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Wagner GJ, Bogart LM, Klein DJ, Lawrence SJ, Goggin K, Gizaw M, Mutchler MG. Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV. AIDS Behav 2024; 28:408-420. [PMID: 38060112 PMCID: PMC10876751 DOI: 10.1007/s10461-023-04233-7] [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: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
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2
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Ogunbajo A, Bogart LM, Mutchler MG, Klein DJ, Lawrence SJ, Goggin K, Wagner GJ. Unmet Social Needs are Associated with Lower Adherence to Antiretroviral Therapy (ART) Medication Among a Sample of Black People Living with HIV (PLHIV). AIDS Behav 2023; 27:3651-3660. [PMID: 37195472 PMCID: PMC10191094 DOI: 10.1007/s10461-023-04079-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: 05/03/2023] [Indexed: 05/18/2023]
Abstract
The current study examined the prevalence and typology of unmet needs and the association between unmet needs and HIV antiretroviral therapy (ART) medication adherence among a sample of Black people living with HIV(PLHIV) (N = 304) in Los Angeles, CA. We found a high prevalence of unmet needs, with 32% of participants reporting having two or more unmet needs. The most common unmet needs category was basic benefits needs (35%), followed by subsistence needs (33%), and health needs (27%). Significant correlates of unmet needs included food insecurity, history of homelessness, and history of incarceration. A greater number of unmet needs and any unmet basic benefits needs were each significantly associated with lower odds of HIV ART medication adherence. These findings provide further evidence linking the social determinants of health and social disenfranchisement to ART medication adherence among Black PLHIV.
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Affiliation(s)
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, United States of America
- California State University Dominguez Hills, Carson, CA, United States of America
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Sean J Lawrence
- APLA Health & Wellness, Los Angeles, CA, United States of America
| | - Kathy Goggin
- Health Services and Outcome Research, Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, United States of America
| | - Glenn J Wagner
- RAND Corporation, Santa Monica, CA, United States of America
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3
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Malika N, Bogart LM, Mutchler MG, Goggin K, Klein DJ, Lawrence SJ, Wagner GJ. Loneliness Among Black/African American Adults Living with HIV: Sociodemographic and Psychosocial Correlates and Implications for Adherence. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01712-4. [PMID: 37436685 DOI: 10.1007/s40615-023-01712-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
Loneliness, an emerging public health problem, is higher among people living with HIV and is associated with negative health outcomes. Black/African Americans have a high burden of HIV, and little is known about the characteristics of loneliness among Black adults living with HIV; therefore, this study sought to understand the sociodemographic and psychosocial correlates of Black adults living with HIV who are lonely and the implications of loneliness for their health outcomes. A sample of 304 Black adults living with HIV (73.8% sexual minority men) in Los Angeles County, CA, USA, completed the survey items assessing sociodemographic and psychosocial characteristics, social determinants of health, health outcomes, and loneliness. Antiretroviral therapy (ART) adherence was assessed electronically with the medication event monitoring system. Bivariate linear regressions analysis showed higher loneliness scores among those with higher levels of internalized HIV stigma, depression, unmet needs, and discrimination related to HIV serostatus, race, and sexual orientation. In addition, participants who were married or living with a partner, had stable housing, and reported receiving more social support had lower levels of loneliness. In multivariable regression models controlling for correlates of loneliness, loneliness was found to be a significant independent predictor of worse general physical health, worse general mental health, and greater depression. Loneliness was marginally associated with lower ART adherence. Findings suggest that Black adults living with HIV, who experience multiple intersectional stigmas, require targeted interventions and resources.
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Affiliation(s)
- Nipher Malika
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
| | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri-Kansas City, School of Medicine and Pharmacy, Kansas City, MO, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | | | - Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
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Bogart LM, Mutchler MG, Goggin K, Ghosh-Dastidar M, Klein DJ, Saya U, Linnemayr S, Lawrence SJ, Tyagi K, Thomas D, Gizaw M, Bailey J, Wagner GJ. Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV. AIDS Behav 2022; 27:1573-1586. [PMID: 36399252 PMCID: PMC9673878 DOI: 10.1007/s10461-022-03921-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Matt G. Mutchler
- APLA Health & Wellness, Los Angeles, CA USA ,California State University Dominguez Hills, Carson, CA USA
| | - Kathy Goggin
- Children’s Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO USA
| | | | - David J. Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | | | - Damone Thomas
- APLA Health & Wellness, Los Angeles, CA USA ,HEALING with HOPE Corp., Los Angeles, CA USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | - Glenn J. Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
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Mutchler MG, Wagner GJ, McDavitt B, Woldetsadik MA, Kegeles SM, El-Khoury C, Nogg KA, Klinger IA, Mokhbat J, Ballan EG. Psychometric Properties of a Scale on Judgmental Communication with Peers About Sex Among YMSM and Their Close Friends in Lebanon. AIDS Behav 2022; 26:3089-3098. [PMID: 35322311 PMCID: PMC10234618 DOI: 10.1007/s10461-022-03640-6] [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: 03/01/2022] [Indexed: 11/29/2022]
Abstract
We are not aware of any validated sexual health communication scales for use with young men who have sex with men (YMSM). We used data from an HIV prevention study in Lebanon with 226 YMSM aged 18-29 to assess the psychometric characteristics of our scale, Judgmental Communication with Peers about Sex (JCPS). The construct validity of the JCPS scale was supported by it being negatively correlated with general social support, percentage of alters perceived to be supportive, and the percentage of peers who are perceived to use condoms. The scale was positively correlated with gay-related discrimination, feeling part of the gay community, and gay social integration. These findings reflect a reliable, valid measure to assess judgmental sexual health communication between YMSM.
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Affiliation(s)
- Matt G Mutchler
- Department of Health Science, California State University, Dominguez Hills, 1000 E. Victoria Street, Carson, CA, 90747, USA.
- Community-Based Research, AIDS Project Los Angeles (APLA Health), Los Angeles, USA.
| | | | - Bryce McDavitt
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | | | - Susan M Kegeles
- University of California San Francisco School of Medicine, San Francisco, USA
| | | | | | - Ian A Klinger
- Community-Based Research, AIDS Project Los Angeles (APLA Health), Los Angeles, USA
- Department of Sociology, California State University, Dominguez Hills, Carson, USA
| | | | - Elie G Ballan
- The Arab Foundation for Freedoms and Equality, Beirut, Lebanon
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Wagner GJ, Ghosh-Dastidar B, Tebbetts S, Ballan E, Mutchler MG, Green H, Chamas S, Mokhbat J, Kegeles S. A Pilot Evaluation of "Tayf", a Cultural Adaptation of Mpowerment for Young Men who Have Sex with Men (YMSM) in Beirut, Lebanon, and Its Effects on Condomless Sex and HIV Testing. AIDS Behav 2022; 26:639-650. [PMID: 34389890 PMCID: PMC8840954 DOI: 10.1007/s10461-021-03424-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
We evaluated the effects of a culturally adapted evidence-based HIV prevention intervention (Mpowerment), named "Tayf", on condom use and HIV testing among young men who have sex with men (YMSM) in Beirut. A 2-year implementation of Tayf was carried out independently and in parallel with a research cohort of 226 YMSM who were surveyed at baseline and months 6, 12, 18 and 24 after Tayf initiation. Primary outcomes were (1) any condomless anal sex with HIV-positive or unknown status partners in the past 3 months, and (2) HIV testing in the past six months. Hierarchical logistic regression models examined the association of Tayf participation with the outcomes averaged across all assessments, and the moderating effect of Tayf participation on change in the outcomes over the follow-up period. A total of 331 YMSM attended at least one event, including 33% of the cohort. Tayf participation was associated with a higher rate of any condomless sex with HIV-positive or unknown status partners averaged across the five assessments, but there was no moderating effect of Tayf participation on change in this outcome over time. Tayf participation was associated with higher HIV testing when averaged across all assessments, but its interaction with time showed that the strength of this association diminished over time. In conclusion, Tayf proved feasible and acceptable in Beirut, but with limited effects. Further work is needed, including innovative publicity and marketing strategies, to bolster effects in high stigma settings where security and legal risks are prominent.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
| | | | - Scott Tebbetts
- University of California at San Francisco, San Francisco, CA, USA
| | - Elie Ballan
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
| | - Matt G Mutchler
- California State University, Dominguez Hills, Carson, CA, USA
- AIDS Project Los Angeles, Los Angeles, CA, USA
| | - Harold Green
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA
- Indiana University, Bloomington, IN, USA
| | - Sally Chamas
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
| | - Jacques Mokhbat
- Division of Infectious Diseases, University Medical Center Rizk Hospital, Beirut, Lebanon
- Lebanese AIDS Society, Beirut, Lebanon
| | - Susan Kegeles
- University of California at San Francisco, San Francisco, CA, USA
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Khoury CE, Mutchler MG, Ghanem CA, Kegeles SM, Ballan E, Mokhbat JE, Wagner GJ. Sexual Violence in Childhood and Post-Childhood: The Experiences of Young Men Who Have Sex With Men in Beirut. J Interpers Violence 2021; 36:NP11198-NP11217. [PMID: 31608777 PMCID: PMC7881839 DOI: 10.1177/0886260519880164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Sexual violence has been found to have psychosocial and sexual ramifications for men who have sex with men (MSM) but has not been studied in the Middle East. We assessed the prevalence and correlates of experiences of child and post-child sexual violence among young MSM residing in Beirut, Lebanon. In total, 226 MSM, aged 18 to 29, were recruited with long-chain peer referrals and administered a survey that included questions on history of being pressured to have sex, as well as specific forms of sexual harassment and abuse, in addition to measures of psychosocial functioning and sexual behavior. Logistic regression analysis was used to examine correlates of child sex abuse and experiences of sexual violence post-childhood; 17.3% experienced sexual abuse as a child (below age 13), while 63.3% experienced any form of sexual violence post-childhood-furthermore, 48.7% had experienced being forced or pressured to have sex during their lifetime, including 32.3% prior to age 18. Participants who experienced child sex abuse were more likely to experience abusive relationships in adulthood, as well as at least one type of sexual harassment/abuse post-childhood. Experience of any sexual violence post-childhood was correlated with greater recent sexuality-related discrimination and more recent male sex partners. These findings reveal a high prevalence of sexual violence among MSM in Beirut, both in childhood and post-childhood. More research within the Middle East is needed to better understand the drivers of sexual violence in this population, and how to best provide prevention and coping services.
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Affiliation(s)
| | | | | | | | - Elie Ballan
- Arab Foundation for Freedoms and Equality, Beirut, Lebanon
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Storholm ED, Mutchler MG, Ghosh-Dastidar B, Balan E, Mokhbat J, Kegeles SM, Wagner GJ. Gearing up for PrEP in the Middle East and North Africa: An Initial Look at Willingness to Take PrEP among Young Men Who Have Sex with Men in Beirut, Lebanon. Behav Med 2021; 47:111-119. [PMID: 31851587 PMCID: PMC7299800 DOI: 10.1080/08964289.2019.1661822] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/03/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.
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Affiliation(s)
| | - Matt G Mutchler
- Urban Community Research Center, California State University
| | | | - Elie Balan
- Arab Foundation for Freedom and Equality
| | - Jacques Mokhbat
- Department of Medicine, Lebanese American University School of Medicine
| | - Susan M Kegeles
- School of Medicine, Division of Prevention Science, University of California, San Francisco
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021. [DOI: https://doi.org.10.1097/qai.0000000000002570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021; 86:200-207. [PMID: 33196555 PMCID: PMC7808278 DOI: 10.1097/qai.0000000000002570] [Citation(s) in RCA: 278] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. METHODS Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. RESULTS Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = -5.19 (2.08), P = 0.02]. DISCUSSION To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.
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Affiliation(s)
| | - Bisola O. Ojikutu
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA
- Division of Global Health Equity, Harvard Medical School, Boston, MA
| | - Keshav Tyagi
- Community-Based Research, APLA Health & Wellness; and
| | | | - Matt G. Mutchler
- Community-Based Research, APLA Health & Wellness; and
- Department of Health Science, California State University, Dominguez Hills
| | | | | | | | - Sarah Kellman
- Community-Based Research, APLA Health & Wellness; and
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Wagner G, Ghosh-Dastidar B, El Khoury C, Abi Ghanem C, Mutchler MG, Balan E, Green H, Kegeles S, Mokhbat J. A Serial, Cross-Sectional Comparison of Condomless Anal Sex and HIV Testing Among Young MSM in Beirut, Lebanon. Arch Sex Behav 2020; 49:321-330. [PMID: 31127453 PMCID: PMC7881840 DOI: 10.1007/s10508-018-1359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/25/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
In 2012, our research with young men who have sex with men (YMSM) in Beirut showed high rates of recent condomless anal sex and low rates of recent HIV testing. In 2017, we collected data from YMSM to assess for temporal changes and sociodemographic correlates. Propensity score weighting was used to eliminate any sociodemographic differences between the 2012 (n = 164) and 2017 (n = 226) samples of YMSM (age 18-29) recruited with long-chain peer referral sampling. Regression analysis was used to examine sociodemographic correlates of recent condomless anal sex and HIV testing using the 2017 sample, and whether these behaviors differed between the samples. Compared to the 2012 sample, the 2017 sample was about half as likely to report any condomless anal sex in the past 3 months with partners whose HIV status was positive or unknown (14% vs. 23%; OR [95%CI] 0.56 [0.32, 0.98]), and nearly 2.5 times as likely to report HIV testing in the past 6 months (48% vs. 27%; OR [95%CI] 2.44 [1.46, 4.10]). In the 2017 sample, any recent condomless anal sex with partners whose HIV status was positive or unknown was associated with employment and Christian religious affiliation. Low income was the sole correlate of having recently tested for HIV. These findings suggest a temporal trend toward increased HIV protective behaviors among YMSM in Beirut over the past 5 years. Further inroads could be secured if HIV prevention programming targeted economic influences.
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Affiliation(s)
- Glenn Wagner
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
| | | | - Cynthia El Khoury
- Association for Progressive Communications, Johannesburg, South Africa
| | | | - Matt G Mutchler
- Urban Community Research Center, California State University, Dominguez Hills, Carson, CA, USA
- AIDS Project Los Angeles, Los Angeles, CA, USA
| | - Elie Balan
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
| | - Harold Green
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
- Health Unit, Indiana University, Bloomington, IN, USA
| | - Susan Kegeles
- Health Unit, University of California at San Francisco, San Francisco, CA, USA
| | - Jacques Mokhbat
- Department of Medicine, Lebanese American University School of Medicine, Beirut, Lebanon
- Lebanese AIDS Society, Beirut, Lebanon
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Wagner GJ, Ghosh-Dastidar B, El Khoury C, Abi Ghanem C, Balan E, Kegeles S, Mutchler MG, Mokhbat J. Major Depression Among Young Men Who Have Sex with Men in Beirut, and Its Association with Structural and Sexual Minority-Related Stressors, and Social Support. Sex Res Social Policy 2019; 16:513-520. [PMID: 32051694 PMCID: PMC7013382 DOI: 10.1007/s13178-018-0352-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18-29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. 16% had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one's sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one's sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma and discrimination.
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Affiliation(s)
| | | | | | | | - Elie Balan
- Arab Foundation for Freedom and Equality, Beirut, Lebanon
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13
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Mutchler MG, Bogart LM, Klein DJ, Wagner GJ, Klinger IA, Tyagi K, McDavitt B. Age matters: differences in correlates of self-reported HIV antiretroviral treatment adherence between older and younger Black men who have sex with men living with HIV. AIDS Care 2019; 31:965-972. [PMID: 31072114 DOI: 10.1080/09540121.2019.1612020] [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: 01/25/2023]
Abstract
Black men who have sex with men (BMSM) show lower levels of adherence to antiretroviral therapy (ART) for HIV medications than other racial/ethnic groups in the U.S. Yet, little is known about age differences in factors that predict ART adherence among BMSM. We combined data from two surveys of HIV-positive BMSM, resulting in 209 participants (130 aged 18-50 years; 79 aged 50 years or older). Multivariate linear regressions examined associations between baseline characteristics and adherence to HIV medications as well as interactions of baseline characteristics with age. The associations between trust in healthcare and doctor satisfaction ratings with higher adherence were stronger for older vs younger men (p < .05); the association between problem drinking and lower adherence was stronger among younger men (p < .05). Future research should examine how interventions may address these age-specific factors to improve ART adherence among BMSM living with HIV.
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Affiliation(s)
- Matt G Mutchler
- a Department of Sociology , California State University , Dominguez Hills , Carson , USA.,b Community-Based Research , AIDS Project Los Angeles , Los Angeles , USA
| | | | | | | | - Ian A Klinger
- a Department of Sociology , California State University , Dominguez Hills , Carson , USA
| | - Keshav Tyagi
- b Community-Based Research , AIDS Project Los Angeles , Los Angeles , USA
| | - Bryce McDavitt
- d Department of Psychiatry and Behavioral Sciences , Keck School of Medicine of the University of Southern California , Los Angeles , USA
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Mutchler MG, McDavitt BW, Tran TN, El Khoury C, Ballan E, Tohme J, Kegeles SM, Wagner G. This is who we are: building community for HIV prevention with young gay and bisexual men in Beirut, Lebanon. Cult Health Sex 2018; 20:690-703. [PMID: 28922101 PMCID: PMC5857392 DOI: 10.1080/13691058.2017.1371334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/31/2023]
Abstract
Young gay men in Beirut are at significantly elevated risk of HIV infection compared with the general Lebanese population. Despite nascent HIV prevention efforts in the region, there is a need for effective community-level HIV prevention interventions tailored for young gay men. This qualitative study examined internal dynamics within Beirut's gay community as a basis for developing community-level interventions. Peer ethnographers were trained to collect field notes on conversations between young gay men in public spaces in Beirut, and conducted follow-up focus groups with young gay men. Analyses revealed three major themes: (1) the need for safe spaces in which to socialise, (2) the importance of being able to locate and connect with other young gay men, and (3) ambivalence regarding a gay community that was supportive in some ways but also fragmented and often judgemental. Study findings also confirm the existence of external threats to community such as stigma, cultural and familial norms regarding heterosexuality and criminalisation of refugee status. Understanding such community dynamics and the environmental context is central to designing effective community-based HIV prevention programmes.
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Affiliation(s)
- Matt G. Mutchler
- Department of Sociology, California State University Dominguez Hills, Carson, CA, USA
| | | | - Tu N. Tran
- Community Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
| | | | - Ellie Ballan
- The Arab Foundation for Freedoms and Equality, Beirut, Lebanon
| | | | - Susan M. Kegeles
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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15
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Lichtenstein B, Kay ES, Klinger I, Mutchler MG. Ricky and Lucy: gender stereotyping among young Black men who have sex with men in the US Deep South and the implications for HIV risk in a severely affected population. Cult Health Sex 2018; 20:351-365. [PMID: 28720021 PMCID: PMC5775064 DOI: 10.1080/13691058.2017.1347280] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
HIV disproportionately affects young Black men who have sex with men in the USA, with especially high rates in the Deep South. In this Alabama study, we interviewed 24 pairs of young Black men who have sex with men aged 19-24 and their close friends (n = 48) about sexual scripts, dating men and condom use. Three main themes emerged from the study: the power dynamics of 'top' and 'bottom' sexual positions for condom use; gender stereotyping in the iconic style of the 'I Love Lucy' show of the 1950s; and the sexual dominance of 'trade' men. Gender stereotyping was attributed to the cultural mores of Black families in the South, to the preferences of 'trade' men who exerted sexual and financial control and to internalised stigma relating to being Black, gay and marginalised. The findings suggest that HIV prevention education for young Black men who have sex with men is misguided if gendered power dynamics are ignored, and that funded access to self-protective strategies such as pre-exposure prophylaxis and post-exposure prophylaxis could reduce HIV risk for this severely affected population.
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Affiliation(s)
- Bronwen Lichtenstein
- Department of Criminology/Criminal Justice, The University of Alabama, Tuscaloosa, AL, USA
- Corresponding Author: Bronwen Lichtenstein,
| | - Emma Sophia Kay
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Ian Klinger
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
| | - Matt G. Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
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Brooks RA, Allen VC, Regan R, Mutchler MG, Cervantes-Tadeo R, Lee SJ. HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS 2017; 29:375-381. [PMID: 28853676 DOI: 10.1177/0956462417727691] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 11/16/2022]
Abstract
In the United States, black men who have sex with men (MSM) are the group most affected by the HIV/AIDS epidemic. Pre-exposure prophylaxis (PrEP) is an important new HIV prevention strategy that may help reduce new HIV infections among black MSM. This analysis examined the association between HIV/AIDS conspiracy beliefs and intentions to adopt PrEP among 224 black MSM. The likelihood of adopting PrEP was assessed and more than half (60%) of the study population indicated a high intention to adopt PrEP. HIV/AIDS genocidal and treatment-related conspiracies were assessed using scales previously validated with black MSM. Almost two-thirds (63%) endorsed at least one of eight HIV/AIDS conspiracy beliefs presented. In multivariable analyses, black MSM who agreed with the genocidal or treatment-related conspiracy beliefs scales had a lower intention to adopt PrEP (Adjusted Odds Ratio [AOR] = 0.73, 95% CI = 0.54, 0.99 and AOR = 0.36, 95% CI = 0.23, 0.55, respectively). Our findings indicate that preexisting HIV/AIDS conspiracy beliefs may deter some black MSM from adopting PrEP. We suggest strategies PrEP implementers may want to employ to address the influence that HIV/AIDS conspiracy beliefs may have on the adoption of PrEP among black MSM, a population disproportionately affected by HIV/AIDS.
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Affiliation(s)
- Ronald A Brooks
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vincent C Allen
- 2 Georgia State University Counseling and Testing Center, Atlanta, GA, USA
| | - Rotrease Regan
- 3 Department of Medicine, Division of Infectious Diseases, 1371 Emory University , Atlanta, GA, USA
| | - Matt G Mutchler
- 4 Department of Sociology, California State University, Dominguez Hills, CA, USA.,5 Community-Based Research, AIDS Project Los Angeles, CA, USA
| | - Ramon Cervantes-Tadeo
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sung-Jae Lee
- 6 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Wagner GJ, Bogart LM, Klein DJ, Green HD, Mutchler MG, McDavitt B, Hilliard C. Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men. Arch Sex Behav 2016; 45:1347-55. [PMID: 26718361 PMCID: PMC4929056 DOI: 10.1007/s10508-015-0641-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/01/2014] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 05/26/2023]
Abstract
We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.
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Affiliation(s)
- Glenn J Wagner
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
| | - Laura M Bogart
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David J Klein
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Harold D Green
- Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA
| | - Matt G Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
| | - Bryce McDavitt
- Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
- Clinical Psychology, Pacifica Graduate Institute, Carpinteria, CA, USA
| | - Charles Hilliard
- Department of Psychiatry & Human Behavior, Charles Drew University of Medicine and Science, Los Angeles, CA, USA
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18
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Wagner GJ, Bogart LM, Mutchler MG, McDavitt B, Mutepfa KD, Risley B. Increasing Antiretroviral Adherence for HIV-Positive African Americans (Project Rise): A Treatment Education Intervention Protocol. JMIR Res Protoc 2016; 5:e45. [PMID: 27025399 PMCID: PMC4829729 DOI: 10.2196/resprot.5245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/14/2015] [Accepted: 11/02/2015] [Indexed: 11/13/2022] Open
Abstract
Background HIV-positive African Americans have been shown to have lower adherence to antiretroviral therapy (ART) than those of other races/ethnicities, yet adherence interventions have rarely been tailored to the needs of this population. Objective We developed and will evaluate a treatment education adherence intervention (called Rise) that was culturally adapted to address the needs of African Americans living with HIV. Methods This randomized controlled trial will examine the effects of the Rise intervention on ART adherence and HIV viral load. African Americans on ART who report adherence problems will be recruited from the community and randomly assigned to receive the intervention or usual care for 6 months. The intervention consists of 6-10 individual counseling sessions, with more sessions provided to those who demonstrate lower adherence. Primary outcomes include adherence as monitored continuously with Medication Event Monitoring Systems (MEMS) caps, and viral load data received from the participant’s medical provider. Survey assessments will be administered at baseline and month 6. Results The trial is ongoing. Conclusions If effective, the Rise intervention will provide community-based organizations with an intervention tailored to address the needs of African Americans for promoting optimal ART adherence and HIV clinical outcomes. Trial Registration Clinicaltrials.gov NCT01350544; https://clinicaltrials.gov/ct2/show/NCT01350544 (Archived by WebCite at http://www.webcitation.org/6fjqqnmn0).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, Health Unit, Santa Monica, CA, United States.
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19
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Bogart LM, Wagner GJ, Green HD, Mutchler MG, Klein DJ, McDavitt B, Lawrence SJ, Hilliard CL. Medical mistrust among social network members may contribute to antiretroviral treatment nonadherence in African Americans living with HIV. Soc Sci Med 2016; 164:133-140. [PMID: 27046475 DOI: 10.1016/j.socscimed.2016.03.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [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] [Received: 10/12/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE African Americans living with HIV are less likely to adhere to antiretroviral treatment (ART) compared to other racial/ethnic groups. Medical mistrust is thought to be a factor in this disparity. OBJECTIVE We examined (1) whether exposure to HIV conspiracy beliefs, a specific type of HIV-related mistrust (about the origins and treatment of HIV) in social networks is associated with ART nonadherence among African Americans living with HIV; and (2) the characteristics of individuals who discuss HIV-related mistrust in the social networks of African Americans living with HIV. METHODS At baseline and 6- and 12-months post-baseline, 175 African Americans living with HIV on ART completed egocentric social network assessments, from which we assessed the structure and composition of their personal networks (the social context immediately surrounding them). HIV-related mistrust was operationalized with an indicator of whether any social network member had expressed HIV conspiracy beliefs to the participant. Daily medication adherence was monitored electronically. RESULTS At baseline, 63% of participants agreed with at least one conspiracy belief, and 55% reported hearing at least one social network member ("alter") express conspiracy beliefs. In a multivariate linear repeated measures regression, expression of conspiracy beliefs by similar others in the network (in terms of age, gender, HIV status, sexual orientation, and race/ethnicity) was associated with ART nonadherence (i.e., percentage of prescribed doses taken). In a multivariate logistic regression, expression of conspiracy beliefs was more likely among social network members who were HIV-positive, who knew the participants' serostatus, and with whom participants interacted frequently, and less likely among more well-connected social network members. CONCLUSION HIV-related mistrust in the network may be most influential when expressed by similar others who may be HIV-positive themselves.
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Affiliation(s)
| | | | | | - Matt G Mutchler
- Department of Sociology, California State University, Dominguez Hills, CA, USA; Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
| | - David J Klein
- Health Unit, RAND Corporation, Santa Monica, CA, USA
| | - Bryce McDavitt
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA; University of Southern California, Los Angeles, CA, USA
| | - Sean J Lawrence
- Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA
| | - Charles L Hilliard
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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20
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McDavitt B, Bogart LM, Mutchler MG, Wagner GJ, Green HD, Lawrence SJ, Mutepfa KD, Nogg KA. Dissemination as Dialogue: Building Trust and Sharing Research Findings Through Community Engagement. Prev Chronic Dis 2016; 13:E38. [PMID: 26986541 PMCID: PMC4797478 DOI: 10.5888/pcd13.150473] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A fundamental feature of community-based participatory research (CBPR) is sharing findings with community members and engaging community partners in the dissemination process. To be truly collaborative, dissemination should involve community members in a two-way dialogue about new research findings. Yet little literature describes how to engage communities in dialogue about research findings, especially with historically marginalized communities where mistrust of researchers may exist because of past or present social injustices. Through a series of interactive community presentations on findings from a longitudinal study, we developed a process for community dissemination that involved several overlapping phases: planning, outreach, content development, interactive presentations, and follow-up. Through this process, we built on existing and new community relationships. Following each interactive presentation, the research team debriefed and reviewed notes to identify lessons learned from the process. Key themes included the importance of creating a flexible dissemination plan, tailoring presentations to each community group, establishing a point person to serve as a community liaison, and continuing dialogue with community members after the presentations. Core strategies for developing trust during dissemination included engaging community members at every step, reserving ample time for discussion during presentations, building rapport by sharing personal experiences, being receptive to and learning from criticism, and implementing input from community members. This process led to a deeper understanding of research findings and ensured that results reached community members who were invested in them.
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Affiliation(s)
- Bryce McDavitt
- AIDS Project Los Angeles, 611 South Kingsley Dr, Los Angeles, CA 90005. . Dr McDavitt is also affiliated with University of Southern California, Los Angeles, California and Pacifica Graduate Institute, Carpinteria, California
| | - Laura M Bogart
- Boston Children's Hospital, Boston, Massachusetts, Harvard Medical School, Boston, Massachusetts, RAND Corporation, Santa Monica, California
| | - Matt G Mutchler
- AIDS Project Los Angeles, Los Angeles, California, California State University, Dominguez Hills, Carson, California
| | | | | | - Sean Jamar Lawrence
- AIDS Project Los Angeles, Los Angeles, California; Kieta D. Mutepfa, UCLA CARE Center, Los Angeles, California
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Hoover MA, Green HD, Bogart LM, Wagner GJ, Mutchler MG, Galvan FH, McDavitt B. Do People Know I'm Poz?: Factors Associated with Knowledge of Serostatus Among HIV-Positive African Americans' Social Network Members. AIDS Behav 2016; 20:137-46. [PMID: 25903505 DOI: 10.1007/s10461-015-1039-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/06/2023]
Abstract
We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members' knowledge of respondents' serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents' networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents' HIV serostatus; African American network members were less likely to know respondents' serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members' knowledge of respondents' serostatus.
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Affiliation(s)
- Matthew A Hoover
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Harold D Green
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Laura M Bogart
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Matt G Mutchler
- California State University, Dominguez Hills, Carson, CA, USA
- AIDS Project Los Angeles, Los Angeles, CA, USA
| | | | - Bryce McDavitt
- California State University, Dominguez Hills, Carson, CA, USA
- AIDS Project Los Angeles, Los Angeles, CA, USA
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22
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Mutchler MG, McDavitt B, Ghani MA, Nogg K, Winder TJ, Soto JK. Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era. AIDS Patient Care STDS 2015; 29:490-502. [PMID: 26121564 DOI: 10.1089/apc.2015.0002] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options.
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Affiliation(s)
- Matt G. Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Bryce McDavitt
- Department of Sociology, California State University, Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Mansur A. Ghani
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Kelsey Nogg
- AIDS Project Los Angeles, Community Based Research Program, Los Angeles, California
| | - Terrell J.A. Winder
- Department of Sociology, University of California Los Angeles, Los Angeles, California
| | - Juliana K. Soto
- Department of Sociology, California State University, Dominguez Hills, Carson, California
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Pines HA, Gorbach PM, Reback CJ, Landovitz RJ, Mutchler MG, Mitsuyasu R. Commercial lubricant use among HIV-negative men who have sex with men in Los Angeles: implications for the development of rectal microbicides for HIV prevention. AIDS Care 2014; 26:1609-18. [PMID: 25022198 DOI: 10.1080/09540121.2014.936821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/25/2022]
Abstract
To inform the development and assess potential use of rectal microbicide gels for HIV prevention among men who have sex with men (MSM), we examined the dynamics and contexts of commercial lubricant use during receptive anal intercourse (RAI) within this population. From 2007 to 2010, 168 HIV-negative MSM living in Los Angeles who practice RAI completed computer-assisted self-interviews, which collected information on their last sexual event with ≤3 recent partners, at baseline, three months, and one-year study visits. Logistic generalized linear mixed models were used to identify individual- and sexual event-level characteristics associated with commercial lubricant use during RAI at the last sexual event within 421 partnerships reported by participants over the course of follow-up. During RAI at their last sexual event, 57% of partnerships used a condom and 69% used commercial lubricant. Among partnerships that used commercial lubricant, 56% reported lubricant application by both members of the partnership, 66% first applied lubricant during sex, but before penetration, and 98% applied lubricant at multiple locations. The relationship between substance use and commercial lubricant use varied by condom use (interaction p-value = 0.01). Substance use was positively associated with commercial lubricant use within partnerships that did not use condoms during RAI at their last sexual event (AOR = 4.47, 95% [corrected] [CI]: 1.63-12.28), but no association was observed within partnerships that did use condoms (AOR = 0.66, 95% CI: 0.23-1.85). Commercial lubricant use during RAI was also positively associated with reporting more sexual partners (AOR = 1.18, 95% CI: 1.05-1.31), while older age (units = 5 years; AOR = 0.75, 95% CI: 0.61-0.94), homelessness (past year; AOR = 0.32, 95% CI: 0.13-0.76), and having sex with an older (>10 years) partner (AOR = 0.37, 95% CI: 0.14-0.95) were negatively associated with commercial lubricant use. These factors should be considered in the development of rectal microbicide gels to enhance their acceptability and use among MSM.
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Affiliation(s)
- Heather A Pines
- a Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
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24
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McDavitt B, Mutchler MG. "Dude, You're Such a Slut!" Barriers and Facilitators of Sexual Communication Among Young Gay Men and Their Best Friends. J Adolesc Res 2014; 29:464-498. [PMID: 25419044 DOI: 10.1177/0743558414528974] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/17/2022]
Abstract
Conversations with friends are a crucial source of information about sexuality for young gay men, and a key way that sexual health norms are shared during emerging adulthood. However, friends can only provide this support if they are able to talk openly about sexuality. We explored this issue through qualitative interviews with an ethnically diverse sample of young gay men and their best friends. Using theories of sexual scripts, stigma, and emerging adulthood, we examined how conversations about sex could be obstructed or facilitated by several key factors, including judgmentalism, comfort/discomfort, and receptivity. Gay male friends sometimes spoke about unprotected sex in judgmental ways (e.g., calling a friend "slut" or "whore" for having sex without condoms). In some cases, this language could be used playfully, while in others it had the effect of shaming a friend and obstructing further communication about sexual risk. Female friends were rarely openly judgmental, but often felt uncomfortable talking about gay male sexuality, which could render this topic taboo. Sexual communication was facilitated most effectively when friends encouraged it through humor or supportive questioning. Drawing on these findings, we show how judgmentalism and discomfort may generate sexual scripts with contradictory norms, and potentially obstruct support from friends around sexual exploration during a period of life when it may be most developmentally important.
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Affiliation(s)
- Bryce McDavitt
- AIDS Project Los Angeles, CA, USA ; California State University, Dominguez Hills, CA, USA ; Pacifica Graduate Institute, CA, USA
| | - Matt G Mutchler
- AIDS Project Los Angeles, CA, USA ; California State University, Dominguez Hills, CA, USA
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Mutchler MG, McDavitt B, Gordon KK. "Becoming bold": alcohol use and sexual exploration among Black and Latino young men who have sex with men (YMSM). J Sex Res 2013; 51:696-710. [PMID: 23730733 PMCID: PMC3766459 DOI: 10.1080/00224499.2013.772086] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Alcohol use is correlated with unprotected sex, which may place young men who have sex with men (YMSM) who use alcohol with sex at increased risk for contracting HIV. However, little is known about how this link develops. This study used qualitative interviews to explore how alcohol became associated with sex and sexual risk among YMSM. We purposively sampled 20 Black and 20 Latino YMSM (N = 40), ages 21 to 24, who used substances (alcohol, marijuana, and crystal methamphetamine) with sex. Interviews focused on participants' personal histories to trace how these associations developed for each individual. Drawing on sexual script, emotion regulation, and alcohol expectancy theories, analyses followed a modified grounded theory approach. Participants stated that alcohol enabled them to engage in sexual behaviors with men that they wanted to try, allowing them to be more "bold," overcome stigma about homosexuality, and feel increased comfort with their sexual desires and identities. The use of alcohol during sex was helpful to some of the participants but could also lead to sexual risk behaviors. Intervention programs seeking to reduce alcohol misuse and sexual risk should take into account how YMSM conceptualize associations between alcohol and sex. These programs may be more effective if they provide support for sexual identity exploration.
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Affiliation(s)
- Matt G. Mutchler
- CSU-Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Los Angeles, California
| | - Bryce McDavitt
- CSU-Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Los Angeles, California
- Pacifica Graduate Institute, Carpinteria, California
| | - Kristie K. Gordon
- CSU-Dominguez Hills, Carson, California
- AIDS Project Los Angeles, Los Angeles, California
- University of Alabama, Tuscaloosa
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Mutchler MG, McKay T, McDavitt B, Gordon KK. Using peer ethnography to address health disparities among young urban Black and Latino men who have sex with men. Am J Public Health 2013; 103:849-52. [PMID: 23488490 DOI: 10.2105/ajph.2012.300988] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effectiveness of peer ethnography to gain insider views on substance use and sex among a diverse range of high-risk substance-using Black and Latino young men who have sex with men. METHODS We recruited 9 peer ethnographers aged 21 to 24 years from youth programs for the lesbian, gay, bisexual, and transgender community in Los Angeles, California, and trained them in ethnography, study protocol, and human participant protection. Peer ethnographers collected 137 single-spaced pages of field notes in 2009 and 2010 derived from observation of 150 members of the target population. RESULTS Peer ethnography revealed local language and phrasing and provided a window into new and different social contexts. Peers provided valuable information on current trends in substance use, revealing themes that needed to be addressed in further research, such as the use of substances during sex to "clock coin" (exchange sex for money and substances). These data enabled us to refine our recruitment strategies and ask more culturally relevant questions in a later phase of the study. CONCLUSIONS The peer ethnography method can provide a sound basis for further research phases in multistage studies on numerous other social issues and with other hard-to-reach populations.
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Affiliation(s)
- Matt G Mutchler
- Sociology Department and Urban Community Research Center, California State University, Dominguez Hills, Carson, CA 90747, USA.
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George S, Phillips R, McDavitt B, Adams W, Mutchler MG. The cellular generation and a new risk environment: implications for texting-based sexual health promotion interventions among minority young men who have sex with men. AMIA Annu Symp Proc 2012; 2012:247-256. [PMID: 23304294 PMCID: PMC3540519] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
African American and Latino young men who have sex with men (YMSM) are at the forefront of the U.S. HIV epidemic. As members of the "cellular generation," these youth are very likely to use text messaging; yet, relatively little research has explored use of text messaging as a tool for sexual health promotion, particularly among racial ethnic minorities who are also sexual minorities. We report on the results of ten focus groups conducted among African American and Latino YMSM, aged 18-25, regarding their current texting practices and the feasibility/acceptability of text messaging as a means of conducting sexual health promotion. Our analyses revealed four main themes around their texting behaviors, texting preferences, perceived advantages/disadvantages of texting, and the "etiquette" of texting. We consider implications of these findings for the development of texting-based sexual health promotion interventions, particularly in conjunction with other existing interventions operating in a new risk environment.
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Affiliation(s)
- Sheba George
- Charles R. Drew University of Medicine and Science
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Bogart LM, Wagner GJ, Mutchler MG, Risley B, McDavitt BW, McKay T, Klein DJ. Community HIV treatment advocacy programs may support treatment adherence. AIDS Educ Prev 2012; 24:1-14. [PMID: 22339141 PMCID: PMC3286035 DOI: 10.1521/aeap.2012.24.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Treatment advocacy (TA) programs, based in AIDS service organizations and clinics, aim to engage clients into care and support antiretroviral treatment (ART) adherence through client-centered counseling; advocate for patients with providers; and provide social service referrals. Systematic evaluations of TA are lacking. We conducted a non-randomized evaluation examining relationships of TA participation to adherence, care engagement, social services utilization, unmet needs, patient self-advocacy, and adherence self-efficacy among 121 HIV-positive clients (36 in TA, 85 not in TA; 87% male, 34% African American, 31% White, 19% Latino). In multivariate models, TA participants (vs. non-TA participants) showed higher electronically monitored [85.3% vs. 70.7% of doses taken; b(SE) = 13.16(5.55), p < .05] and self-reported [91.1% vs. 75.0%; b(SE) = 11.60(5.65), p < .05] adherence; utilized more social service programs [Ms = 5.2 vs. 3.4; b(SE) = 1.97(0.48), p < .0001]; and had fewer unmet social-service needs [Ms = 1.8 vs. 2.7; b(SE) = -1.06(0.48), p < .05]. Findings suggest the need for a randomized controlled trial of TA.
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Affiliation(s)
- Laura M Bogart
- Division of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA.
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McKay TA, McDavitt B, George S, Mutchler MG. 'Their type of drugs': perceptions of substance use, sex and social boundaries among young African American and Latino gay and bisexual men. Cult Health Sex 2012; 14:1183-96. [PMID: 23013278 PMCID: PMC3507549 DOI: 10.1080/13691058.2012.720033] [Citation(s) in RCA: 8] [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: 05/21/2023]
Abstract
Studies of sexuality have increasingly shifted their attention towards understanding the social contexts that inform and organise sexual behaviour. Building on this work, we examine how substance use and sex are socially organised and meaningful activities for young African American and Latino gay and bisexual men who use substances with sex. Drawing on 30 qualitative interviews in Los Angeles and New York, we identify the ways in which social boundaries inform substance use among these young men. We find that many of them view the gay and racial/ethnic communities they belong to as differentiated by patterns of substance use. Further, they see these communities as actively constructing group boundaries through substance use, sanctioning the use of particular substances while simultaneously discouraging the use or discussion of others. For these young men, racial/ethnic and gay communities provide salient contexts in which the use of certain substances and not others is socially meaningful. Findings demonstrate the important and heretofore unrecognised ways that perceived social boundaries inform these young men's use of substances. As both protective and marginalising influences, perceptions of communities and social identities have real consequences for the sexual health of young African American and Latino gay and bisexual men.
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Affiliation(s)
- Tara A McKay
- Department of Sociology, University of California, Los Angeles, USA.
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Mutchler MG, McDavitt B. 'Gay boy talk' meets 'girl talk': HIV risk assessment assumptions in young gay men's sexual health communication with best friends. Health Educ Res 2011; 26:489-505. [PMID: 21059803 PMCID: PMC3099184 DOI: 10.1093/her/cyq069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 10/05/2010] [Indexed: 05/25/2023]
Abstract
Young adults, particularly young gay men (YGM), are vulnerable to human immunodeficiency virus (HIV). Yet, little is known about how YGM discuss sexual health issues with their friends ('gay boy talk'). We conducted semi-structured interviews with YGM and their best friends (11 YGM/YGM dyads and 13 YGM/heterosexual female dyads). In this paper, we examine risk assessment assumptions conveyed within YGM's communication about sexual health with their friends and how, if at all, the sexual scripts guiding these assumptions may differ between YGM and young women. Findings demonstrated that, while these young adults clearly intended to support their friends and promote safer sex, they also conveyed assumptions about HIV risk assessment, especially regarding sexual partner selection, that may actually increase their friends' risk for HIV infection. Since inaccurate HIV risk assessment assumptions were transmitted via sexual health communication between peers, it is suggested that such assumptions may need to be addressed in HIV prevention programs working with YGM and their friends. Further, gender differences were identified within the sexual scripts shared between YGM and their friends, suggesting that such interventions should be tailored to the specific needs of different friendship networks.
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Affiliation(s)
- Matt G Mutchler
- Department of Sociology, California State University, Dominguez Hills, Carson, CA 90747, USA.
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Mutchler MG, Wagner G, Cowgill BO, McKay T, Risley B, Bogart LM. Improving HIV/AIDS care through treatment advocacy: going beyond client education to empowerment by facilitating client-provider relationships. AIDS Care 2011; 23:79-90. [PMID: 21218280 DOI: 10.1080/09540121.2010.496847] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Treatment advocacy (TA) programs have been implemented by AIDS service organizations (ASOs) and primary care clinics across the USA to help engage clients with HIV into care and support their adherence to antiretroviral therapy (ART). TA aims to empower people with HIV through education and client-centered counseling regarding HIV, ART, and other health issues; advocate on behalf of patients with providers; and make referrals to healthcare services and clinical trials. However, relatively little is known about the impact TA has on clients' healthcare experiences. The present study's objectives included exploring how TA services help clients engage in HIV care, initiate ART, and adhere to HIV medications. We conducted 25 semi-structured qualitative open-ended interviews with clients living with HIV/AIDS recruited from AIDS Project Los Angeles (APLA); four HIV medical providers; and two TA staff at APLA. Of the 25 clients interviewed, 92% were male and 8% were female. The average age was 43 years (SD=9). About 60% were African-American, 20% were White, 12% were other or multiracial, 4% were Latino, and 4% were Asian/Pacific Islander. Five interconnected themes consistently emerged across clients, TAs, and providers. TAs helped clients understand treatments and supported adherence within a holistic context. Further, TAs acted as a bridge to providers and helped clients build self-advocacy skills. Our data show that TA services go beyond traditional areas of education and treatment adherence. TA services within an ASO also provide a safe place to discuss initial HIV diagnoses and other health issues in a more comprehensive manner. TA services complemented medical and other social services by preparing clients with HIV to be better consumers of healthcare services. Future quantitative research examining the effectiveness of TA on improving clients' engagement in care and adherence is a critical next step.
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Affiliation(s)
- Matt G Mutchler
- Department of Sociology, California State University, Carson, CA, USA.
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Mutchler MG, McKay T, Candelario N, Liu H, Stackhouse B, Bingham T, Ayala G. Sex drugs, peer connections, and HIV: Use and risk among African American, Latino, and Multiracial young men who have sex with men (YMSM) in Los Angeles and New York. J Gay Lesbian Soc Serv 2011; 23:271-295. [PMID: 21731406 PMCID: PMC3126154 DOI: 10.1080/10538720.2011.560100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
African American and Latino young men who have sex with men are at high risk for HIV infection. We administered brief intercept surveys (N=416) at 18 Black and Latino gay pride events in Los Angeles and New York in 2006 and 2007. Ordinal logistic regressions were used to model the effects of substance use during sex, peer connectedness, relationship status, and homelessness on condom use. Alcohol use, crystal use, homelessness, and having a primary relationship partner were negatively associated with condom use, while peer connectedness and marijuana use during sex were positively associated with condom use. Implications for service providers and future research are discussed.
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Affiliation(s)
- Matt G. Mutchler
- Corresponding author. Department of Sociology, California State University - Dominguez Hills, Carson, CA; Community Based Research, AIDS Project Los Angeles, 3550 Wilshire Blvd Ste 300, Los Angeles, CA
| | - Tara McKay
- Department of Sociology, University of California – Los Angeles, CA
| | | | - Honghu Liu
- Department of Biostatistics, University of California – Los Angeles, CA
| | | | - Trista Bingham
- Los Angeles County HIV Epidemiology Program—Los Angeles, CA
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Mutchler MG, Bogart LM, Elliott MN, McKay T, Suttorp MJ, Schuster MA. Psychosocial correlates of unprotected sex without disclosure of HIV-positivity among African-American, Latino, and White men who have sex with men and women. Arch Sex Behav 2008; 37:736-47. [PMID: 18506613 PMCID: PMC2673702 DOI: 10.1007/s10508-008-9363-8] [Citation(s) in RCA: 35] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.
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Mutchler MG, Bingham T, Chion M, Jenkins RA, Klosinski LE, Secura G. Comparing sexual behavioral patterns between two bathhouses: implications for HIV prevention intervention policy. J Homosex 2003; 44:221-242. [PMID: 12962184 DOI: 10.1300/j082v44n03_10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
There is a glaring lack of data to inform culturally appropriate HIV prevention interventions targeting environments such as bathhouses where men who have sex with men (MSM) practice sexual risk behaviors. This study compares sexual behavioral patterns across two bathhouse sites in order to identify important themes to address when tailoring HIV prevention interventions to bathhouse environments. We analyzed semi-structured interviews with workers and patrons at two bathhouses to explore similarities and differences. A coding scheme was established and data were organized according to conceptual themes. We found that differences between the two sites emerged in six key areas: bathhouse clientele, attraction to particular sites, sexual practices and condom use, communication about sex and HIV status, bathhouse rules, and substance use. Implications for HIV prevention intervention policy are discussed.
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Affiliation(s)
- Matt G Mutchler
- AIDS Project Los Angeles, 3550 Wilshire Boulevard, Suite #300, Los Angeles, CA 90010, USA
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Mutchler MG. Client characteristics emerge from data. Posit Living 2002; 11:46. [PMID: 12038460] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Mutchler MG. Survey shows prevention concerns. Posit Living 2000; 9:33. [PMID: 12492022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Mutchler MG. Making space for safer sex. AIDS Educ Prev 2000; 12:1-14. [PMID: 10749382] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There is much concern about the second wave of HIV infections among gay male youth. Yet qualitative research showing how to produce effective HIV prevention programs for this population are scarce. Traditional models for education are not sufficient. This study uses ethnographic data to illustrate a community empowerment HIV prevention project found to significantly reduce rates of unprotected anal sex among young gay males between the ages of 18 and 29. It seeks to show how safer sex norms among gay youth are produced. Analyses of these data reveal that a sense of ownership in a youth space is a critical component of this model. This research should facilitate AIDS educators in their efforts to end the second wave of infections among gay youth by providing a detailed map of how a successful HIV prevention project operates and by stressing the need to make spaces for safer sex education.
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