneliness and perceptions of choice and purpose in caregiving, and (c) whether those associations with loneliness differ by caregivers' race. METHOD Descriptive statistics and ordinal logistic regression were conducted in a population-based sample of 1000 caregivers (Black caregivers, n = 199; White caregivers, n = 801) from the 2020 Caregiving in the U.S. STUDY The survey design was properly addressed. Key variables included loneliness (level of feeling alone about being a caregiver), choice (whether or not reporting a choice in taking on the caregiver responsibility), sense of purpose (level of purpose/meaning in life from caregiving), and race (Black/White). Models adjusted for caregiving characteristics (e.g., hour of caregiving) and sociodemographic characteristics (e.g., age and education). RESULTS Black caregivers had lower odds of reporting a higher level vs. a lower level of loneliness than White caregivers (aOR = 0.67, 95%CI = 0.47, 0.96). Reporting having no choice was associated with higher odds of a higher level of loneliness (aOR, 0.77, 95%CI = 0.67, 0.88). Higher sense of purpose scores were associated with lower odds of a higher level of loneliness (aOR = 0.81, 95%CI = 0.71, 0.93). No significant moderation effects of race were found. CONCLUSION Black caregivers reported lower loneliness scores than White caregivers. Reporting no choice and lower sense of purpose were associated with higher loneliness in both racial groups.
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Affiliation(s)
- Yiqing Qian
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, USA.
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | - Lixin Song
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Li C, Xiong Y, Maman S, Matthews DD, Fisher EB, Tang W, Huang H, Mu T, Tong X, Yu J, Yang Z, Sherer R, Hazra A, Lio J, Li L, Tucker JD, Muessig KE. An instant messaging mobile phone application for promoting HIV pre-exposure prophylaxis uptake among Chinese gay, bisexual and other men who have sex with men: A mixed methods feasibility and piloting randomized controlled trial study. PLoS One 2023; 18:e0285036. [PMID: 37956177 PMCID: PMC10642832 DOI: 10.1371/journal.pone.0285036] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 04/18/2023] [Accepted: 08/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) is a promising intervention mode for HIV prevention, but little is known about its feasibility and effects in promoting pre-exposure prophylaxis (PrEP) uptake among Chinese gay, bisexual and other men who have sex with men (GBMSM). METHODS We evaluated an instant messaging application using a WeChat-based mini-app to promote PrEP uptake among GBMSM via a mixed-methods design that includes a 12-week, two-arm randomized controlled pilot trial and in-depth progress interviews in Guangzhou, China. Primary outcomes include the number of PrEP initiations, individual-level psychosocial variables related to PrEP initiation, and usability of the PrEP mini-app. RESULTS Between November 2020 and April 2021, 70 GBMSM were successfully enrolled and randomized into two arms at 2:1 ratio (46 to the intervention arm, 24 to the control arm). By the end of 12-week follow-up, 22 (31.4%) participants completed the initial consultation and lab tests for PrEP, and 13 (18.6%) filled their initial PrEP prescription. We observed modest but non-significant improvements in participants' intention to use PrEP, actual PrEP initiation, PrEP-related self-efficacy, stigma, and attitudes over 12 weeks when comparing the mini-app and the control arms. Qualitative interviews revealed the key barriers to PrEP uptake include anticipated stigma and discrimination in clinical settings, burden of PrEP care, and limited operating hours of the PrEP clinic. In-person clinic navigation support was highly valued. CONCLUSIONS This pilot trial of a mobile phone-based PrEP mini-app demonstrated feasibility and identified limitations in facilitating PrEP uptake among Chinese GBMSM. Future improvements may include diversifying the content presentation in engaging media formats, adding user engagement features, and providing off-line in-clinic navigation support during initial PrEP visit. More efforts are needed to understand optimal strategies to identify and implement alternative PrEP provision models especially in highly stigmatized settings with diverse needs. TRIAL REGISTRATION Trial registration: The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June, 2020.
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Affiliation(s)
- Chunyan Li
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Tokyo College, The University of Tokyo, Tokyo, Japan
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Yuan Xiong
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Derrick D. Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Edwin B. Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haojie Huang
- Wuhan Tongxing LGBTQ Center, Wuhan, Hubei, China
| | - Tong Mu
- Qingdao Eighth People’s Hospital, Qingdao, Shandong, China
| | - Xiaokai Tong
- Xi’an Polytechnic University, Xi’an, Shannxi, China
| | | | - Zeyu Yang
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
| | - Renslow Sherer
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Aniruddha Hazra
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Number Eight People’s Hospital, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill, Project-China, Guangzhou, Guangdong, China
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Efird CR, Barrington C, Metzl JM, Muessig KE, Matthews DD, Lightfoot AF. "We grew up in the church": A critical discourse analysis of Black and White rural residents' perceptions of mental health. Soc Sci Med 2023; 336:116245. [PMID: 37793270 DOI: 10.1016/j.socscimed.2023.116245] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
RATIONALE Known as the "Black-White mental health paradox," Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. OBJECTIVE The purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. METHODS We conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. RESULTS White rural residents' condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. CONCLUSIONS Our findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations.
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Affiliation(s)
- Caroline R Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan M Metzl
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
| | | | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Davis DA, Muessig KE, Matthews DD, Angeles G, McNaughton-Reyes L, Guzmán K, Northbrook S, Barrington C. 'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV. Health Promot Int 2023; 38:daab188. [PMID: 34849870 PMCID: PMC9233178 DOI: 10.1093/heapro/daab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 11/14/2022] Open
Abstract
Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.
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Affiliation(s)
- Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Karla Guzmán
- HIV Central America Regional Program, Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sanny Northbrook
- US Center for Disease Control and Prevention (CDC) Central America Region, 11 calle 15-79, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
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Chandler CJ, Liu Q, Brown AL, Matthews DD, Tsai AC, Bukowski LA, Eaton LA, Stall RD, Friedman MR. Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black Sexual Minority Men. Stigma Health 2023; 8:372-380. [PMID: 37789829 PMCID: PMC10545331 DOI: 10.1037/sah0000435] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
This secondary analysis of a mixed serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status or some "other" reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality and Resilience (POWER), a serial, cross-sectional study conducted between 2014-2017 (N=4430). Experiences of multiple stigmas were reported by n=938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with "other" stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and SES, particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM, but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.
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Affiliation(s)
- Cristian J. Chandler
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Qimin Liu
- Psychological Sciences, Vanderbilt University 2301 Vanderbilt Place · Nashville, TN 37240-7817, USA
| | - Andre L. Brown
- Behavioral and Community Health Science, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - Derrick D. Matthews
- Health Behavior, Gillings School of Public Health, University of North Carolina, 361 Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital 100 Cambridge St Suite 1600, Boston, MA 02114, USA
| | - Leigh A. Bukowski
- Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street Scaife Hall, Suite 600 Pittsburgh, PA 15213, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Rd, Storrs, CT 06269-1248, USA
| | - Ronald D. Stall
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
- Center for LGBT Health Research, 130 DeSoto Street, Pittsburgh, PA, 15260, USA
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Polston PM, Matthews DD, Golden SD, Golin CE, Hall MG, Saint-Phard E, Lightfoot AF. Institutional Reform to Promote Antiracism: A Tool for Developing an Organizational Equity Action and Accountability Plan. Prev Chronic Dis 2023; 20:E50. [PMID: 37319342 DOI: 10.5888/pcd20.220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Racism is a public health problem. Systems, structures, policies, and practices perpetuate a culture built on racism. Institutional reform is needed to promote antiracism. This article describes 1) a tool used to develop an equity action and accountability plan (EAAP) that promotes antiracism in the Department of Health Behavior at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health, 2) strategies that were developed, and 3) short-term outcomes and lessons learned. A study coordinator, not affiliated with the Department of Health Behavior, was hired to collect qualitative data that documented the lived experiences of students and alumni of color (ie, racial and ethnic minority students) over time in the department. Seeking action from faculty and departmental leadership, students engaged in collective organizing covered the department chair's office door with notes describing microaggressions, and visited faculty one-on-one to demand action. In response, 6 faculty members volunteered to form the Equity Task Force (ETF) to explicitly address students' concerns. The ETF identified priority areas for action based on 2 student-led reports, gathered resources from other institutions and the public health literature, and examined departmental policies and procedures. The ETF drafted the EAAP, solicited feedback, and revised it according to 6 priority strategies with actionable steps: 1) transform culture and climate, 2) enhance teaching, mentoring, and training, 3) revisit performance and evaluation of faculty and staff, 4) strengthen recruitment and retention of faculty of color, 5) increase transparency in student hiring practices and financial resources, and 6) improve equity-oriented research practices. This planning tool and process can be used by other institutions to achieve antiracist reform.
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Affiliation(s)
- Patsy M Polston
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Rosenau Hall, Room 302, Campus Box 7440, 135 Dauer Dr, Chapel Hill, NC 27599-7440
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Emmanuel Saint-Phard
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Alexandra F Lightfoot
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Eden TM, Smallwood SW, Matthews DD. Using a Measurement Model to Reconceptualize the Church Experiences of Black Men who have Sex with Men. J Relig Health 2023; 62:2213-2225. [PMID: 36260262 PMCID: PMC10113399 DOI: 10.1007/s10943-022-01671-w] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Religious spaces have proven to be effective sites of health intervention among Black Americans. Less is known about how religious environments impact the health of subgroups of Black Americans, specifically Black men who have sex with men (MSM). Using data from the Promoting Our Worth, Equality, and Resilience study, we explored the factor structure of a 10-item religious environment scale among Black MSM (N = 2,482). Exploratory factor analysis revealed three distinct factors: (1) visibility of MSM, (2) structural support, and (3) structural homonegativity. The relationship between Black MSM and their religious environments is complex and should be investigated using measures that accurately reflect their lived experiences.
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Affiliation(s)
- Tiffany M Eden
- Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Stacy W Smallwood
- Department of Health Policy & Community Health, Georgia Southern University, Statesboro, GA, USA
| | - Derrick D Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
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Coulter-Thompson EI, Matthews DD, Applegate J, Broder-Fingert S, Dubé K. Survey of Lesbian, Gay, Bisexual, Transgender, and Queer Parents' Experiences Accessing Health Care for their Children With Developmental Disabilities. J Pediatr Health Care 2023; 37:291-301. [PMID: 36914456 DOI: 10.1016/j.pedhc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 03/16/2023]
Abstract
INTRODUCTION This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with developmental disabilities. METHOD We conducted a national online survey of LGBTQ parents of children with developmental disabilities using social media and professional networks. Descriptive statistics were compiled. Open-ended responses were coded using inductive and deductive approaches. RESULTS Thirty-seven parents completed the survey. Most participants identified as highly educated, White, lesbian or queer, cisgender women and reported positive experiences. Some reported bias and discrimination, including heterosexist forms, LGBTQ disclosure challenges, and, because of their LGBTQ identity, feeling mistreated by their children's providers or being refused needed HC for their child. DISCUSSION This study advances knowledge around LGBTQ parents' experiences of bias and discrimination while accessing children's HC. Findings highlight the need for additional research, policy change, and workforce development to improve HC for LGBTQ families.
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Efird CR, Matthews DD, Muessig KE, Barrington CL, Metzl JM, Lightfoot AF. Rural and nonrural racial variation in mentally unhealthy days: Findings from the behavioral risk factor surveillance system in North Carolina, 2015–2019. SSM - Mental Health 2023. [DOI: 10.1016/j.ssmmh.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Coulter-Thompson EI, Matthews DD, Applegate J, Broder-Fingert S, Dubé K. Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. J Pediatr Health Care 2023; 37:5-16. [PMID: 36184374 DOI: 10.1016/j.pedhc.2022.09.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with disabilities in the United States, including the timing of developmental screening and diagnosis. METHOD We conducted semistructured interviews with 16 LGBTQ parents of children with developmental concerns or disabilities recruited through a prior national survey. Interviews were transcribed and analyzed using a combined inductive and deductive approach. RESULTS Discrimination types reported included noninclusive forms, disclosure challenges, and providers dismissing nongestational parents and diverse families. Few parents reported screening and diagnosis delays. Parents' recommendations included: avoiding assumptions, honoring family diversity, increasing LGBTQ family support, improving HC forms, increasing antibias training, and convening a learning community. DISCUSSION Our study advances the knowledge around HC bias and discrimination among LGBTQ parents of children with disabilities. Findings highlight the need for increased LGBTQ-affirming family support and research representing LGBTQ family diversity in U.S. health care.
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Affiliation(s)
- Emilee I Coulter-Thompson
- Emilee I. Coulter-Thompson, Manager, Research, Education, and Career Development, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI.
| | - Derrick D Matthews
- Derrick D. Matthews, Assistant Professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Julia Applegate
- Julia Applegate, Senior Lecturer, the Ohio State University, Columbus, OH
| | - Sarabeth Broder-Fingert
- Sarabeth Broder-Fingert, Associate Professor, University of Massachusetts Chan Medical School, Worcester, MA
| | - Karine Dubé
- Karine Dubé, Assistant Professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
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13
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Li C, Xiong Y, Muessig KE, Tang W, Huang H, Mu T, Tong X, Yu J, Yang Z, Sherer R, Hazra A, Lio J, Matthews DD, Fisher EB, Li L, Tucker JD. Community-engaged mHealth intervention to increase uptake of HIV pre-exposure prophylaxis (PrEP) among gay, bisexual and other men who have sex with men in China: study protocol for a pilot randomised controlled trial. BMJ Open 2022; 12:e055899. [PMID: 35537794 PMCID: PMC9092176 DOI: 10.1136/bmjopen-2021-055899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The large number of key populations in China who would benefit from HIV pre-exposure prophylaxis (PrEP) in the context of limited health system capacity and public awareness will pose challenges for timely PrEP scale-up, suggesting an urgent need for innovative and accessible interventions. This study aims to develop and pilot test a theory-informed, tailored mobile phone intervention that was codeveloped by young gay men, HIV clinicians and public health researchers to increase engagement in PrEP education and initiation among Chinese gay, bisexual and other men who have sex with men (GBMSM), who bear a disproportionate burden of HIV infections and remain underserved in the healthcare system. METHODS AND ANALYSIS This two-phase study includes a formative assessment using in-depth interviews (N=30) and a 12-week experimental pilot study using a two-arm randomised controlled trial design (N=70). The primary intervention is delivered through a WeChat-based mini-app (a program built into a Chinese multipurpose social media application) developed by young GBMSM from a 2019 crowdsourcing hackathon. Using mixed methods, we will further investigate the specific needs and concerns among GBMSM in terms of using PrEP as an HIV prevention strategy, how their concerns and PrEP use behaviours may change with exposure to the mini-app intervention during the study period and how we can further refine this intervention tool to better meet GBMSM's needs for broader implementation. ETHICS AND DISSEMINATION This study and its protocols have been reviewed and approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, USA (19-3481), the Guangdong Provincial Dermatology Hospital, China (2020031) and the Guangzhou Eighth People's Hospital, China (202022155). Study staff will work with local GBMSM community-based organisations to disseminate the study results to participants and the community via social media, workshops and journal publications. TRIAL REGISTRATION NUMBER The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June 2020.
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Affiliation(s)
- Chunyan Li
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Yuan Xiong
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Haojie Huang
- Wuhan Tongxing LGBTQ Center, Wuhan, Hubei, China
| | - Tong Mu
- Qingdao Eighth People's Hospital, Qingdao, Shandong, China
| | - Xiaokai Tong
- Xi'an Polytechnic University, Xi'an, Shaanxi, China
| | | | - Zeyu Yang
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Renslow Sherer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Aniruddha Hazra
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Derrick D Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Linghua Li
- Infectious Diseases Research Department, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- Institute of Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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14
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Brown AL, Matthews DD, Meanley S, Brennan-Ing M, Haberlen S, D’Souza G, Ware D, Egan J, Shoptaw S, Teplin LA, Friedman M, Plankey M. The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men. Stigma Health 2022; 7:113-121. [PMID: 35935592 PMCID: PMC9355118 DOI: 10.1037/sah0000327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.
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Affiliation(s)
- Andre L. Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | | | - Mark Brennan-Ing
- Roosevelt House Public Policy Institute at Hunter College, City University of New York
| | | | | | - Deanna Ware
- Department of Epidemiology, Georgetown University
| | - James Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | - Steve Shoptaw
- Department of Family Medicine, University of California Los Angeles
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh
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15
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Meanley SP, Plankey MW, Matthews DD, Hawk ME, Egan JE, Teplin LA, Shoptaw SJ, Surkan PJ, Stall RD. Lifetime Prevalence and Sociodemographic Correlates of Multifactorial Discrimination Among Middle-Aged and Older Adult Men Who Have Sex with Men. J Homosex 2021; 68:1591-1608. [PMID: 31860386 PMCID: PMC7305044 DOI: 10.1080/00918369.2019.1702353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study describes multifactorial discrimination (discrimination attributed to multiple social identities) among middle-aged and older adult MSM. MSM aged 40+ years (N = 1,193) enrolled in the Multicenter AIDS Cohort Study completed behavioral surveys ascertaining experiences of discrimination and their social identity attributions. Non-proportional odds regressions assessed multifactorial discrimination by age, race/ethnicity, HIV status, and covariates. Twenty-seven percent of participants reported multifactorial discrimination. Adjusted models indicated that middle-aged men were more likely to report multifactorial discrimination compared to older adult men. Racial/ethnic minorities were more likely to report multifactorial discrimination compared to non-Hispanic white participants. These same patterns emerged among the sub-sample of participants living with HIV. To our knowledge, this is the first assessment of multifactorial discrimination in middle-aged and older MSM. Our findings support the deleterious association between multiple-marginalization and multifactorial discrimination. Multilevel interventions targeting interconnected experiences of stigma may improve the health of MSM in transition to older age.
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Affiliation(s)
- Steven P. Meanley
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA
| | - Michael W. Plankey
- Georgetown University Department of Medicine, Division of Infectious Diseases, Washington, DC
| | - Derrick D. Matthews
- University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, Pittsburgh, PA
| | - Mary E. Hawk
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - James E. Egan
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Linda A. Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Steven J. Shoptaw
- University of California – Los Angeles, Department of Family Medicine and Psychiatry and Biobehavioral Sciences, Los Angeles, CA
| | - Pamela J. Surkan
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | - Ron D. Stall
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
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16
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McGuire FH, Carl A, Woodcock L, Frey L, Dake E, Matthews DD, Russell KJ, Adkins D. Differences in Patient and Parent Informant Reports of Depression and Anxiety Symptoms in a Clinical Sample of Transgender and Gender Diverse Youth. LGBT Health 2021; 8:404-411. [PMID: 34388043 DOI: 10.1089/lgbt.2020.0478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: We assessed characteristics of patients at a pediatric gender clinic and investigated if reports of mental health concerns provided by transgender and gender diverse (TGD) youth patients differed from reports provided by a parent informant on their behalf. Methods: This cross-sectional study included 259 TGD patients 8 to 22 years of age attending a pediatric gender clinic in the southeast United States from 2015 to 2020. Pearson correlations and paired sample t-tests compared patient-reported mental health concerns at patient intake with those provided by a parent informant. Clinical symptom severity was assessed with standardized T-scores. Level 2 Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression Scale and Level 2 PROMIS Emotional Distress-Anxiety Scale assessed depression and anxiety symptoms of patients. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure was used with parents. Results: Patients had a mean age of 14.9 at first visit, with most identifying as White (85.5%), non-Hispanic (91.1%), and as a boy or man (63.6%). Half had moderate-to-severe depression (51.2%) or anxiety (47.9%) symptoms. There was a moderate, positive correlation between patient-reported and parent-reported depression symptoms, with no correlation for anxiety symptoms. Informant type differences were statistically significant (patients reporting greater depression and anxiety symptoms). Conclusions: TGD youth patients reported more severe depression and anxiety symptoms compared with parent informants. Despite moderate agreement on depression symptoms, parents did not accurately detect their child's anxiety symptoms. These discrepancies highlight a need for interventions which increase parental recognition of child mental health status.
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Affiliation(s)
- F Hunter McGuire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alexandra Carl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lindsay Woodcock
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren Frey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Dake
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristen J Russell
- Clinical Social Work Division, Department of Case Management, Duke University Medical Center, Durham, North Carolina, USA
| | - Deanna Adkins
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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17
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Sang JM, Egan JE, Meanley SP, Hawk ME, Markovic N, Bear TM, Matthews DD, Bauermeister JA. Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships. J Community Psychol 2021; 49:1732-1747. [PMID: 33608960 PMCID: PMC8316259 DOI: 10.1002/jcop.22522] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 06/03/2023]
Abstract
We developed measures of relational beliefs and expectations among single young gay and bisexual men (YGBM). Data come from an online cross-sectional study YGBM, which ran from July 2012 until January 2013. There were 50 items on relational beliefs and 25 items on relational expectations. We used random split samples and a priori analysis to group items together and applied principal axis factoring with varimax orthogonal rotation. We had a total N = 1582 in our analytical sample and identified six constructs of relational expectations (restrictions, negative break up, masculine and gender norms, optimism, cheating, immediacy) and two constructs of relational beliefs (sex beliefs, equality). Our findings highlight specific relational cognitions among YGBM and offer insight into the beliefs and expectations that may inform their relationships. Findings may be useful for health professionals to help YGBM reflect and understand the health implications of their beliefs and expectations about same-sex relationships to promote healthy decision-making as they seek future partners.
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Affiliation(s)
- Jordan M. Sang
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven P. Meanley
- School of Nursing, University of Pennsylvania, Pittsburgh, Pennsylvania, USA
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary E. Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nina Markovic
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Dental Medicine, University of Pittsburgh, Philadelphia, Pennsylvania, USA
| | - Todd M. Bear
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derrick D. Matthews
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - José A. Bauermeister
- School of Nursing, University of Pennsylvania, Pittsburgh, Pennsylvania, USA
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. Arch Sex Behav 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
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Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Davis DA, Angeles G, McNaughton-Reyes L, Matthews DD, Muessig KE, Northbrook S, Barrington C. Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala. AIDS Patient Care STDS 2021; 35:126-133. [PMID: 33835850 DOI: 10.1089/apc.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps.
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Affiliation(s)
- Dirk A. Davis
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Derrick D. Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sanny Northbrook
- United States Center for Disease Control and Prevention Central America Region, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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20
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Matthews DD, Sang JM, Chandler CJ, Bukowski LA, Friedman MR, Eaton LA, Stall RD. Black Men Who Have Sex with Men and Lifetime HIV Testing: Characterizing the Reasons and Consequences of Having Never Tested for HIV. Prev Sci 2020; 20:1098-1102. [PMID: 31089952 DOI: 10.1007/s11121-019-01022-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/24/2023]
Abstract
HIV testing remains a critical point of entry to HIV treatment services and now biomedical prevention as well. Yet despite the high HIV prevalence among Black men who have sex with men (MSM), insufficient attention has been given to factors associated with those Black MSM in the United States who have never received an HIV test in their lifetime. Promoting Our Worth, Equality, & Resilience (POWER) is a cross-sectional observational study that recruited Black MSM at Black Pride events across six cities in the United States from 2014 to 2017. Participants completed an anonymous questionnaire and were offered free, confidential HIV testing. Of the 4174 Black MSM without a prior HIV diagnosis, 404 (9.68%) had never tested for HIV (mean age = 31.03 years). Lower education and greater internalized homophobia were associated with never having tested for HIV. Higher age (AOR = 1.05, 95%, 1.02-1.07) and assumption of HIV-positivity (AOR = 3.24, 95% CI 1.53-6.84) were both associated with increased odds of an HIV-positive test result (n = 119; 36%). To compare, HIV prevalence among Black MSM who had received at least one HIV test before study participation was 23%. While a minority of Black MSM had never received an HIV test, this group had a significantly higher likelihood of HIV infection. Alternative HIV testing strategies are needed to facilitate HIV testing initiation among Black MSM for whom conventional HIV testing modalities are insufficient.
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Affiliation(s)
- Derrick D Matthews
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Jordan M Sang
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Cristian J Chandler
- Department of Epidemiology, Emory University Rollins School of Public Health, Druid Hills, GA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Mansfield, CT, USA
| | - Ron D Stall
- Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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21
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Meanley SP, Stall RD, Hawk ME, Surkan PJ, Shoptaw SJ, Matthews DD, Teplin LA, Egan JE, Plankey MW. Multifactorial discrimination, discrimination salience, and prevalent experiences of internalized homophobia in middle-aged and older MSM. Aging Ment Health 2020; 24:1167-1174. [PMID: 30938175 PMCID: PMC7041891 DOI: 10.1080/13607863.2019.1594161] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Received: 09/18/2018] [Revised: 01/11/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
Objectives: We sought to test whether discrimination salience and multifactorial discrimination were associated with prevalent experiences of internalized homophobia among middle-aged and older men who have sex with men (MSM).Methods: We analyzed data from 498 middle-aged and older MSM from the Multicenter AIDS Cohort Study (MACS) who reported any lifetime discrimination experience. We estimated the prevalence ratio of current internalized homophobia using multivariable Poisson regressions, accounting for discrimination salience, multifactorial discrimination, and covariates. We then assessed whether multifactorial discrimination moderated the association between discrimination salience and internalized homophobia.Results: Over half (56.4%) of our sample reported any current experience of internalized homophobia. More than two-thirds reported multifactorial discrimination (68.2%) and more than one-third (36.7%) reported moderate-to-high discrimination salience. Increases in discrimination salience (PR = 1.11; 95% CI: 1.03-1.20) were associated with any current internalized homophobia among middle-aged and older MSM. Multifactorial discrimination was not statistically associated with internalized homophobia and did not moderate the association between discrimination salience and internalized homophobia.Conclusions: Our study underscores internalized homophobia as a persisting concern among MSM in midlife and older adulthood. Our findings suggest that salience, as a characteristic of discrimination experiences, may have a greater impact on internalized homophobia compared with exposure. Future research efforts should assess facets of discrimination salience, such as severity, frequency, and chronicity, to better understand how discrimination shapes psychosocial well-being across the life course. Mental health advocates at policy, organizational, and community levels should aim to reduce intersectional stigma and address individual experiences of internalized homophobia.
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Affiliation(s)
- Steven P. Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ron D. Stall
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Mary E. Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven J. Shoptaw
- Department of Family Medicine and Psychiatry and Biobehavioral Sciences, University of California – Los Angeles, Los Angeles, CA, USA
| | - Derrick D. Matthews
- Department of Health Behavior, University of North Carolina – Chapel Hill, Chapel, Hill, NC, USA
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Michael W. Plankey
- Division of Infectious Diseases, Georgetown University Department of Medicine, Washington, DC, USA
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22
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Chandler CJ, Bukowski LA, Matthews DD, Hawk ME, Markovic N, Egan JE, Stall RD. Examining the Impact of a Psychosocial Syndemic on Past Six-Month HIV Screening Behavior of Black Men who have Sex with Men in the United States: Results from the POWER Study. AIDS Behav 2020; 24:428-436. [PMID: 30887191 DOI: 10.1007/s10461-019-02458-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Syndemic production theory has been used to explore HIV transmission risk or infections but has not been used to investigate prevention behavior, or with large samples of non-Whites. This analysis is the first to explore the impact of syndemic factors on previous six-month HIV screening behavior among US Black MSM. Data from Promoting Our Worth, Equality and Resilience (POWER) were analyzed from 3294 participants using syndemic variable counts and measures of interaction/synergy. Syndemic variables included: past three-month poly-drug use, depression, last year intimate partner violence, HIV risk and problematic binge drinking. BMSM reporting two syndemic factors were more likely to report screening (AOR = 1.37, 95% CI 1.04-1.80; p = 0.028) with no significant associations for three or more conditions. Measures of joint effect revealed that there were synergies among depression, problematic binge drinking and poly-drug use but these psychosocial factors cannot entirely explain testing patterns and excess disease burden among BMSM.
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23
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Creasy SL, Henderson ER, Bukowski LA, Matthews DD, Stall RD, Hawk ME. HIV Testing and ART Adherence Among Unstably Housed Black Men Who Have Sex with Men in the United States. AIDS Behav 2019; 23:3044-3051. [PMID: 31456200 DOI: 10.1007/s10461-019-02647-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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
Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12 months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6 months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.
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Affiliation(s)
- Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Emmett R Henderson
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald D Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St., Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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24
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Friedman MR, Sang JM, Bukowski LA, Chandler CJ, Egan JE, Eaton LA, Matthews DD, Ho K, Raymond HF, Stall R. Prevalence and Correlates of PrEP Awareness and Use Among Black Men Who Have Sex with Men and Women (MSMW) in the United States. AIDS Behav 2019; 23:2694-2705. [PMID: 30820849 PMCID: PMC6713621 DOI: 10.1007/s10461-019-02446-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/19/2022]
Abstract
Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014-2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p < 0.001). Among PrEP-aware MSM, MSMW were more likely than MSMO to report PrEP use (p < 0.05). MSMW receiving gay community support were more likely to be PrEP-aware (p < 0.01). MSMW reporting any past-year STI diagnoses were more likely to report PrEP use (p < 0.01). Findings suggest that PrEP awareness campaigns tailored for Black MSMW, concomitant with STI-to-PrEP interventions, will facilitate greater PrEP uptake in this population.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cristian J Chandler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James E Egan
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ken Ho
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Chandler CJ, Bukowski LA, Matthews DD, Hawk ME, Markovic N, Stall RD, Egan JE. Understanding the impact of a syndemic on the use of pre-exposure prophylaxis in a community-based sample of behaviorally PrEP-eligible BMSM in the United States. AIDS Care 2019; 32:551-556. [PMID: 31462067 DOI: 10.1080/09540121.2019.1659921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/06/2023]
Abstract
HIV Pre-Exposure Prophylaxis (PrEP) has shown great promise in reducing HIV transmission among affected populations; however, PrEP uptake among Black men who have sex with men (BMSM) has stalled. This study compares BMSM using PrEP and BMSM at risk for HIV not using PrEP based on differences in behavior, psychosocial conditions and the presence of a syndemic (n = 1,411). BMSM reporting PrEP use were significantly more likely to report three of five HIV risk behaviors and three of four psychosocial conditions. Odds of reporting PrEP use increased as the number of psychosocial conditions increased such that BMSM with three psychosocial conditions (AOR = 5.65, 95% CI: 3.17, 10.08) and four conditions (AOR = 18.34, 95% CI: 5.01, 67.20) demonstrated significantly greater odds of PrEP use compared to BMSM reporting one or less conditions. While BMSM at greatest risk are using PrEP, strategies are still needed for men at varying risk levels.
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Affiliation(s)
- Cristian J Chandler
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Yale University Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Human Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mary E Hawk
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Lee JGL, Landrine H, Martin RJ, Matthews DD, Averett PE, Niederdeppe J. Reasons for Caution When Emphasizing Health Disparities for Sexual and Gender Minority Adults in Public Health Campaigns. Am J Public Health 2019; 107:1223-1225. [PMID: 28700295 DOI: 10.2105/ajph.2017.303883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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]
Affiliation(s)
- Joseph G L Lee
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
| | - Hope Landrine
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
| | - Ryan J Martin
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
| | - Derrick D Matthews
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
| | - Paige E Averett
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
| | - Jeff Niederdeppe
- Joseph G. L. Lee and Ryan J. Martin are with the Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC. Hope Landrine is with the Center for Health Disparities, Brody School of Medicine, East Carolina University. Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Paige E. Averett is with the School of Social Work, College of Health and Human Performance, East Carolina University. Jeff Niederdeppe is with the Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY
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27
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Proulx CN, Coulter RW, Egan JE, Matthews DD, Mair C. Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students. J Adolesc Health 2019; 64:608-614. [PMID: 30691941 PMCID: PMC6478545 DOI: 10.1016/j.jadohealth.2018.11.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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] [Received: 06/05/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)-inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. METHODS Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. RESULTS After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]: .91, 95% confidence interval [CI]: .89-.93) and making a suicide plan (AOR: .79; 95% CI: .77-.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR: .83; CI: .71-.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR: .92; 95% CI: .87-.98). CONCLUSIONS Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels.
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Affiliation(s)
- Chelsea N. Proulx
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Jamie E. Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Derrick D. Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261,Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, United States 15261
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28
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Friedman MR, Bukowski L, Eaton LA, Matthews DD, Dyer TV, Siconolfi D, Stall R. Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support. Arch Sex Behav 2019; 48:213-224. [PMID: 29623533 PMCID: PMC6173653 DOI: 10.1007/s10508-018-1162-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/02/2018] [Accepted: 01/25/2018] [Indexed: 05/04/2023]
Abstract
Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.
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Affiliation(s)
- M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Leigh Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| | - Derrick D Matthews
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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29
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Sang JM, Matthews DD, Meanley SP, Eaton LA, Stall RD. Assessing HIV Stigma on Prevention Strategies for Black Men Who Have Sex with Men in the United States. AIDS Behav 2018; 22:3879-3886. [PMID: 29860555 DOI: 10.1007/s10461-018-2181-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/20/2023]
Abstract
The deleterious effects of HIV stigma on HIV+ Black MSM care continuum outcomes have been well-documented. How HIV stigma shapes HIV prevention for HIV- persons in this community is poorly understood. We sought to test the relationship of HIV stigma with HIV- Black MSM on HIV testing, pre-exposure prophylaxis (PrEP) awareness, and PrEP use. We recruited 772 participants at Black Pride events across five US cities in 2016. Multivariable logistic regression models assessed the association of external HIV stigma on prevention outcomes adjusting for sociodemographic variables. Stigma was positively associated with PrEP awareness (AOR = 1.34; 95% CI = 1.09, 1.66; p value = 0.005), and not associated with PrEP use or HIV testing in our sample. These findings highlight the complex nature of HIV stigma among BMSM and include results for PrEP, which can affect uptake other prevention methods. We support anti-HIV stigma efforts and advise further exploration on HIV stigma among BMSM and prevention outcomes.
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Affiliation(s)
- Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven P Meanley
- Program on Sexuality, Technology & Action Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Ron D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Chandler CJ, Sang JM, Bukowski LA, Andrade E, Eaton LA, Stall RD, Matthews DD. Characterizing the HIV care continuum among a community sample of black men who have sex with men in the United States. AIDS Care 2018; 31:816-820. [PMID: 30497280 DOI: 10.1080/09540121.2018.1549724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/27/2022]
Abstract
Black men who have sex with men (BMSM) have the highest HIV incidence rates among all men who have sex with men (MSM) and have been less likely than other MSM to be diagnosed, linked or retained in care for HIV. The Promoting Our Worth, Equality, and Resilience (POWER) study administered a behavioral health survey and HIV test to BMSM to estimate the HIV continuum of care among a community-derived sample. Of the N = 1,680 BMSM living with HIV, n = 956 (56.9%) were aware of their HIV-positive status. BMSM who had been previously diagnosed reported progression through the care continuum at greater than 80% for linkage to medical care (97.6%), retention in medical care (97.3%), prescription of antiretroviral therapy (93.6%) and viral suppression (86.4%). Results of this analysis reveal the urgent need to ensure BMSM are being screened and diagnosed. Additionally, community-driven samples are a promising method offering the opportunity to build on the resilience of BMSM progressing though the continuum as well as engage BMSM not yet in care. Lastly, such methods can assist in communicating with those lost to retention.
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Affiliation(s)
- Cristian J Chandler
- a Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
| | - Jordan M Sang
- a Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
| | - Leigh A Bukowski
- a Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
| | - Elí Andrade
- a Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
| | - Lisa A Eaton
- c Department of Human Development and Family Studies , University of Connecticut , Storrs , USA
| | - Ronald D Stall
- a Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
| | - Derrick D Matthews
- b Center for LGBT Health Research , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA.,d Department of Infectious Diseases and Microbiology , Graduate School of Public Health, University of Pittsburgh , Pittsburgh , USA
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Eaton LA, Matthews DD, Bukowski LA, Friedman MR, Chandler CJ, Whitfield DL, Sang JM, Stall RD. Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2018; 79:339-346. [PMID: 30063650 PMCID: PMC6510021 DOI: 10.1097/qai.0000000000001822] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/12/2023]
Abstract
BACKGROUND The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood. METHODS A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017. RESULTS HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56). CONCLUSIONS The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.
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Affiliation(s)
- Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT
| | | | - Leigh A Bukowski
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Cristian J Chandler
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Jordan M Sang
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Ron D Stall
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Blosnich JR, Cassese EC, Friedman MR, Coulter RWS, Sang JM, Matthews DD, Mair C. Religious freedom restoration acts and sexual minority population health in the United States. Am J Orthopsychiatry 2018; 89:675-681. [PMID: 30247051 DOI: 10.1037/ort0000349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Religious freedom restoration acts (RFRAs) in the United States potentially facilitate discrimination against lesbian, gay, and bisexual individuals (i.e., sexual minorities). In the current investigation, we explored whether a population health metric among sexual minority adults changed over time based on the presence, absence, or introduction of a state RFRA. Data are from 21 of the United States that gathered sexual orientation data from population-based samples of noninstitutionalized adults in the 2015 Behavioral Risk Factor Surveillance System (CDC, 2015, 2016). The analytic sample included 4,911 sexual minority individuals. Time was measured in 4 3-month quarters (i.e., Q1, Q2, Q3, Q4). For each state, the prevalence of sexual minority adults reporting ≥14 unhealthy days/30 days was calculated. Only Indiana (the only state in the sample that passed an RFRA in 2015) exhibited significant increasing proportions over time of sexual minority adults reporting ≥14 unhealthy days (Q1 = 24.5%, Q2 = 34.8%, Q3 = 41.2%, Q4 = 59.5%; β = 0.50, SE = 0.23, p = .037). Post hoc analyses revealed that unhealthy days did not increase for heterosexual adults in Indiana. Indiana's RFRA could have contributed to the increasing prevalence of unhealthy days among sexual minority adults in that state during 2015. Public health surveillance tools are needed to expedite analyses of the impact of laws on minority population health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- John R Blosnich
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh School of Medicine
| | - Erin C Cassese
- Department of Political Science, West Virginia University
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Robert W S Coulter
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Jordan M Sang
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
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Abstract
This year marks the 30th anniversary of AIDS Education and Prevention. As we approach the United Nations goal of ending the AIDS epidemic by 2030, it is a useful time to reflect on and learn from history. In the United States, no such endeavor can be successful without addressing the specific context of Black men who have sex with men. In this commentary I highlight factors that led us to a state in which Black MSM represent approximately a quarter of all people living with HIV in the United States. I also look back at the power of activism during the beginning of the HIV epidemic. Using Black Lives Matter as a contemporary framework, I highlight natural linkages between activism 30 years ago, its incarnation and relationship to public health today, and its promise as the way forward in achieving the elimination of AIDS for Black MSM by 2030.
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Affiliation(s)
- Derrick D Matthews
- Department of Infectious Diseases and Microbiology, Center for LGBT Health Research, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Coulter RWS, Mair C, Miller E, Blosnich JR, Matthews DD, McCauley HL. Prevalence of Past-Year Sexual Assault Victimization Among Undergraduate Students: Exploring Differences by and Intersections of Gender Identity, Sexual Identity, and Race/Ethnicity. Prev Sci 2018; 18:726-736. [PMID: 28210919 DOI: 10.1007/s11121-017-0762-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [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: 01/08/2023]
Abstract
A critical step in developing sexual assault prevention and treatment is identifying groups at high risk for sexual assault. We explored the independent and interaction effects of sexual identity, gender identity, and race/ethnicity on past-year sexual assault among college students. From 2011 to 2013, 71,421 undergraduate students from 120 US post-secondary education institutions completed cross-sectional surveys. We fit multilevel logistic regression models to examine differences in past-year sexual assault. Compared to cisgender (i.e., non-transgender) men, cisgender women (adjusted odds ratios [AOR] = 2.47; 95% confidence interval [CI] 2.29, 2.68) and transgender people (AOR = 3.93; 95% CI 2.68, 5.76) had higher odds of sexual assault. Among cisgender people, gays/lesbians had higher odds of sexual assault than heterosexuals for men (AOR = 3.50; 95% CI 2.81, 4.35) but not for women (AOR = 1.13; 95% CI 0.87, 1.46). People unsure of their sexual identity had higher odds of sexual assault than heterosexuals, but effects were larger among cisgender men (AOR = 2.92; 95% CI 2.10, 4.08) than cisgender women (AOR = 1.68; 95% CI 1.40, 2.02). Bisexuals had higher odds of sexual assault than heterosexuals with similar magnitude among cisgender men (AOR = 3.19; 95% CI 2.37, 4.27) and women (AOR = 2.31; 95% CI 2.05, 2.60). Among transgender people, Blacks had higher odds of sexual assault than Whites (AOR = 8.26; 95% CI 1.09, 62.82). Predicted probabilities of sexual assault ranged from 2.6 (API cisgender men) to 57.7% (Black transgender people). Epidemiologic research and interventions should consider intersections of gender identity, sexual identity, and race/ethnicity to better tailor sexual assault prevention and treatment for college students.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA. .,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John R Blosnich
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Veterans Affairs, Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather L McCauley
- Department of Human Development and Family Studies, College of Social Science, Michigan State University, East Lansing, MI, USA
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Eaton LA, Matthews DD, Driffin DD, Bukowski L, Wilson PA, Stall RD. A Multi-US City Assessment of Awareness and Uptake of Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Black Men and Transgender Women Who Have Sex with Men. Prev Sci 2017; 18:505-516. [PMID: 28101813 PMCID: PMC5926200 DOI: 10.1007/s11121-017-0756-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [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: 12/11/2022]
Abstract
The HIV epidemic among Black men and transgender women who have sex with men (BMTW) demands an urgent public health response. HIV point prevalence among this population ranges from 25 to 43%-a rate far exceeding any other group. Pre-exposure prophylaxis (PrEP) for HIV prevention is a very promising prevention tool; however, its full potential to slow the epidemic has yet to be realized. For the current study, random time-location sampling at Black Gay Pride Events was used to collect data from N = 1274 BMTW, from five US cities, reporting HIV-negative/unknown status. In-field HIV testing was also provided to participants. Participants were assessed on awareness and use of PrEP, health care factors, HIV testing history, psychosocial variables, and sex behaviors. About one third of participants were aware of PrEP (39%), and a small percentage of participants were users of PrEP (4.6%). In multivariable analyses, being in a relationship, testing for HIV in the past 6 months, and others being aware of one's sexuality were positively associated with PrEP awareness. Higher levels of internalized homophobia and greater numbers of female sex partners were positively associated with PrEP use, while education and condom use were negatively associated. Based on study findings, messaging and uptake of PrEP needs greater expansion and requires novel approaches for scale-up. Improving linkage to HIV testing services is likely critical for engaging BMTW with PrEP. The potential for PrEP to slow the HIV epidemic is high; however, we must strengthen efforts to ensure universal availability and uptake.
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Affiliation(s)
- Lisa A Eaton
- Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1020, USA.
| | | | - Daniel D Driffin
- Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1020, USA
| | | | | | - Ron D Stall
- University of Pittsburgh, Pittsburgh, PA, USA
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Friedman MR, Feliz NB, Netto J, Adams BJ, Matthews DD, Stall RD, Ho KS, Krier SE, Silvestre AJ. High HIV incidence among young black men who have sex with men: constructing a retrospective cohort from a community health programme. Sex Transm Infect 2016; 94:284-286. [PMID: 27941078 DOI: 10.1136/sextrans-2016-052722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/02/2016] [Accepted: 11/19/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought to calculate HIV incidence in a retrospective cohort of young (13-29 years old) black men who have sex with men (YBMSM) accessing repeated HIV-antibody testing in a mid-size city in the USA. METHODS We aggregated site-specific HIV-antibody testing results from the project's inception among YBMSM who received an initial negative result and accessed at least one additional HIV-antibody test. From these data, we assessed number of seroconversions and person-years and calculated HIV incidence using a mid-P exact test to estimate 95% CIs. RESULTS Five seroconversions were documented over 42.3 person-years (the mean age at first onsite test: 19.7 years), resulting in an HIV incidence rate of 11.8% (95% CI 4.3% to 26.2%). The mean age at seroconversion was 20.4 (±3.0) years. CONCLUSIONS Even in mid-size cities with low HIV prevalence rates in the general population, HIV incidence among YBMSM may be high. Community-based HIV-antibody testing organisations serving YBMSM should be encouraged and trained to track repeated HIV testing and calculate HIV incidence rates. Increased resources should be deployed to develop and encourage regular HIV testing in community health sites serving YBMSM.
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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, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nayck B Feliz
- Division of Adolescent Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jess Netto
- Community Human Services, Inc., Pittsburgh, Pennsylvania, USA
| | - Brian J Adams
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derrick D Matthews
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ron D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken S Ho
- Pittsburgh AIDS Center for Treatment, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony J Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Stall R, Egan JE, Kinsky S, Coulter RWS, Friedman MR, Matthews DD, Klindera K, Cowing M. Overview of the University of Pittsburgh/amfAR Training Program in HIV Prevention Research for MSM and Male-to-Female Transgender Populations in Low- and Middle-Income Countries. AIDS Behav 2016; 20:426-436. [PMID: 27037548 DOI: 10.1007/s10461-016-1382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/28/2022]
Abstract
Gay men, other men who have sex with men and transgender (GMT) populations suffer a disproportionate burden of HIV disease around the globe, which is directly attributable to the virulently homophobic environments in which many GMT people live. In addition to the direct effects of homophobia on GMT individuals, the ongoing marginalization of GMT people has meant that there is limited social capital on which effective HIV prevention and care programs can be built in many low- and middle-income countries (LMIC). Thus, meaningful responses meant to address the dire situation of GMT populations in LMIC settings must include a combination of bold and innovative approaches if efforts to end the epidemic are to have any chance of making a real difference. The HIV Scholars Program at the University of Pittsburgh's Center for LGBT Health Research is a prime example of a creative and dynamic approach to raising the expertise needed within GMT populations to respond to the global HIV/AIDS pandemic.
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Affiliation(s)
- Ron Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
| | - James E Egan
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Suzanne Kinsky
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Robert W S Coulter
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kent Klindera
- amfAR, The Foundation for AIDS Research, New York, NY, USA
| | - Michael Cowing
- amfAR, The Foundation for AIDS Research, New York, NY, USA
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Stall R, Matthews DD, Friedman MR, Kinsky S, Egan JE, Coulter RWS, Blosnich JR, Markovic N. The Continuing Development of Health Disparities Research on Lesbian, Gay, Bisexual, and Transgender Individuals. Am J Public Health 2016; 106:787-9. [PMID: 27049415 DOI: 10.2105/ajph.2016.303183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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]
Affiliation(s)
- Ron Stall
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - Derrick D Matthews
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - M Reuel Friedman
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - Suzanne Kinsky
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - James E Egan
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - Robert W S Coulter
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - John R Blosnich
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
| | - Nina Markovic
- All of the authors are with the Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Ron Stall, Suzanne Kinsky, James E. Egan, and Robert W. S. Coulter are also with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh. Derrick D. Matthews and M. Reuel Friedman are also with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh. John R. Blosnich is also with US Department of Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh. Nina Markovic is also with the Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh
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Matthews DD, Blosnich JR, Farmer GW, Adams BJ. Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors. LGBT Health 2016; 1:42-9. [PMID: 25110718 DOI: 10.1089/lgbt.2013.0002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 11/12/2022] Open
Abstract
PURPOSE Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors. METHODS Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior. RESULTS Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as "not sure" also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors. CONCLUSION Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations.
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Affiliation(s)
- Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John R Blosnich
- Department of Psychiatry, University of Rochester, Rochester, New York ; VISN-2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York
| | - Grant W Farmer
- Department of Epidemiology, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri
| | - Brian J Adams
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Matthews DD, Smith JC, Brown AL, Malebranche DJ. Reconciling Epidemiology and Social Justice in the Public Health Discourse Around the Sexual Networks of Black Men Who Have Sex With Men. Am J Public Health 2016; 106:808-14. [PMID: 26890175 DOI: 10.2105/ajph.2015.303031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM.
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Affiliation(s)
- Derrick D Matthews
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - Justin C Smith
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - Andre L Brown
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
| | - David J Malebranche
- Derrick D. Matthews is with the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Justin C. Smith is with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Andre L. Brown is with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. David J. Malebranche is with Student Health Service, University of Pennsylvania, Philadelphia
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Matthews DD, Herrick AL, Coulter RWS, Friedman MR, Mills TC, Eaton LA, Wilson PA, Stall RD. Running Backwards: Consequences of Current HIV Incidence Rates for the Next Generation of Black MSM in the United States. AIDS Behav 2016; 20:7-16. [PMID: 26267251 DOI: 10.1007/s10461-015-1158-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [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: 11/26/2022]
Abstract
Black men who have sex with men (MSM) in the United States are disproportionately impacted by HIV. To better understand this public health problem, we reviewed the literature to calculate an estimate of HIV incidence among Black MSM. We used this rate to model HIV prevalence over time within a simulated cohort, which we subsequently compared to prevalence from community-based samples. We searched all databases accessible through PubMed, and Conference on Retroviruses and Opportunistic Infections abstracts for HIV incidence estimates among Black MSM. Summary HIV incidence rates and 95 % confidence intervals (CIs) were calculated using random effects models. Using the average incidence rate, we modeled HIV prevalence within a simulated cohort of Black MSM (who were all HIV-negative at the start) from ages 18 through 40. Based on five incidence rates totaling 2898 Black MSM, the weighted mean incidence was 4.16 % per year (95 % CI 2.76-5.56). Using this annual incidence rate, our model predicted that 39.94 % of Black MSM within the simulated cohort would be HIV-positive by age 30, and 60.73 % by 40. Projections were similar to HIV prevalence found in community-based samples of Black MSM. High HIV prevalence will persist across the life-course among Black MSM, unless effective prevention and treatment efforts are increased to substantially reduce HIV transmission among this underserved and marginalized population.
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Affiliation(s)
- Derrick D Matthews
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
| | - A L Herrick
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Thomas C Mills
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06209, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Ron D Stall
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
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Farmer GW, Blosnich JR, Jabson JM, Matthews DD. Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Nonrural Individuals. J Rural Health 2015; 32:321-31. [PMID: 26625172 DOI: 10.1111/jrh.12161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/nonrural residence. METHODS Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System surveys. Rural status was defined using metropolitan statistical area, and group differences by sexual orientation were stratified by gender and rural/nonrural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/nonrural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design. FINDINGS Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than nonrural participants. CONCLUSIONS Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/nonrural differences in LGB health.
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Affiliation(s)
- Grant W Farmer
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, Missouri
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer M Jabson
- Department of Public Health, College of Education Health and Human Sciences, University of Tennessee, Knoxville, Tennessee
| | - Derrick D Matthews
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
OBJECTIVES We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey. METHODS Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators. RESULTS LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking. CONCLUSIONS Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.
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Affiliation(s)
- Derrick D Matthews
- At the time of this study, Derrick D. Matthews and Joseph G. L. Lee were with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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Roberts ET, Matthews DD. HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention. Soc Sci Med 2012; 75:1555-61. [PMID: 22495513 PMCID: PMC5849420 DOI: 10.1016/j.socscimed.2012.02.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 12/29/2011] [Accepted: 02/08/2012] [Indexed: 11/16/2022]
Abstract
This manuscript draws connections between chemoprophylaxis and the biomedical model of disease that emphasizes individual behavior. We argue that chemoprophylactic HIV interventions have limited utility at the population-level, and that structural interventions need to be prioritized. We use the recent CAPRISA 004 and iPrEx trials to (a) critique the utility of these trials from a public health perspective by highlighting the difference between efficacy and effectiveness, (b) apply an alternative theory of health behavior as a way to reorient the field toward the discussion of the need to employ structural interventions, and (c) examine two aspects of HIV prevention efforts - funding structures and iatrogenic effects of biomedical approaches - as a means of overcoming obstacles to more widespread adoption of structural interventions.
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Affiliation(s)
- Eric T Roberts
- Columbia University, Department of Epidemiology, Mailman School of Public Health, 710 W 168th Street, NI 614-A, New York, NY 10032, United States.
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Matthews DD, Hammond WP, Cole-Lewis Y, Nuru-Jeter A, Melvin T. Racial Discrimination and Depressive Symptoms Among African-American Men: The Mediating and Moderating Roles of Masculine Self-Reliance and John Henryism. Psychol Men Masc 2012; 14:35-46. [PMID: 30364828 DOI: 10.1037/a0028436] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [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: 11/08/2022]
Abstract
Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.
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Affiliation(s)
- Derrick D Matthews
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Wizdom Powell Hammond
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Amani Nuru-Jeter
- Divisions of Community Health and Human Development and Epidemiology, University of California, Berkeley
| | - Travis Melvin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Hightow-Weidman LB, Smith JC, Valera E, Matthews DD, Lyons P. Keeping them in "STYLE": finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient Care STDS 2011; 25:37-45. [PMID: 21162690 DOI: 10.1089/apc.2010.0192] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [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
Young men who have sex with men (YMSM) of color are at particularly increased risk for HIV infection compared to white MSM. National data highlight the need to link YMSM of color to care to improve their overall health and stem further infections, yet, there is limited data on interventions and clinical outcomes focused on engaging and retaining youth, specifically HIV-infected YMSM of color in care. To address the medical care needs of this underserved population, in 2005, the Health Research and Services Administration (HRSA) created the YMSM of Color Initiative. Utilizing a social marketing campaign targeting youth and members of their sexual and social networks, testing and outreach on college campuses and within the broader community, and a tightly linked medical-social support network, we created STYLE (Strength Through Youth Livin' Empowered), a novel intervention that sought to diagnose, engage, and retain HIV-positive black and Latino YMSM in HIV primary care services. Over a 3-year period, 81 men were either newly diagnosed or reengaged in care. Overall, 63% of the cohort was retained in clinical care; defined as attending at least one medical visit every 4 months. Compared to the 3 years prior to STYLE, the odds ratio for whether or not someone attended a clinic visit was 2.58 (95% confidence interval [CI] 1.34-4.98) if enrolled in STYLE. We conclude that compared to a pre-STYLE cohort, STYLE was an effective intervention that increased HIV diagnoses, provided efficient and timely engagement in care for both those newly diagnosed and those who had fallen out of care and improved overall retention.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin C. Smith
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik Valera
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Derrick D. Matthews
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick Lyons
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Griffith DM, Mason MA, Rodela M, Matthews DD, Tran A, Royster M, Cotten M, Eng E. A structural approach to examining prostate cancer risk for rural southern African American men. J Health Care Poor Underserved 2008; 18:73-101. [PMID: 18065853 DOI: 10.1353/hpu.2007.0121] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Physical, cultural, and social factors influence health risk and behavior, but few have explored how the environmental context affects African American men's prostate cancer screening and treatment. This paper describes a structural analysis of data from eight focus groups of rural, southern African American men (n=66). A structural approach highlights the interrelationships between individuals, the health service system, and community factors that directly and indirectly affect screening and treatment for prostate cancer. The availability of accurate and timely health information and health services, social norms regarding health and professional help-seeking, and the sociopolitical context shaped men's screening and treatment behaviors. These proximal and distal health factors affected men's prostate cancer knowledge, perceived risk, willingness to seek care and trust in the health service system. The findings suggest that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.
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Affiliation(s)
- Derek M Griffith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
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Matthews DD. Letter: Abdominal decompression in pregnancy. Br Med J 1974; 2:725-6. [PMID: 4852670 PMCID: PMC1611107 DOI: 10.1136/bmj.2.5921.725-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Matthews DD. Sedation in pregnancy. Br Med J 1973; 1:800. [PMID: 4735116 PMCID: PMC1588952 DOI: 10.1136/bmj.1.5856.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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