1
|
Weinstein ER, Broos HC, Lozano A, Jones MA, Serrano LP, Harkness A. Longitudinal predictors of post-exposure prophylaxis awareness among latino sexual minority men in South Florida. J Behav Med 2024; 47:434-445. [PMID: 38409554 DOI: 10.1007/s10865-024-00466-6] [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: 07/16/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024]
Abstract
Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool.
Collapse
Affiliation(s)
| | - Hannah C Broos
- Department of Psychology, University of Miami, Coral Gables, USA
| | - Alyssa Lozano
- School of Nursing and Health Studies, University of Miami, Coral Gables, USA
| | - Megan A Jones
- Department of Psychology, University of Miami, Coral Gables, USA
| | | | - Audrey Harkness
- Department of Psychology, University of Miami, Coral Gables, USA.
- School of Nursing and Health Studies, University of Miami, Coral Gables, USA.
| |
Collapse
|
2
|
Weinstein ER, Chen YO, Maya D, Saber R, Harkness A. Factors associated with meningitis vaccine awareness and engagement among Latino men who have sex with men in South Florida. J Behav Med 2024; 47:446-457. [PMID: 38581595 DOI: 10.1007/s10865-024-00486-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
Awareness and uptake of the meningitis vaccine remains low among marginalized groups, such as Latino men who have sex with men (LMSM), potentially due to structural and psychosocial barriers in accessing preventative healthcare. The current study explored awareness and uptake of meningitis vaccines among a group of LMSM (N = 99) living in South Florida. A three-pronged variable selection approach was utilized prior to conducting regression models (linear and logistic). Overall, 48.5% of the participants reported little to no knowledge about meningitis vaccines, and 20.2% reported being vaccinated. Living with HIV (OR = 10.48) and time since outbreak (OR = 1.03) were significant predictors of meningitis vaccine uptake. No significant correlates of meningitis vaccine awareness were identified. More research is needed to identify other important factors associated with meningitis vaccine awareness and uptake among LMSM, a multiple marginalized group.
Collapse
Affiliation(s)
| | | | - Daniel Maya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Valorous Health Innovation, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Florida, USA.
| |
Collapse
|
3
|
Weinstein ER, Puccinelli M, Cardenas N, Safren SA, Harkness A. PrEP to Party: Exploring MSM's PrEP Use and Interest in the Context of Sexually Themed Events. AIDS Behav 2024; 28:1384-1389. [PMID: 37982942 PMCID: PMC10947865 DOI: 10.1007/s10461-023-04225-7] [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: 11/15/2023] [Indexed: 11/21/2023]
Abstract
Sexually themed events present a unique opportunity for scaling up pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM). This study descriptively explored PrEP uptake among MSM who anticipated attending a week-long major South Florida sexually themed event and examined potential facilitators and barriers to PrEP engagement among potential attendees. Of the participating HIV-negative MSM (n = 96), 66.7% were currently taking PrEP. Prior attendance at sexually themed events was significantly associated with current PrEP engagement and almost 75% of HIV-negative MSM not on PrEP reported high interest in taking PrEP if offered for free at future events.
Collapse
Affiliation(s)
- Elliott R Weinstein
- Department of Psychology, University of Miami, 1120 NW 14th Street, Suite 784, Miami, FL, 33136, USA.
| | - Marc Puccinelli
- Department of Psychology, University of Miami, 1120 NW 14th Street, Suite 784, Miami, FL, 33136, USA
| | - Nicolas Cardenas
- Department of Psychology, University of Miami, 1120 NW 14th Street, Suite 784, Miami, FL, 33136, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 1120 NW 14th Street, Suite 784, Miami, FL, 33136, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, Fl, USA
| |
Collapse
|
4
|
Jimenez DE, Weinstein ER, Carrico AW. Is Behavioral Activation Higher Ground for the Silver Tsunami? Am J Geriatr Psychiatry 2024; 32:256-258. [PMID: 37949802 DOI: 10.1016/j.jagp.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences (D.E.J.), University of Miami Miller School of Medicine, Miami, FL.
| | | | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work (A.W.C.), Florida International University, Miami, FL
| |
Collapse
|
5
|
Lozano A, Weinstein ER, Fernandez A, Bainter S, Atuluru P, Hurtado A, Morales V, Prado G, Safren SA, Harkness A. Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men. Am J Health Promot 2024; 38:19-39. [PMID: 37616445 PMCID: PMC10840990 DOI: 10.1177/08901171231198430] [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: 08/26/2023]
Abstract
PURPOSE The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). DESIGN Cross-sectional measure validation. SETTING Participants from Miami, FL. SUBJECTS 290 LSMM from the DÍMELO study. MEASURES Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. ANALYSIS All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. RESULTS Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. CONCLUSION Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.
Collapse
Affiliation(s)
- Alyssa Lozano
- School of Nursing and Health Studies, University of Miami
| | | | | | | | | | | | - Vanessa Morales
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | | | | |
Collapse
|
6
|
Atuluru P, Weinstein ER, Serrano LP, Doblecki-Lewis S, Rogers BG, Harkness A. A Rapid Environmental Scan of South Florida HIV Organizations' Mpox Messaging During the August 2022 Peak of the U.S. Outbreak. AIDS Behav 2023:10.1007/s10461-023-04176-z. [PMID: 37870691 DOI: 10.1007/s10461-023-04176-z] [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] [Accepted: 09/09/2023] [Indexed: 10/24/2023]
Abstract
The 2022 outbreak of mpox disproportionately impacted men who have sex with men and people living with HIV. As such, HIV organizations were uniquely situated to reach populations affected by mpox. However, the extent to which these organizations pivoted to address mpox, and what form mpox messaging took, is unknown. We conducted a rapid environmental scan of 29 HIV or sexual health organizations to assess the frequency and content of mpox messaging in August 2022, the peak of the mpox outbreak in Miami, FL. Approximately half of the organizations provided mpox messaging, most of which was accurate. Only 5% of the messages were in Spanish and 4% in Spanish and Haitian Creole. Our findings suggest HIV organizations' pivot to mpox messaging may have been delayed overall and in reaching Spanish- and Haitian Creole-speaking communities. Results could inform modifications to mpox messaging campaigns and future outbreaks that disproportionately affect minoritized communities.
Collapse
Affiliation(s)
- Pranusha Atuluru
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Lorenzo P Serrano
- Department of Biological Science, Florida International University, Miami, FL, USA
| | | | - Brooke G Rogers
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Audrey Harkness
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Coral Gables, Miami, FL, 33146, USA.
| |
Collapse
|
7
|
Weinstein ER, Lozano A, Jones MA, Jimenez DE, Safren SA. Factors Associated with Antiretroviral Therapy Adherence Among a Community-Based Sample of Sexual Minority Older Adults with HIV. AIDS Behav 2023; 27:3285-3293. [PMID: 36971877 DOI: 10.1007/s10461-023-04048-6] [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: 03/14/2023] [Indexed: 03/29/2023]
Abstract
Older sexual minorities (e.g., gay, bisexual) living with HIV are at risk for poor HIV outcomes due to their frequent experience with both psychosocial challenges and structural barriers to care. This study utilized a stochastic search variable selection (SVSS) approach to explore potential psychosocial and structural factors associated with HIV-related health outcomes among a community-based sample of older sexual minorities (N = 150) in South Florida, an U.S. HIV-epidemic epicenter. After SVSS, a forward entry regression approach suggested unstable housing, illicit substance use, current nicotine use, and depression were all associated with poorer ART adherence among older sexual minority adults living with HIV. No associations between potential correlates and biological measures of HIV disease severity were observed. Findings highlight a need to focus on multiple levels of intervention that target a combination of psychosocial and structural factors to improve HIV-care outcomes among older sexual minorities and achieve Ending the HIV Epidemic goals.
Collapse
Affiliation(s)
| | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Megan A Jones
- Department of Psychology, University of Miami, Miami, USA
| | - Daniel E Jimenez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, USA
| | | |
Collapse
|
8
|
Weinstein ER, Harkness A, Ironson G, Shrader CH, Duncan DT, Safren SA. Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV. Int J Behav Med 2023; 30:345-355. [PMID: 35499813 PMCID: PMC9626397 DOI: 10.1007/s12529-022-10095-5] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes-viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. METHODS Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. RESULTS Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = - 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = - 0.40, BSTP [- 0.87, - 0.09]). CONCLUSION This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.
Collapse
Affiliation(s)
- Elliott R Weinstein
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA.
| | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA
| | - Cho-Hee Shrader
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA
| |
Collapse
|
9
|
Lozano A, Lee TK, Weinstein ER, Estrada Y, Graefe B, Tapia MI, Prado G. Trajectories of Drug Use and Depressive Symptoms among Latinx Youth and Sexual Minority Youth. Int J Environ Res Public Health 2023; 20:ijerph20105883. [PMID: 37239609 DOI: 10.3390/ijerph20105883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Drug use and depression co-occur and disproportionately affect Latinx sexual minority youth relative to their heterosexual Latinx peers. However, heterogeneity in co-occurring patterns of drug use and depressive symptoms is unknown. The objective of the current study was to identify patterns of drug use and depressive symptom trajectories and examine how these patterns varied between Latinx sexual minority youth and Latinx non-sexual minority youth. Latent class trajectory analysis identified distinct patterns of drug use and depressive symptom trajectories among 231 Latinx adolescents (Latinx sexual minority youth: n = 46, 21.4%; Latinx non-sexual minority youth: n = 169, 78.6%). After identifying class mean trajectories, we examined differences in mean trajectories across groups. A 3-class model was selected as the optimal class trajectory model for both groups, yet classes and trajectories differed. There were differences in initial levels of depression and drug use trajectories between both groups, as well as differences in patterns of drug use trajectories between both groups in two of the three classes. Given the variation in trajectory patterns, there is a need for practitioners to consider the unique needs of both groups to inform the development of preventive interventions for these two populations.
Collapse
Affiliation(s)
- Alyssa Lozano
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education/Social Innovation Convergence Program, Sungkyunkwan University, Seoul 03063, Republic of Korea
| | | | - Yannine Estrada
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Beck Graefe
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Maria I Tapia
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
| |
Collapse
|
10
|
Weinstein ER, Balise R, Metheny N, Jose Baeza Robba M, Mayo D, Michel C, Chan B, Safren SA, Harkness A. Factors associated with latino sexual minority men's likelihood and motivation for obtaining a COVID-19 vaccine: a mixed-methods study. J Behav Med 2023; 46:116-128. [PMID: 35476250 PMCID: PMC9043889 DOI: 10.1007/s10865-022-00315-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/29/2022] [Indexed: 01/01/2023]
Abstract
Minoritized communities are underreached by biomedical interventions, such as the COVID-19 vaccine. This mixed-methods study identified factors associated with vaccine likelihood (VL) and uptake (VU) among 187 Latino sexual minority men (LSMM) in South Florida. Regression models with LASSO variable selection and Classification and Regression Trees (CART) assessed determinants of VL and VU while open-ended questions were evaluated using thematic content analysis. VL (range 1-7; M = 6.00, SD = 1.84) and VU (63.6%) was high. LASSO modeling identified being insured, worrying about others, fear of transmitting COVID-19, and financial stress as the most influential factors for VL; working remotely from home was important for VU. Time (weeks) since addition of COVID-19 vaccination-related questions (December 2nd, 2020) was associated with both outcomes across both modeling techniques. Convergence between data suggests capitalizing on altruistic motivations and improving accessibility to vaccine campaigns are valuable assets to increase LSMM's vaccine confidence.
Collapse
Affiliation(s)
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Miami, USA
| | | | - Daniel Mayo
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Bill Chan
- Department of Psychology, University of Miami, Miami, USA
| | | | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, USA
| |
Collapse
|
11
|
Weinstein ER, Jimenez DE. Prioritizing recruitment: the benefits to using a disease registry to recruit older adults with HIV and intersecting identities. AIDS Care 2023; 35:624-628. [PMID: 35676752 PMCID: PMC9729382 DOI: 10.1080/09540121.2022.2085867] [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: 08/13/2021] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
The success of a study hinges on its recruitment procedures, however there is a paucity of papers focused on innovative recruitment strategies, especially as it relates to the recruitment and retention of marginalized populations. This paper aims to outline how consent-to-contact databases can be used as an effective tool for recruitment. First, we begin by describing the consent-to-contact databases we used. Then, we offer insight into how a consent-to-contact database was utilized to recruit Latino older adults with HIV participants for an interdisciplinary behavioral and physical health promotion intervention. We outline barriers and challenges to recruitment and research participation with a specific emphasis on the unique hurdles associated with recruiting and retaining racial/ethnic minority older adults with HIV in behavioral health studies. Finally, we provide final recommendations for future researchers interested in how to best employ this type of recruitment tool in their own research.
Collapse
Affiliation(s)
| | - Daniel E. Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| |
Collapse
|
12
|
Jimenez DE, Weinstein ER, Batsis J. You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men. Pilot Feasibility Stud 2023; 9:32. [PMID: 36855194 PMCID: PMC9972624 DOI: 10.1186/s40814-023-01262-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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Older Latinos living with the human immunodeficiency virus (HIV) have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. These health disparities are largely related to lifestyle and are either preventable or amenable to early detection or intervention. Despite existing resources to deliver an intervention to reduce this compounded health disparity, there is little information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. The Happy Older Latinos are Active (HOLA) intervention is an innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the HOLA health promotion intervention for older HIV-positive Latino men. METHODS/DESIGN HOLA, which is informed by Behavioral Activation and Social Learning theory is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW for 45 min, 3×/week for 16 weeks; (3) pleasant events (e.g., going to brunch with friends) scheduling. Eighteen community dwelling Latinos living with HIV aged 50+ will be recruited for this feasibility study adapting the HOLA intervention. Participants will be assessed at three time points (baseline, post-intervention, and 3 months post-intervention) on measures of cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning, and health-related quality of life. CONCLUSIONS If HOLA can be delivered successfully by CHWs, then the scalability, accessibility, and potential for dissemination is increased. Additionally, this study will inform feasibility and identify modifications needed in the design of a larger hypothesis testing study. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03839212. Date of Registration: 8 February, 2019.
Collapse
Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA.
| | | | - John Batsis
- Division of Geriatric Medicine, Department of Medicine and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| |
Collapse
|
13
|
St. George SM, Harkness AR, Rodriguez-Diaz CE, Weinstein ER, Pavia V, Hamilton AB. Applying Rapid Qualitative Analysis for Health Equity: Lessons Learned Using "EARS" With Latino Communities. Int J Qual Methods 2023; 22:10.1177/16094069231164938. [PMID: 38463016 PMCID: PMC10923582 DOI: 10.1177/16094069231164938] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Qualitative research amplifies the voices of marginalized communities and thus plays a critical role in shaping our understanding of health inequities and their social determinants. Traditional qualitative approaches, such as grounded theory or thematic analysis, require extensive training and are time- and labor-intensive; as such, they may not be adequately suited to address healthy equity issues that require a swift response. Rapid qualitative analysis (RQA) is an action-oriented approach to qualitative data analysis that may be used when findings are needed to quickly inform practice. RQA capitalizes on using a team to summarize key points from qualitative data into matrices to explore relevant themes efficiently and systematically. In this paper, we provide case examples from our work applying RQA to health equity research with Latino communities to address community needs, such as responses to public health emergencies and the development of service delivery and technology interventions for infectious and chronic diseases. We draw from our collective experiences to share lessons learned and provide the following specific recommendations ("EARS") to researchers interested in applying RQA for health equity research: (1) Employ RQA to address rapidly evolving, urgent, health equity challenges; (2) Assure quality and rigor throughout the RQA process; (3) Respond to barriers and problem-solve as needed; and (4) Strengthen community relationships before, during, and after using RQA. Overall, we advocate for the use of RQA to promote health equity due to its ability to integrate the vital perspectives of marginalized communities and efficiently respond to their needs.
Collapse
Affiliation(s)
- Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audrey R. Harkness
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Carlos E. Rodriguez-Diaz
- Department of Prevention and Community Health and Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Vanina Pavia
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alison B. Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
14
|
Weinstein ER, Herrera CM, Pla Serrano L, Martí Kring E, Harkness A. Promoting health equity in HIV prevention and treatment research: a practical guide to establishing, implementing, and sustaining community advisory boards. Ther Adv Infect Dis 2023; 10:20499361231151508. [PMID: 36755989 PMCID: PMC9900661 DOI: 10.1177/20499361231151508] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/27/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last 25 years, community-based participatory research (CBPR) has emerged as an innovative methodological approach to break down the barriers toward health equity in biopsychosocial research. Although there are several methods one can use to conduct CBPR research, one widely used established tool that has shown to be effective for engaging community meaningfully in research is community advisory boards (CABs). CABs are formalized collaborative bodies consisting of community and research stakeholders and have been integral in engaging underserved groups experiencing HIV-related health inequities at the early stages of the AIDS crisis. Even though evidence suggests that CABs are an effective tool for conducting high-quality, rigorous, and community-centered HIV-related research, there are minimal guidelines summarizing the steps needed for developing and maintaining a CAB. Therefore, to fill this gap in the literature, this article offers a practical guide to help researchers with minimal experience, particularly graduate students and early-stage investigators, feel more comfortable with establishing a CAB for equity-focused HIV-related research. This article synthesizes already established guidelines and frameworks for CAB development while specifically outlining unique steps related to the three main stages of CAB formation - establishment, implementation, and sustainment. Throughout this article, the authors offer tension points, generated from the literature and with consultation from a CAB working alongside the authors, that researchers and community partners may need to navigate during each of these three stages. In addition, best practices from the literature are identified for each step in the guidelines so that readers can see firsthand how research groups have carried out these steps in their own practice.
Collapse
|
15
|
Harkness A, Morales V, Defreitas W, Atuluru P, Jaramillo J, Weinstein ER, Feaster DJ, Safren S, Balise R. Impact of COVID-19 on HIV service delivery in Miami-Dade County: a mixed methods study. BMC Health Serv Res 2022; 22:1476. [PMID: 36463177 PMCID: PMC9719219 DOI: 10.1186/s12913-022-08849-8] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Facilitating access to HIV prevention and treatment is imperative in Miami-Dade County (MDC), a U.S. HIV epicenter. With COVID-19, disruptions to these services have occurred, leading HIV organizations to innovate and demonstrate resilience. This study documented COVID-19 related disruptions and resilient innovations in HIV services within MDC. METHODS This mixed methods cross-sectional study included HIV test counselors in MDC. In the quantitative component (N=106), participants reported COVID-19 impacts on HIV service delivery. Data visualization examined patterns within organizations and throughout the study period. Generalized estimating equation modeling examined differences in service disruptions and innovations. In the qualitative component, participants (N=20) completed interviews regarding COVID-19 impacts on HIV services. Rapid qualitative analysis was employed to analyze interviews. RESULTS Quantitative data showed that innovations generally matched or outpaced disruptions, demonstrating resilience on HIV service delivery during COVID-19. HIV testing (36%, 95%CI[28%, 46%]) and STI testing (42%, 95%CI[33%, 52%]) were most likely to be disrupted. Sexual/reproductive health (45%, 95%CI[35%, 55%]), HIV testing (57%, 95%CI[47%,66%]), HIV case management (51%, 95%CI[41%, 60%]), PrEP initiation (47%, 95%CI[37%,57%]), and STI testing (47%, 95%CI[37%, 57%]) were most likely to be innovated. Qualitative analysis revealed three orthogonal themes related to 1) disruptions (with five sub-components), 2) resilient innovations (with four sub-components), and 3) emerging and ongoing health disparities. CONCLUSIONS HIV organizations faced service disruptions during COVID-19 while also meaningfully innovating. Our findings point to potential changes in policy and practice that could be maintained beyond the immediate impacts of COVID-19 to enhance the resilience of HIV services. Aligning with the US Ending the HIV Epidemic Plan and the National Strategy for HIV/AIDS, capitalizing on the observed innovations would facilitate improved HIV-related health services for people living in MDC and beyond.
Collapse
Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Miami, FL, 33146, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Vanessa Morales
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wayne Defreitas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
16
|
Weinstein ER, Glynn TR, Simmons EM, Safren SA, Harkness A. Structural Life Instability and Factors Related to Latino Sexual Minority Men's Intention to Engage with Biomedical HIV-Prevention Services. AIDS Behav 2022; 26:3914-3924. [PMID: 35661015 PMCID: PMC9166207 DOI: 10.1007/s10461-022-03718-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Latino sexual minority men (LSMM) experience high rates of HIV and co-occurring health inequities. Structural and psychosocial factors may lead to mental health problems and decreased engagement with biomedical HIV-prevention behaviors. This cross-sectional study assessed the extent to which structural life instability is related to biomedical HIV-prevention services engagement (HIV-testing and PrEP uptake) indirectly through psychological distress among 290 LSMM living in Greater Miami. Using hybrid structural equation modeling, significant direct effects from structural life instability to psychological distress emerged, as did effects from psychological distress (i.e., depression and anxiety) to HIV-prevention engagement. Structural life instability had a significant indirect effect to HIV-prevention engagement via psychological distress. Findings show a possible mechanism explaining the relationship between structural life instability and biomedical HIV-prevention engagement among a group of LSMM, a subpopulation at increased susceptibility for HIV acquisition in an U.S. HIV epicenter.
Collapse
Affiliation(s)
| | - Tiffany R Glynn
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Ervin M Simmons
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Audrey Harkness
- Department of Psychology, University of Miami, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| |
Collapse
|
17
|
Jimenez DE, Park M, Rosen D, Joo JH, Garza DM, Weinstein ER, Conner K, Silva C, Okereke O. Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color. Am J Geriatr Psychiatry 2022; 30:1234-1251. [PMID: 35914985 PMCID: PMC9799260 DOI: 10.1016/j.jagp.2022.07.001] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023]
Abstract
Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.
Collapse
|
18
|
Weinstein ER, Lozano A, Jones MA, Safren SA, Harkness A. Factors Associated with Post-Exposure Prophylaxis Awareness Among Latino Sexual Minority Men in South Florida. AIDS Patient Care STDS 2022; 36:405-412. [PMID: 36286577 PMCID: PMC9595620 DOI: 10.1089/apc.2022.0090] [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: 01/29/2023] Open
Abstract
Despite their efficacy, biomedical HIV prevention tools such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) have been insufficiently scaled up and disseminated, especially among marginalized subgroups that face substantial HIV disparities. Given the minimal literature available on PEP among Latino sexual minority men (LSMM), this cross-sectional secondary analysis explored factors associated with PEP awareness among a group of LSMM living in South Florida, a US HIV epicenter. The parent study examined patterns of engagement in PrEP and behavioral health treatment services among LSMM (N = 290). The current secondary analysis (N = 243) identified factors associated with PEP awareness using three methods: stochastic search variable selection, participatory data science, and literature review-before being modeled using linear regression. Most participants (67.5%) reported having little to no awareness about PEP before initiating our study. Simple linear regression models suggested that higher PrEP knowledge (B = 0.17, SE = 0.02, p < 0.001), HIV knowledge (B = 0.15, SE = 0.04, p < 0.001), PrEP self-efficacy (B = 0.37, SE = 0.13, p < 0.05), and high perceived community norms for HIV testing (B = 0.29, SE = 0.14, p < 0.05) were each associated with LSMM's greater PEP awareness, while identity affirmation was associated with less PEP awareness (B = -0.13, SE = 0.05, p < 0.01). Results suggest the utility of our three-pronged variable selection approach and address gaps in PEP awareness and use among LSMM living in a US HIV epicenter to support Ending the HIV Epidemic goals.
Collapse
Affiliation(s)
| | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Megan A. Jones
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Audrey Harkness
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
19
|
Harkness A, Weinstein ER, Lozano A, Mayo D, Doblecki-Lewis S, Rodríguez-Díaz CE, Hendricks Brown C, Prado G, Safren SA. Refining an Implementation Strategy to Enhance the Reach of HIV-Prevention and Behavioral Health Treatments to Latino Men Who Have Sex with Men. Implement Res Pract 2022; 3:26334895221096293. [PMID: 36406189 PMCID: PMC9674182 DOI: 10.1177/26334895221096293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/15/2022] Open
Abstract
Background Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase uptake of evidence-based HIV prevention and behavioral health treatments among LMSM. Methods Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale up HIV-prevention and behavioral health services to LMSM were collected via focus groups (N=3) and individual interviews (N=3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM.
Collapse
Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | | | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of
Medicine, Miami, FL, USA
| | - Carlos E. Rodríguez-Díaz
- Department of Community Health and Prevention, Milken Institute
School of Public Health, The George Washington University, Washington DC, USA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | | |
Collapse
|
20
|
Jimenez DE, Weinstein ER, Batsis JA. "Me Dieron Vida": The Effects of a Pilot Health Promotion Intervention to Reduce Cardiometabolic Risk and Improve Behavioral Health among Older Latinos with HIV. Int J Environ Res Public Health 2022; 19:2667. [PMID: 35270360 PMCID: PMC8910201 DOI: 10.3390/ijerph19052667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023]
Abstract
There are significant gaps in knowledge about the synergistic and disparate burden of health disparities associated with cardiovascular health issues, poorer mental health outcomes, and suboptimal HIV-care management on the health of older Latinos living with HIV (OLLWH). This pilot study sought to evaluate the feasibility and acceptability of an innovative application of an already established health-promotion intervention-Happy Older Latinos are Active (HOLA)-among this marginalized population. Eighteen self-identified Latino men with an undetectable HIV viral load and documented risk of cardiometabolic disease participated in this study. Although the attrition rate of 22% was higher than expected, participants attended 77% of the sessions and almost 95% of the virtual walks. Participants reported high satisfaction with the intervention, as evident by self-report quantitative (CSQ-8; M = 31, SD = 1.5) and qualitative metrics. Participants appreciated bonding with the community health worker and their peers to reduce social isolation. Results indicate that the HOLA intervention is an innovative way of delivering a health promotion intervention adapted to meet the diverse needs and circumstances of OLLWH, is feasible and acceptable, and has the potential to have positive effects on the health of OLLWH.
Collapse
Affiliation(s)
- Daniel E. Jimenez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - John A. Batsis
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
21
|
Weinstein ER, Jimenez DE. To Activate or Not to Activate: An Integral Question for Self-Guided Behavioral Activation Interventions for Older Adults with Sub-Clinical Depression. Am J Geriatr Psychiatry 2022; 30:208-210. [PMID: 34330624 PMCID: PMC8742833 DOI: 10.1016/j.jagp.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL.
| |
Collapse
|
22
|
Harkness A, Weinstein ER, Atuluru P, Hernandez Altamirano D, Vidal R, Rodriguez-Diaz CE, Safren SA. Latino sexual minority men’s intersectional minority stress, general stress, and coping during COVID-19: A rapid qualitative study. Journal of Gay & Lesbian Mental Health 2022; 26:130-157. [DOI: 10.1080/19359705.2021.1995096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | | | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Ronald Vidal
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Carlos E. Rodriguez-Diaz
- Milken Institute of Public Health, The George Washington University, Washington, DC, USA
- School of Public Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
23
|
Harkness A, Weinstein ER, Atuluru P, Mayo D, Vidal R, Rodríguez-Díaz CE, Safren SA. Latinx Sexual Minority Men's Access to HIV and Behavioral Health Services in South Florida During COVID-19: A Qualitative Study of Barriers, Facilitators, and Innovations. J Assoc Nurses AIDS Care 2022; 33:9-21. [PMID: 34939984 PMCID: PMC8981513 DOI: 10.1097/jnc.0000000000000280] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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
ABSTRACT Despite the availability of HIV prevention and treatment tools, HIV disparities continue to affect Latinx sexual minority men (LSMM). Behavioral health concerns further exacerbate HIV disparities among LSMM. This study used rapid qualitative analysis to understand factors influencing LSMM's access to HIV and behavioral health services during coronavirus disease 2019 (COVID-19). Participants included LSMM with (n = 10) and without HIV (n = 10). The analysis identified 15 themes. Themes revealed that LSMM's access was disrupted by new and worsening barriers resulting from COVID-19, such as anxiety about COVID-19 exposure, confusion and disruptions to services, and new structural challenges. Other themes highlight positive changes, such as telehealth and relaxed clinic protocols, which enhanced LSMM's access to services during COVID-19. The findings suggest the need for HIV and behavioral health clinics to innovate and ensure LSMM's continued access to services during and beyond COVID-19.
Collapse
Affiliation(s)
- Audrey Harkness
- Research Assistant Professor of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Elliott R. Weinstein
- Predoctoral Psychology Trainee, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Pranusha Atuluru
- medical student, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniel Mayo
- Research Associate, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Ronald Vidal
- graduate student, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Carlos E. Rodríguez-Díaz
- Associate Professor, The George Washington University, Washington, D.C., USA, and Associate Professor, University of Puerto Rico-Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico
| | - Steven A. Safren
- Professor, Department of Psychology, University of Miami, Miami, Florida
| |
Collapse
|
24
|
Weinstein ER, Jimenez DE. "Gloria a Dios": How Spirituality and Religiosity Can Improve Healthy Cognitive Aging Interventions for Older Latinos. Am J Geriatr Psychiatry 2021; 29:1089-1091. [PMID: 34183239 PMCID: PMC8713536 DOI: 10.1016/j.jagp.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL.
| |
Collapse
|
25
|
Affiliation(s)
| | - Jasper S. Lee
- Department of Psychology, University of Miami, Miami, FL
| | | | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | - Wafaa El-Sadr
- ICAP, Columbia University’s Mailman School of Public Health, New York City, NY, USA
| |
Collapse
|
26
|
Harkness A, Weinstein ER, Atuluru P, Vidal R, Rodriguez-Diaz CE, Safren SA. "Let's Hook Up When the Pandemic is Over:" Latinx Sexual Minority Men's Sexual Behavior During COVID-19. J Sex Res 2021; 58:951-957. [PMID: 33661064 PMCID: PMC8417157 DOI: 10.1080/00224499.2021.1888064] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 06/12/2023]
Abstract
COVID-19 led to substantial changes in individuals' lives due to preventive measures, including social distancing and "stay at home" orders. One type of social interaction likely impacted is intimacy and sexual relationships. Sexual minority men have long navigated the impact of another pandemic, HIV, on their sexual lives. This study explored the impact of COVID-19 on Latinx sexual minority men's (LSMM) sexual behaviors in South Florida, an HIV and COVID-19 epicenter. A rapid qualitative analysis of semi-structured interviews with LSMM (N = 20) revealed five themes: (1) increased sex with a primary partner, (2) fewer sexual partners, (3) continued pre-COVID-19 sexual activity, often following "quarantine fatigue," (4) opportunities and challenges related to navigating COVID-19 prevention and sex, and (5) using sexual networking apps in new ways. The findings suggest LSMM's resilience and their ongoing health needs during COVID-19, with implications for interventions to promote LSMM's safe and satisfying sex.
Collapse
Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Center, Miami, FL, USA
| | | | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ronald Vidal
- Department of Public Health Sciences, University of Miami, Clinical Research Center, Miami, FL, USA
| | - Carlos E. Rodriguez-Diaz
- Milken Institute of School of Public Health, The George Washington University, Washington, DC, USA
- University of Puerto Rico-Medical Sciences Campus, School of Public Health, San Juan, PR, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
27
|
Harkness A, Rogers BG, Balise R, Mayo D, Weinstein ER, Safren SA, Pachankis JE. Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav 2021; 25:2195-2209. [PMID: 33483898 PMCID: PMC8169533 DOI: 10.1007/s10461-020-03148-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.
Collapse
Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA.
| | - Brooke G Rogers
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, Clinical Research Building, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - John E Pachankis
- Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division, Yale School of Public Health, Yale University, New Haven, CT, USA
| |
Collapse
|
28
|
Harkness A, Weinstein ER, Mayo D, Rodriguez-Diaz C, Safren SA. Latinx Sexual Minority Men's Behavioral, Psychosocial, and Medical Experiences during COVID-19: Differences across Immigration Statuses. Ann LGBTQ Public Popul Health 2021; 2:104-115. [PMID: 34790911 PMCID: PMC8594873 DOI: 10.1891/lgbtq-2020-0054] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Latinx sexual minority men (LSMM) are at the intersection of two communities disproportionately impacted by COVID-19. To develop and deploy appropriate resources to support LSMM, it is important to understand the behavioral, psychosocial, and medical experiences of this population during COVID-19, as well as for LSMM of different immigration statuses. The current study uses the Pandemic Stress Index (PSI) to describe LSMM's self-reported behavioral, psychosocial, and medical experiences during COVID-19. Logistic and linear regressions compared experiences during COVID-19 among LSMM across different immigration statuses (recent, established, and US-born as the reference group). LSMM's responses to the PSI indicated they experienced anxiety (64.4%), depression (59.0%), alcohol/substance use (27.6%), as well as loneliness (50.1%) and sleep problems (60.4%). Overall, over half reported personal financial loss, the odds of which were 2.75 times greater among LSMM who were recent immigrants compared to US-born LSMM (OR = 2.75, 95% CI: 1.30, 5.82). Nearly 8% reported being diagnosed with COVID-19, with the odds four and a half times greater among established immigrants compared to US-born LSMM (OR = 4.52, 95% CI: 1.60, 12.81). The findings have implications for tailored support resources and public health interventions to reach LSMM in general and LSMM with immigration histories.
Collapse
Affiliation(s)
| | | | - Daniel Mayo
- University of Miami, Department of Psychology
| | | | | |
Collapse
|
29
|
Myers JE, El-Sadr Davis OY, Weinstein ER, Remch M, Edelstein A, Khawja A, Schillinger JA. Availability, Accessibility, and Price of Rapid HIV Self-Tests, New York City Pharmacies, Summer 2013. AIDS Behav 2017; 21:515-524. [PMID: 27804092 DOI: 10.1007/s10461-016-1594-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/29/2022]
Abstract
We conducted an in-person survey of New York City (NYC) pharmacies to assess the availability, accessibility, and price of the over-the-counter, rapid HIV self-test kit. NYC pharmacies were stratified into high, moderate and low morbidity neighborhoods by the HIV diagnosis rate of the neighborhood in which the pharmacy was located. A random sample of 500 pharmacies was taken [250 from high morbidity neighborhoods (HighMN) and 250 from low morbidity neighborhoods (LowMN)]. Pharmacies were excluded if: closed during survey, non-retail, or >10 min walk from subway. Project staff visited pharmacies to determine kit availability (in pharmacy on day of survey), accessibility (not locked/behind counter), and price (marked on shelf/product). Of 361 pharmacies (161 LowMN; 200 HighMN), kits were available in 27 % and accessible in 10 %; there was no difference by neighborhood. Kits were most often kept behind the pharmacy counter; this was more common in HighMN than in LowMN. Kits were kept solely behind the pharmacy counter in 52 %. Median price was US $42.99 without variability across neighborhoods. The rapid HIV self-test had limited availability and access in retail pharmacies. The high median price measured suggests that cost remained a barrier.
Collapse
Affiliation(s)
- Julie E Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA.
- Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Olivia Y El-Sadr Davis
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA
| | - Elliott R Weinstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA
| | - Molly Remch
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA
| | - Amy Edelstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA
| | - Amina Khawja
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 22-84, Queens, New York, NY, 11101, USA
| | - Julia A Schillinger
- Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene, New York, NY, USA
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| |
Collapse
|
30
|
Burgess L, Pulsifer MB, Yeap BY, Grieco JA, Weinstein ER, MacDonald SM, Tarbell N, Yock TI. Systematic difference between Estimated IQ (EIQ) and Full Scale IQ (FSIQ) in survivors irradiated for pediatric brain tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|