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Mullis CE, Goldberg AJ, Avila K, Hall B, Golub SA, Keller MJ. Understanding Attitudes of Postpartum Cisgender Women Toward Integration of HIV Prevention Services into Routine Prenatal and Postpartum Sexual Health Discussions. AIDS Patient Care STDS 2024; 38:185-193. [PMID: 38656218 DOI: 10.1089/apc.2023.0307] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Oral pre-exposure prophylaxis (PrEP) is an effective, user-controlled method for HIV prevention. However, awareness, uptake, and adherence to PrEP remain low among cisgender women (CGW). The prenatal and postpartum periods present an opportunity for delivery of comprehensive sexual health services that include HIV prevention education and services. However, little is known about postpartum CGW's attitudes toward integration of HIV prevention education and services into obstetric care in the US. We conducted semistructured interviews with 20 postpartum CGW in the Bronx, NY from July to November 2022 to explore their experiences with prenatal and postpartum sexual health care, examine their attitudes toward integration of HIV prevention services into obstetric sexual health care, and identify components of future implementation strategies. Transcripts were analyzed thematically using a framework approach. Among CGW interviewed, fewer than half reported prior knowledge of PrEP. Ten participants preferred long-acting injectable PrEP relative to six who preferred daily oral PrEP. Most participants reported no discussion of sex with their provider during pregnancy, and when discussions occurred, they focused on permission or prohibition of sexual activity. Participants described a reliance on providers to lead prenatal sexual health discussions. Even when not perceived as personally relevant, most respondents valued education on HIV prevention and PrEP services. In the postpartum period, sexual health discussions were similarly limited despite participants describing complex experiential sexual health concerns. This study supports the potential for integration of HIV prevention education and services into routine prenatal and postpartum sexual health discussions in an area of high HIV prevalence in the US.
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Affiliation(s)
- Caroline E Mullis
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Alison J Goldberg
- Department of Psychology, Hunter College of the City University of New York, New York, New York, USA
| | - Karina Avila
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Bianca Hall
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York, USA
- PhD Program in Basic and Applied Social Psychology, Graduate Center of the City University of New York, New York, New York, USA
| | - Marla J Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Guo Y, Westmoreland DA, D'Angelo AB, Mirzayi C, Dearolf M, Ray M, Carneiro PB, Pantalone DW, Carrico AW, Patel VV, Golub SA, Hirshfield S, Hoover DR, Nash D, Grov C. PrEP Uptake and Methamphetamine Use Patterns in a 4-Year U.S. National Prospective Cohort Study of Sexual and Gender Minority People, 2017-2022. AIDS Behav 2024:10.1007/s10461-024-04306-1. [PMID: 38436807 DOI: 10.1007/s10461-024-04306-1] [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: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Methamphetamine use is on the rise among sexual and gender minority people who have sex with men (SGMSM), escalating their HIV risk. Despite pre-exposure prophylaxis (PrEP) being an effective biomedical HIV prevention tool, its uptake in relation to methamphetamine use patterns in SGMSM has not been studied. In a U.S. cohort study from 2017 to 2022, 6,253 HIV-negative SGMSM indicated for but not using PrEP were followed for four years. Methamphetamine use was categorized (i.e., newly initiated, persistently used, never used, used but quit), and PrEP uptake assessed using generalized estimating equation (GEE), adjusted for attrition. Participants had a median age of 29, with 51.9% White, 11.1% Black, 24.5% Latinx, and 12.5% other races/ethnicities. Over the four years, PrEP use increased from 16.3 to 27.2%. GEE models identified risk factors including housing instability and food insecurity. In contrast, older age, health insurance, clinical indications, and prior PrEP use increased uptake. Notably, Latinx participants were more likely to use PrEP than Whites. Regarding methamphetamine use, those who newly initiated it were more likely to use PrEP compared to non-users. However, those who quit methamphetamine and those who persistently used it had PrEP usage rates comparable to those of non-users. Though PrEP uptake increased, it remained low in SGMSM. Methamphetamine use was associated with PrEP uptake. Healthcare providers should assess methamphetamine use for harm reduction. Prioritizing younger, uninsured SGMSM and addressing basic needs can enhance PrEP uptake and reduce HIV vulnerabilities.
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Affiliation(s)
- Yan Guo
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Drew A Westmoreland
- Department of Epidemiology, College of Medicine & College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Alexa B D'Angelo
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Chloe Mirzayi
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Michelle Dearolf
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Pedro B Carneiro
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Adam W Carrico
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System Bronx, Miami, NY, USA
| | - Sarit A Golub
- Hunter HIV/AIDS Research Team, Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, NJ, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA.
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
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Guo Y, Westmoreland DA, D'Angelo A, Mirzayi C, Dearolf M, Carneiro PB, Ray M, Pantalone DW, Carrico AW, Patel VV, Golub SA, Hirshfield S, Hoover D, Nash D, Grov C. PrEP Discontinuation In A US National Cohort Of Sexual And Gender Minority Populations, 2017-22. Health Aff (Millwood) 2024; 43:443-451. [PMID: 38437609 DOI: 10.1377/hlthaff.2023.00867] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
In the US, sexual and gender minority populations are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a key prevention method, but its effectiveness relies on consistent usage. Our four-year national cohort study explored PrEP discontinuation among sexual and gender minority people who initiated PrEP. We found a high annual rate of discontinuation (35-40 percent) after PrEP initiation. Multivariable analysis with 6,410 person-years identified housing instability and prior history of PrEP discontinuation as predictors of discontinuation. Conversely, older age, clinical indication for PrEP, and having health insurance were associated with ongoing PrEP use. To promote sustained PrEP use, strategies should focus on supporting those at high risk for discontinuation, such as younger people, those without stable housing or health insurance, and prior PrEP discontinuers.
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Affiliation(s)
- Yan Guo
- Yan Guo, City University of New York, New York, New York
| | | | | | | | | | | | - Meredith Ray
- Meredith Ray, University of Memphis, Memphis, Tennessee
| | - David W Pantalone
- David W. Pantalone, University of Massachusetts Boston, Boston, Massachusetts
| | - Adam W Carrico
- Adam W. Carrico, Florida International University, Miami, Florida
| | - Viraj V Patel
- Viraj V. Patel, Albert Einstein College of Medicine, New York, New York
| | | | - Sabina Hirshfield
- Sabina Hirshfield, SUNY Downstate Health Sciences University, New York, New York
| | - Donald Hoover
- Donald Hoover, Rutgers University, New Brunswick, New Jersey
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Chakrapani V, Gulfam FR, Arumugam V, Aher A, Shaikh S, Prasad R, Safren S, Golub SA, Patel VV. Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India. AIDS Care 2023; 35:572-580. [PMID: 35819879 PMCID: PMC9834431 DOI: 10.1080/09540121.2022.2099511] [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: 04/02/2021] [Accepted: 07/04/2022] [Indexed: 01/14/2023]
Abstract
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipated stigma due to transgender identity, HIV, or sex work status, and lack of gender affirmation (e.g., misgendering) in healthcare settings delayed ART initiation and promoted care disengagement. Having supportive physicians and counsellors within ART centres and peer outreach workers facilitated ART initiation, adherence, and retention. Findings also revealed that HIV stigma within TGW communities led to concealment of HIV status or syndemic conditions such as depression and alcohol use, thereby affecting care engagement. However, the TGW community itself was also described as a resilience resource, offering emotional, psychological and tangible support that decreased the impact of discrimination on care engagement. HIV care engagement efforts among Indian TGWLH could be strengthened by reducing intersecting stigmas in healthcare settings and within TGW communities, providing gender-affirming and culturally competent healthcare, addressing psychosocial syndemic conditions, and strengthening support within transgender communities.
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Affiliation(s)
| | | | | | | | | | | | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
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Rahman M, Fikslin RA, Matthews E, Vazquez Sanchez MA, Ahn GO, Kobrak PH, Lovinger ES, Golub SA. Exploring Factors Affecting Patient-Provider Interactions and Healthcare Engagement Among a Diverse Sample of Women Who Have Sex with Women in New York City. Arch Sex Behav 2023; 52:833-849. [PMID: 36478134 PMCID: PMC9886640 DOI: 10.1007/s10508-022-02478-2] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Women who have sex with women (WSW) have lower rates of engagement in health care and preventive screenings than women who have sex exclusively with men. Existing literature provides limited insight into how intersecting and overlapping identities, such as race, ethnicity, sexual orientation, gender identity, and identities related to gender expression, may shape individuals' experiences within health care. We conducted qualitative interviews in New York City with 30 people who identified as women, reported sex with people who identify as women, were age 18-65, and were diverse in race, ethnicity, and sexual orientation and gender identity. The semi-structured questionnaire asked participants about positive and negative healthcare experiences to elicit what could encourage or prevent seeking care, with a focus on provider-related factors. Factors that led to positive healthcare experiences included having a provider who was knowledgeable about LGBTQ experience and health and who affirmed their sexuality, gender identity, and other intersecting identities. Factors that contributed to negative healthcare experiences included poor interactions with providers, and providers' perceived heteronormativity and lack of awareness of WSW healthcare needs. WSW of different races, ethnicities, sexual orientations, and gender identities seek validating healthcare experiences that acknowledge and affirm their identities. We present a visual summary of the main thematic factors that contributed to positive and negative WSW healthcare experiences. Increasing access to care requires training providers on how to engage WSW patients, including WSW of diverse race/ethnicity and gender identity and expression.
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Affiliation(s)
- Musarrat Rahman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
| | - Rachel A Fikslin
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
| | - Eugene Matthews
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
| | - Maria A Vazquez Sanchez
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | | | - Paul H Kobrak
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | | | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
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Golub SA, Starbuck L, Fikslin R, Gamarel KE. Psychometric Evaluation and Predictive Validity of an Adapted Adherence Self-Efficacy Scale for PrEP. AIDS Behav 2023; 27:218-230. [PMID: 35809144 DOI: 10.1007/s10461-022-03758-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Adherence to and sustainment of HIV pre-exposure prophylaxis (PrEP) are critical to its effectiveness. Adherence self-efficacy, i.e., confidence in one's ability to adhere to a particular medication, is a key psychological determinant of health behavior that strongly predicts HIV treatment adherence but has been understudied in PrEP research. This paper describes the psychometric evaluation and validation of the PrEP Adherence Self-Efficacy Scale (PrEP-ASES), adapted from the previously validated HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Data are drawn from two studies conducted at a community health center, one focused on gay and bisexual cisgender men and the other on transgender women. Factor analyses support a one-factor score (eigenvalue = 6.78) that explained 75.3% of the variance, with good test-retest reliability (rs > 0.40). In both studies, higher PrEP-ASES scores were associated with PrEP uptake, adherence, and sustainment. Findings support the utility of the PrEP-ASES in research and suggest the importance of addressing self-efficacy in PrEP programs and services.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA.
| | - Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Rachel Fikslin
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Meyers K, Nguyen N, Zucker JE, Kutner BA, Carnevale C, Castor D, Sobieszczyk ME, Yin MT, Golub SA, Remien RH. The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation. AIDS Behav 2023; 27:4-9. [PMID: 36056997 DOI: 10.1007/s10461-022-03816-0] [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: 08/10/2022] [Indexed: 01/24/2023]
Abstract
The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug "tail" that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 W. 168th Street, HHSC 1102, 10032, New York, NY, USA.
| | - Nadia Nguyen
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 W. 168th Street, HHSC 1102, 10032, New York, NY, USA
| | - Jason E Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Caroline Carnevale
- NYP HIV Prevention Program, New York-Presbyterian Hospital, New York, NY, USA
| | - Delivette Castor
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Graduate Center of the City University of New York, New York, NY, USA
- Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, State Psychiatric Institute, Columbia University, New York, NY, NY, USA
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Bhutada K, Chakrapani V, Gulfam FR, Ross J, Golub SA, Safren SA, Prasad R, Patel VV. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India. J Int Assoc Provid AIDS Care 2023; 22:23259582231199398. [PMID: 37701971 PMCID: PMC10501078 DOI: 10.1177/23259582231199398] [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: 03/21/2023] [Revised: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21-58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community.
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Affiliation(s)
- Kiran Bhutada
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | - Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), C-ShaRP, Chennai, India Chennai, India
| | | | - Jonathan Ross
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | | | | | | | - Viraj V Patel
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
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Klein A, Golub SA. Ethical HIV research with transgender and non-binary communities in the United States. J Int AIDS Soc 2022; 25 Suppl 5:e25971. [PMID: 36225134 PMCID: PMC9557013 DOI: 10.1002/jia2.25971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Because transgender individuals experience disproportionately high rates of HIV infection, this population is an increasing focus of epidemiological and implementation science research to combat the epidemic. However, study participants, providers and other advocates have become increasingly concerned about research practices that may alienate, objectify, exploit or even re-traumatize the communities they are designed to benefit. This commentary explores the common pitfalls of HIV research with transgender communities and provides a potential framework for ethical, community-engaged research practice. DISCUSSION We review some of the critical challenges to HIV research with transgender and non-binary communities that limit the potential for such studies to improve practice. For example, scales that measure stigma perceptions/experiences often include activating language, while the consistent focus in research on risk and trauma can often feel judgemental and redundant. Because of limited employment opportunities, some participants may feel undue influence by research stipends; others may perceive their participation as fuelling the larger research economy without providing research jobs to community members. Questions remain regarding optimal strategies for authentic research partnership beyond community advisory boards or focus groups. Transgender and non-binary researchers are under-represented and may be tokenized. Many demonstration projects provide much-needed services that disappear when the research funding is over, and community-based dissemination efforts are often perceived as "too little, too late" to effect change. CONCLUSIONS Based on this review and input from study participants across the United States, we detail six recommendations for ethical HIV research with transgender and non-binary communities, including (1) equitable budgeting with community-based programme partners; (2) representation in the development of both research agenda and methods; (3) integration of research activities into the ongoing work of any clinical or service site, so that individuals' needs as "clients" can continue to be prioritized over their role as "participants;" (4) mindfully considered compensation that values the contributions of community members, but avoids undue influence; (5) transparent, community-focused and timely communication at every stage of the study, including research purpose, data usage, preliminary findings and full-scale results; and (6) planning for sustainability of any programme or services beyond the life of the research project.
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Affiliation(s)
- Augustus Klein
- Hunter Alliance for Research and TranslationHunter CollegeNew York CityNew YorkUSA
| | - Sarit A. Golub
- Hunter Alliance for Research and TranslationHunter CollegeNew York CityNew YorkUSA,Department of PsychologyHunter CollegeNew York CityNew YorkUSA,Department of Basic and Applied Social PsychologyThe Graduate Center of the City University of New YorkNew York CityNew YorkUSA
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Unger ZD, Golub SA, Borges C, Edelstein ZR, Hedberg T, Myers J. Reasons for PrEP Discontinuation After Navigation at Sexual Health Clinics: Interactions Among Systemic Barriers, Behavioral Relevance, and Medication Concerns. J Acquir Immune Defic Syndr 2022; 90:316-324. [PMID: 35286280 PMCID: PMC9203912 DOI: 10.1097/qai.0000000000002952] [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] [Received: 12/08/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV prevention requires engagement throughout the PrEP care continuum. Using data from a PrEP navigation program, we examine reasons for PrEP discontinuation. SETTING Participants were recruited from New York City Health Department Sexual Health Clinics with PrEP navigation programs. METHODS Participants completed a survey and up to 3 interviews about PrEP navigation and use. This analysis includes 94 PrEP initiators that were PrEP-naive before their clinic visit, started PrEP during the study, and completed at least 2 interviews. Interview transcripts were reviewed to assess reasons for PrEP discontinuation. RESULTS Approximately half of PrEP initiators discontinued PrEP during the study period (n = 44; 47%). Most participants (71%) noted systemic issues (insurance or financial problems, clinic or pharmacy logistics, and scheduling barriers) as reasons for discontinuation. One-third cited medication concerns (side effects, potential long-term side effects, and medication beliefs; 32%) and behavioral factors (low relevance of PrEP because of sexual behavior change; 34%) as contributing reasons. Over half (53.5%) highlighted systemic issues alone, while an additional 19% attributed discontinuation to systemic issues in combination with other factors. Of those who discontinued, approximately one-third (30%) restarted PrEP during the follow-up period, citing resolution of systemic issues or behavior change that increased PrEP relevance. CONCLUSIONS PrEP continuation is dependent on interacting factors and often presents complex hurdles for patients to navigate. To promote sustained engagement in PrEP care, financial, clinic, and pharmacy barriers must be addressed and counseling and navigation should acknowledge factors beyond sexual risk that influence PrEP use.
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Affiliation(s)
- Zoe D Unger
- Department of Psychology, Hunter College, City University of New York, New York, NY
| | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York, New York, NY
- Basic and Applied Social Psychology (BASP) PhD Program, Graduate Center of the City University of New York, New York, NY
- Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, NY
| | - Christine Borges
- New York City Department of Health and Mental Hygiene, Bureau of Public Health Clinics, New York, NY
| | - Zoe R Edelstein
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV and STI, New York, NY
| | - Trevor Hedberg
- New York City Department of Health and Mental Hygiene, Bureau of Public Health Clinics, New York, NY
- Howard Brown Health, Chicago, IL; and
| | - Julie Myers
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV and STI, New York, NY
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
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Golub SA, Fikslin RA. Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action. J Int AIDS Soc 2022; 25 Suppl 1:e25930. [PMID: 35818865 PMCID: PMC9274207 DOI: 10.1002/jia2.25930] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/04/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra-personal processes (i.e. knowledge or internalization of community-level stigma that might limit clients' engagement in care) or inter-personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity. DISCUSSION We apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV-specific and intersectional stigma. CONCLUSIONS This commentary is a theory-informed call to action for the assessment of existing HIV service implementation, for the development of new stigma-reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system-level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College, New York, New York, USA.,Basic and Applied Social Psychology, The Graduate Center of the City University of New York, New York, New York, USA.,Hunter Alliance for Research and Translation, Hunter College, New York, New York, USA.,Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, New York, USA
| | - Rachel A Fikslin
- Department of Psychology, Hunter College, New York, New York, USA.,Basic and Applied Social Psychology, The Graduate Center of the City University of New York, New York, New York, USA.,Hunter Alliance for Research and Translation, Hunter College, New York, New York, USA
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12
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Price DM, English D, Golub SA. Parallel reductions in anxiety and HIV-related worry among pre-exposure prophylaxis (PrEP) users over time. Psychol Health 2022; 41:433-441. [PMID: 35604704 DOI: 10.1037/hea0001189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The threat of HIV has been proposed as a major contributing factor to the disproportionately higher rates of anxiety among gay and bisexual men compared to their heterosexual counterparts. The current study examined 12-month trajectories of anxiety symptoms and concomitant HIV-related worry among a cohort of preexposure prophylaxis (PrEP) users, compared to a comparison cohort who were not taking PrEP. METHOD SPARK was a community-based PrEP demonstration project conducted between February 2014 and May 2017. Self-report anxiety and worry data were collected from PrEP patients (n = 300) quarterly, and from non-PrEP patients (n = 131) at baseline, 3, and 12 months. We ran a series of unconditional latent growth curve models (LGCMs) to examine changes in anxiety and HIV worry over the 12-month study period, followed by parallel process LGCMs to examine the association between both intercepts and growth factors, adjusting for demographic factors. RESULTS In a parallel process model, both an association between baseline levels of HIV worry and anxiety decreases in both variables over time among PrEP users but not among non-PrEP users. Additionally, a multigroup analysis was conducted, restricting both groups to 3 time points, and forcing a comparison of slopes between the 2 groups. This analysis revealed that there was no difference in the anxiety slopes between the 2 cohorts. However, the HIV worry slope remained significantly different among the PrEP cohort compared to the non-PrEP cohort. CONCLUSIONS These data provide some of the first quantitative evidence for the potential of PrEP to reduce both HIV worry and anxiety symptoms. Emphasizing positive mental health "side effects" of PrEP may be a strategy for engaging priority populations in biomedical HIV prevention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Devon M Price
- Department of Psychology, Hunter College, City University of New York
| | | | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York
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13
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Starbuck L, Golub SA, Klein A, Harris AB, Guerra A, Rincon C, Radix AE. Brief Report: Transgender Women and Preexposure Prophylaxis Care: High Preexposure Prophylaxis Adherence in a Real-World Health Care Setting in New York City. J Acquir Immune Defic Syndr 2022; 90:15-19. [PMID: 35013087 PMCID: PMC8986585 DOI: 10.1097/qai.0000000000002915] [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] [Received: 05/13/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transgender women and trans feminine individuals (TGW/TFI) are a high priority population for the provision of HIV preexposure prophylaxis (PrEP) care within the United States, but there is limited research that focuses specifically on PrEP adherence within this population. SETTING Observational study of patients prescribed PrEP at a community-based health center. METHODS We enrolled 100 TGW/TFI PrEP patients at a community health center during clinic visits. Adherence data were collected at 3 time points, using self-report surveys, patient interviews, and urine assays measuring tenofovir. Data were summarized descriptively. RESULTS The sample was diverse in age, race/ethnicity, and socioeconomic characteristics. Participants demonstrated strong PrEP adherence; at least 80% of the sample reported 90% or greater adherence at each time point. Concordance between self-report and urine assay was high. Among patients who reported taking PrEP within the past 48 hours, 82%-92% had detectable urine tenofovir. However, many patients reported PrEP stop periods of 4 or more days (28%-39% per time point). CONCLUSIONS Our data highlight TGW/TFI's capacity to adhere to daily PrEP and sustain PrEP use over time. The concordance between patient self-report and urine TFV levels suggest that providers can trust patient reports of PrEP adherence behavior and support the use of adherence conversations in clinical settings, without the need for point of care biological monitoring. Findings also underscore the importance of continued attention to drivers of PrEP stops at the patient, clinic, and systems levels and the development of strategies that support sustained PrEP use.
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Affiliation(s)
- Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY USA
| | - Augustus Klein
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | | | - Amiyah Guerra
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Christopher Rincon
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Asa E. Radix
- Callen-Lorde Community Health Center, New York, NY, USA
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14
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Starbuck L, Golub SA, Klein A, Harris AB, Guerra A, Rincon C, Radix AE. Brief Report: Transgender Women and Preexposure Prophylaxis Care: High Preexposure Prophylaxis Adherence in a Real-World Health Care Setting in New York City. J Acquir Immune Defic Syndr 2022. [PMID: 35013087 DOI: 10.1097/qai.0000000000002915]] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Transgender women and trans feminine individuals (TGW/TFI) are a high priority population for the provision of HIV preexposure prophylaxis (PrEP) care within the United States, but there is limited research that focuses specifically on PrEP adherence within this population. SETTING Observational study of patients prescribed PrEP at a community-based health center. METHODS We enrolled 100 TGW/TFI PrEP patients at a community health center during clinic visits. Adherence data were collected at 3 time points, using self-report surveys, patient interviews, and urine assays measuring tenofovir. Data were summarized descriptively. RESULTS The sample was diverse in age, race/ethnicity, and socioeconomic characteristics. Participants demonstrated strong PrEP adherence; at least 80% of the sample reported 90% or greater adherence at each time point. Concordance between self-report and urine assay was high. Among patients who reported taking PrEP within the past 48 hours, 82%-92% had detectable urine tenofovir. However, many patients reported PrEP stop periods of 4 or more days (28%-39% per time point). CONCLUSIONS Our data highlight TGW/TFI's capacity to adhere to daily PrEP and sustain PrEP use over time. The concordance between patient self-report and urine TFV levels suggest that providers can trust patient reports of PrEP adherence behavior and support the use of adherence conversations in clinical settings, without the need for point of care biological monitoring. Findings also underscore the importance of continued attention to drivers of PrEP stops at the patient, clinic, and systems levels and the development of strategies that support sustained PrEP use.
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Affiliation(s)
- Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY
- Department of Psychology, Graduate Center of the City University of New York, New York, NY; and
| | - Augustus Klein
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Alexander B Harris
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
| | - Amiyah Guerra
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
| | - Christopher Rincon
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
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15
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Price DM, Unger Z, Wu Y, Meyers K, Golub SA. Clinic-Level Strategies for Mitigating Structural and Interpersonal HIV Pre-Exposure Prophylaxis Stigma. AIDS Patient Care STDS 2022; 36:115-122. [PMID: 35289691 PMCID: PMC8971970 DOI: 10.1089/apc.2021.0176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Uptake of and persistence on pre-exposure prophylaxis (PrEP) in the United States have been limited. The potential of new PrEP modalities to increase access will be hindered if underlying structural and interpersonal barriers-including, insurance coverage, initiation and maintenance clinical protocols, provider bias, stigma, and lack of trust in health care-are not adequately addressed. We conducted in-person and telephone-based recorded interviews with 32 US-based clinical and nonclinical PrEP providers spanning the PrEP implementation continuum (clinicians, counselors, and support staff). Providers were recruited at biomedical HIV prevention conferences and networks to explore barriers to and strategies for PrEP implementation. Providers provided care to clients spanning adolescents to adulthood and a variety of genders across all geographic regions of the United States. To directly mitigate stigma, providers called for clinic-level interventions to normalize and universalize PrEP education and services, counseling and other services that center patients' lived experiences and circumstance, staffing and community engagement models that value patients, and implementation of specific programs and processes that facilitate access to services. To address disparities in access, PrEP implementation should acknowledge the interconnectedness of stigma and structural barriers to care.
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Affiliation(s)
- Devon M. Price
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA.,Address correspondence to: Devon M. Price, PhD, Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY 10065-5024, USA
| | - Zoe Unger
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA.,Department of Psychology, The Graduate Center of the City University of New York, New York, New York, USA
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16
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Klein A, Golub SA. Enhancing Gender-Affirming Provider Communication to Increase Health Care Access and Utilization Among Transgender Men and Trans-Masculine Non-Binary Individuals. LGBT Health 2020; 7:292-304. [PMID: 32493100 DOI: 10.1089/lgbt.2019.0294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study was designed to enhance health care providers' abilities to engage transgender men and trans-masculine non-binary individuals (TMNBI) in sexual and reproductive health care conversations by identifying preferences for provider communication and terminology related to sexual and reproductive anatomy and associated examinations. Methods: From May to July 2017, we conducted a cross-sectional online survey with a convenience sample of TMNBI (N = 1788) in the United States. We examined participants' provider communication experiences and preferences related to sexual and reproductive anatomy, and preferred terminology for sexual and reproductive anatomy and associated examinations. Communication experiences/preferences and preferred terminology were assessed by gender identity and gender-affirming medical interventions (hormones and/or surgery). Results: Most participants had regular access to health care (81.3%); of those, 83% received care from a provider knowledgeable in transgender health. Only 26.9% of participants reported that a provider had ever asked about preferred language for their genitalia/anatomy. The majority of the sample (77.7%) wanted a provider to ask directly for preferred language and 65% wanted a provider to use medical terminology, rather than slang when talking about their body. Participants provided varied responses for their preferred terminology related to sexual and reproductive anatomy and associated examinations. Conclusions: These data underscore the importance of medical providers asking for and then using TMNBI' preferred language during sexual and reproductive health conversations and examinations, rather than assuming that all TMNBI use the same language. Asking for and using TMNBI' preferred language may improve gender-affirming sexual and reproductive health care and increase patient engagement and retention among these individuals.
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Affiliation(s)
- Augustus Klein
- Hunter Alliance for Research and Translation, Hunter College of the City University of New York (CUNY), New York, New York, USA.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
| | - Sarit A Golub
- Hunter Alliance for Research and Translation, Hunter College of the City University of New York (CUNY), New York, New York, USA.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA.,The Graduate Center of the City University of New York (CUNY), New York, New York, USA
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17
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Grov C, Westmoreland D, Golub SA, Nash D. Prior HIV testing behaviour is associated with HIV testing results among men, trans women and trans men who have sex with men in the United States. J Epidemiol Community Health 2020; 74:741-753. [PMID: 32434861 DOI: 10.1136/jech-2019-213493] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/30/2020] [Accepted: 04/17/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Among those at high risk for HIV, it is important to examine the ways in which someone who has recently tested for HIV might differ from someone who has not. METHODS In 2017-2018, a total of 5001 men, trans women and trans men who have sex with men from across the United States completed an online survey about their recent testing behaviour as well as self-collected oral samples for HIV testing. RESULTS In total, 3.8% tested HIV-positive and-among those with positive results-35% were recent HIV infections (ie, self-reported an HIV-negative test result within the 12 months prior to enrollment). Those with HIV-positive results-regardless of how recent their HIV test was prior to enrollment-differed from those with negative results in ways that are known to be associated with HIV risk: racial and income disparities, housing instability, recent transactional sex and recent methamphetamine use. Among those with HIV-positive results at enrollment, only having a primary care physician distinguished those who recently tested negative prior to enrollment versus not. Among those with HIV-negative results, there were numerous differences between those who had recently tested for HIV prior to enrollment, versus not, such that those who had not recently tested were significantly more likely to report being at higher risk for HIV. CONCLUSION Strategies aimed at improving more frequent HIV testing among HIV-negative persons at high risk for HIV should address other needs including stable housing, transactional sex, access to a primary care provider and methamphetamine use.
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Affiliation(s)
- Christian Grov
- CUNY School of Public Health, New York, New York, USA .,CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Drew Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Sarit A Golub
- Psychology, Hunter College at CUNY, New York, New York, USA
| | - Denis Nash
- CUNY School of Public Health, New York, New York, USA.,CUNY Institute for Implementation Science in Population Health, New York, New York, USA
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18
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Patel VV, Rawat S, Dange A, Lelutiu-Weinberger C, Golub SA. An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial. JMIR Public Health Surveill 2020; 6:e16494. [PMID: 32297875 PMCID: PMC7193444 DOI: 10.2196/16494] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/08/2020] [Accepted: 02/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions. Objective The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model. Methods Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention. Results Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up. Conclusions As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates.
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Affiliation(s)
- Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
| | | | | | - Corina Lelutiu-Weinberger
- François-Xavier Bagnoud Center, School of Nursing, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
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19
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Gamarel KE, Golub SA. Sexual goals and perceptions of goal congruence in individuals' PrEP adoption decisions: A mixed-methods study of gay and bisexual men who are in primary relationships. Ann Behav Med 2020; 54:237-248. [PMID: 31624825 PMCID: PMC7093261 DOI: 10.1093/abm/kaz043] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although health goals are recognized as a central feature of health behavior theories, the relational context through which goals are conceptualized is often overlooked. Interdependence theory represents a valuable framework for understanding goals in the adoption of health behaviors, such as pre-exposure prophylaxis (PrEP), among gay and bisexual men in primary relationships. PURPOSE We examined the content and focus of men's sexual health goals, as well as whether goal content, goal focus, or perceptions of goal congruence with a primary partner were related to PrEP adoption among gay and bisexual men in primary relationships. METHODS Mixed-methods data were collected from a PrEP demonstration project from 145 HIV-negative gay and bisexual men in primary relationships. Participants reported their sexual health goals and completed measures of perceptions of goal congruence, relationship factors, and sociodemographic factors. RESULTS Three main goal content categories were identified: prevention, satisfaction, and intimacy. In expressing these goals, participants framed them with either a self-focus or a relationship-focus. Men in serodiscordant relationships reported more intimacy goals and greater perceptions of goal congruence. There were no differences in goal content or focus by sexual agreement. In the multivariable logistic regression model, perceived goal congruence was associated with PrEP adoption, over and above covariates. CONCLUSIONS Intimate relationships play a significant role in the formation of health-related goals. Goal content, focus, and perceived congruence with partners may represent important targets for HIV prevention interventions for gay and bisexual men in primary relationships, especially in the context of PrEP.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarit A Golub
- Hunter College and the Graduate Center of the City University of New York, New York, NY USA
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20
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Golub SA, Meyers K, Enemchukwu C. Perspectives and Recommendations From Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Youth of Color Regarding Engagement in Biomedical HIV Prevention. J Adolesc Health 2020; 66:281-287. [PMID: 31780384 PMCID: PMC7007846 DOI: 10.1016/j.jadohealth.2019.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/20/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Young people of color have high HIV incidence rates and suffer the greatest health inequities with regard to daily oral pre-exposure prophylaxis. Although the next generation of biomedical HIV prevention products is already under clinical development, little research has examined whether such products address the needs of this population or identified specific strategies for educating this population about prevention options that might result in the greatest interest in and uptake of new prevention modalities. METHODS We analyzed data from seven focus groups (n = 93) conducted between July 2016 and March 2017 in partnership with a lesbian, gay, bisexual, transgender, and queer/questioning youth-serving community-based organization in the northeastern U.S. The study aimed to understand concerns, priorities, and preferences around biomedical HIV prevention modalities (i.e., daily oral pill, long-acting injectable, and topical microbicide) among lesbian, gay, bisexual, transgender, and queer/questioning youth of color. RESULTS Our findings identified four key dynamics specific to educating young people about biomedical prevention, including (1) providing information with a sufficient level of detail and complexity, (2) contextualizing messaging in terms of young people's existing knowledge and beliefs, (3) providing detailed information about side effects, drug- and multi-method interactions, and dosing/usage contingencies, and (4) working proactively to support transgender youth and ensure that prevention products are accessible to them. CONCLUSIONS As we plan for a future of choice in biomedical HIV prevention, we should consider how novel products can address inequities in pre-exposure prophylaxis access and HIV incidence by valuing the concerns and needs of this highest priority population.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065 USA,Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, 365 Fifth Avenue, New York, NY 10016, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, 455 First Avenue, New York, NY 10016, USA
| | - Chibuzo Enemchukwu
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065 USA
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Abstract
Increasing PrEP adoption for eligible individuals is critical, but limited research has examined individual-level factors that might be amenable to educational or behavioral intervention. Using data from a PrEP demonstration project conducted at a community health center, we examined differences in behavioral and psychosocial factors between patients offered PrEP who chose to accept it and those who declined. In a multivariable model, the odds of accepting PrEP were higher among those with an HIV-positive main partner, greater risk behavior in the past 3 months, and higher HIV risk perception. PrEP adoption was positively associated with PrEP adherence self-efficacy and negatively associated with perceived sensitivity to medicines. These psychological variables were associated with measures of PrEP- and HIV-related stigma. In the multivariable model, there were no differences in PrEP adoption by demographic factors or socioeconomic status. Data suggest that patients' decisions about PrEP uptake may be impacted not only by objective and subjective HIV risk, but also by psychological variables such as stigma beliefs, medication beliefs, and self-efficacy.
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22
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Abstract
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
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23
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Klein A, Golub SA. Increasing Access to Pre-Exposure Prophylaxis Among Transgender Women and Transfeminine Nonbinary Individuals. AIDS Patient Care STDS 2019; 33:262-269. [PMID: 31166785 DOI: 10.1089/apc.2019.0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the United States, transgender women and transfeminine nonbinary individuals (TGWNBI) are a highly vulnerable and marginalized population at high risk for HIV. Despite disproportionate rates of HIV, a striking lack of research exists on pre-exposure prophylaxis (PrEP) use among TGWNBI. We conducted 30 semi-structured interviews with TGWNBI both on PrEP and those not on PrEP. Questions explored PrEP access, initiation, and factors to increase broad interest and participation in PrEP. Qualitative data were coded and analyzed using thematic analysis. Participants identified five components to increase PrEP use among TGWNBI: (1) eliminating the practice of conflating TGWNBI with cisgender men who have sex with men, (2) recognition of and support for the contextual factors associated with HIV risk among TGWNBI, (3) ensuring the design and development of transgender-inclusive and gender-affirming sexual health programs that include PrEP, (4) active provider engagement and assistance around PrEP, and (5) identification and implementation of strategies to bolster existing community mobilization/activism around PrEP.
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Affiliation(s)
- Augustus Klein
- Department of Psychology, Hunter College of the City University of New York, New York, New York
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York
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Golub SA, Lelutiu-Weinberger C, Surace A. Experimental Investigation of Implicit HIV and Preexposure Prophylaxis Stigma: Evidence for Ancillary Benefits of Preexposure Prophylaxis Use. J Acquir Immune Defic Syndr 2019; 77:264-271. [PMID: 29140872 DOI: 10.1097/qai.0000000000001592] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) stigma (ie, negative attitudes toward PrEP users) has been widely documented and is considered a significant barrier to implementation. However, few studies have examined PrEP stigma using implicit measures designed to reduce demand characteristics in responding. This study examined implicit PrEP- and HIV-related stigma among gay and bisexual men using geospatial social networking applications (ie, "hookup apps"). METHODS Participants were presented with 4 simulated online profiles (pretested for comparability) paired with each of the following characteristics: HIV negative, HIV positive, on PrEP, or substance user. Participants rated the profiles on attractiveness, desirability, trustworthiness, likelihood of condom use, and riskiness of sex. RESULTS There was no evidence of PrEP-related stigma, ie, participants did not rate profiles of PrEP users more negatively than profiles of HIV-negative individuals not disclosing PrEP use. However, profiles of HIV-positive individuals were rated significantly less attractive and desirable than HIV-negative or PrEP profiles. When the sample was split by history of PrEP use, negative ratings of HIV-positive profiles remained only among participants who had never taken PrEP. Participants with any history of PrEP use demonstrated no difference in ratings by HIV status. CONCLUSION These data provide the first empirical evidence for lower HIV stigma among PrEP users. Individuals who have used PrEP may "see" HIV-positive individuals differently than those without a history of PrEP use. The lack of evidence for PrEP-related stigma is encouraging and suggests that negative stereotypes about PrEP users may not extend to negative implicit judgments about them on social networking sites.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York, New York, NY.,Department of Psychology, Hunter HIV/AIDS Research Team (HART), New York, NY
| | - Corina Lelutiu-Weinberger
- Department of Psychology, Hunter HIV/AIDS Research Team (HART), New York, NY.,Department of Psychology, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, NJ
| | - Anthony Surace
- Department of Psychology, Hunter HIV/AIDS Research Team (HART), New York, NY.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Abstract
Relational closeness has been positively associated with relationship quality and mental health; however, desire for closeness and intimacy in a relationship may also motivate sexual risk-taking, that is, forgoing condom use. This study examined the impact of desiring more closeness with a primary partner (i.e., motivation for reducing closeness discrepancies) on HIV prevention behavior. Using pre-exposure prophylaxis (PrEP) as a case study, we examined the extent to which closeness discrepancies motivate behavioral intentions (Study 1) and actual behavior (Study 2). In both studies, desiring more closeness and believing that condoms interfere with intimacy were independently positively associated with PrEP adoption. Understanding the relational needs for closeness and intimacy in motivating prevention behavior is critical for social psychology, relationship science, and public health efforts to improve sexual health.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarit A. Golub
- Hunter College and the Graduate Center of the City University of New York, New York, NY USA
- Hunter HIV/AIDS Research Team, New York, NY USA
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26
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Patel VV, Ginsburg Z, Golub SA, Horvath KJ, Rios N, Mayer KH, Kim RS, Arnsten JH. Empowering With PrEP (E-PrEP), a Peer-Led Social Media-Based Intervention to Facilitate HIV Preexposure Prophylaxis Adoption Among Young Black and Latinx Gay and Bisexual Men: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11375. [PMID: 30154071 PMCID: PMC6134229 DOI: 10.2196/11375] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 07/11/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption. Objective Our overall goal was to develop and pilot test a theoretically grounded, social media–based, peer-led intervention to increase PrEP uptake in YBLGBM. We used diffusion of innovation and information-motivation-behavioral skills frameworks to (1) identify potential factors associated with interest in and adoption of PrEP among YBLGBM; (2) develop Empowering with PrEP (E-PrEP), a social media–based, peer-led intervention to increase PrEP uptake in YBLGBM; and (3) pilot test the feasibility and acceptability of E-PrEP, and determine its preliminary efficacy for increasing adoption of PrEP by YBLGBM. We describe the development and protocol for E-PrEP. Methods Using a participatory research approach, we partnered with YBLGBM intervention development partners to develop a social media–based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks. We designed the 6-week campaign to provide education about PrEP, increase motivation to use PrEP, and facilitate access to PrEP. We then conducted a cluster-randomized trial of E-PrEP compared with an attention-matched general health control condition (E-Health) among YBLGBM aged 18 to 29 years to assess E-PrEP’s feasibility, acceptability, preliminary efficacy for increasing self-reported intention to use PrEP, PrEP uptake, and impact on knowledge and attitudes about PrEP at 12-week follow-up (6 weeks after the end of the online campaign). Results From October 2016 to March 2017, we developed, pretested, and refined E-PrEP with 6 YBLGBM intervention development partners. From May to June 2017, we recruited, enrolled, and randomly assigned 10 peer leaders (n=5 for each condition). The 10 peer leaders then recruited and enrolled 152 participants from their existing online networks (range 3-33 per peer leader), during June and July 2017. Intervention follow-up was completed after 12 weeks, in November 2017, with analyses underway. Conclusions We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also show changes in potential mediators of PrEP uptake (knowledge, attitudes, stigma, and access). A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant population-level impact. Trial Registration ClinicalTrials.gov NCT03213366; https://clinicaltrials.gov/ct2/show/NCT03213366 (Archived by WebCite at http://www.webcitation.org/71onSdcXY) Registered Report Identifier RR1-10.2196/11375
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Affiliation(s)
- Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Zoë Ginsburg
- Department of Family Medicine, Swedish Cherry Hill Campus, Swedish Medical Center, Seattle, WA, United States
| | - Sarit A Golub
- Hunter HIV/AIDS Research Team, Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Keith J Horvath
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Nataly Rios
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Infectious Disease Fellowship, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ryung S Kim
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States
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Meyers K, Wu Y, Brill A, Sandfort T, Golub SA. To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PLoS One 2018; 13:e0200296. [PMID: 30024903 PMCID: PMC6053164 DOI: 10.1371/journal.pone.0200296] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method. METHODS Participants (n = 105; ages 19-63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for ≥ 12 months. Participants were given information about LAI PrEP and asked whether they would be interested in switching from oral to LAI PrEP. Participants were also asked about specific pros/cons of LAI PrEP, PrEP attitudes and experiences, and personality factors. RESULTS Two-thirds (66.7%) of current oral PrEP users would switch to LAI PrEP. Intention to switch was associated with product-level and psychosocial factors. Attitudes towards logistical factors (i.e. getting to regular clinic visits for recurring shots) featured more prominently than factors related to the physical experience of PrEP modality (i.e., concerns about injection pain) as motivators for switching. In a multivariate regression model, psychosocial factors including the emotional burden of daily pill taking, deriving a sense of responsibility from PrEP use, and self-identifying as an early adopter, were the strongest predictors of switching. CONCLUSIONS These data underscore the importance of attending not only to product-level factors, but also to the logistical and psychological experience of prevention methods for users. Findings have significant implications for the development of patient education materials and patient-provider shared decision aids.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Atrina Brill
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
- Department of Psychology, the Graduate Center of the City University of New York, New York, New York, United States of America
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28
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York, New York, NY 10065, USA.
| | - Chibuzo U Enemchukwu
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY, USA
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29
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Meyers K, Rodriguez K, Brill AL, Wu Y, La Mar M, Dunbar D, Koblin B, Margolis D, Sobieszczyk ME, Van Tieu H, Frank I, Markowitz M, Golub SA. Lessons for Patient Education Around Long-Acting Injectable PrEP: Findings from a Mixed-Method Study of Phase II Trial Participants. AIDS Behav 2018; 22:1209-1216. [PMID: 28744666 PMCID: PMC5785575 DOI: 10.1007/s10461-017-1871-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aimed to identify patients' physical and psychosocial experiences of an investigational long-acting injectable PrEP product to aid in the development of patient and provider education materials. Twenty-eight participants of a Phase 2 safety, tolerability, and acceptability study of long-acting integrase inhibitor cabotegravir (CAB-LA) were interviewed on their physical and psychosocial experiences of the injections. Five themes emerged through a framework analysis on these interview transcripts: (1) injection-related pain is highly variable across individuals; (2) pain is more impactful after the injections than during; (3) patient anxiety is critical, but does not determine the experience of injections and decreases over time; (4) intimacy and awkwardness of gluteal injections impacts patients' experiences; (5) patient education and care strategies can mitigate the above factors. These findings can inform further sociobehavioral research within Phase 3 efficacy trials of CAB-LA, as well as patient education and provider guidance for future injectable PrEP products.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
| | - Kristina Rodriguez
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
- School of Public Health, City University of New York (CUNY), New York, USA
| | - Atrina L Brill
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
| | - Melissa La Mar
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
| | - Debora Dunbar
- HIV Prevention Division, University of Pennsylvania, Philadelphia, USA
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, USA
| | | | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
| | - Hong Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, USA
| | - Ian Frank
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Markowitz
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), New York, USA.
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30
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Van Dyk K, Golub SA, Porter JB, Robin KJ, Kowalczyk WJ, Tomassilli JC, Ly JJ, Foldi NS. The effects of age and physical health on processing speed in HIV. AIDS Care 2018; 27:1326-31. [PMID: 26468908 DOI: 10.1080/09540121.2015.1054340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The impact of age and physical health on processing speed was investigated in 42 non-demented HIV+ individuals ranging in age from 30 to 75. We used the Medical Outcomes Study-HIV Healthy Survey (MOS-HIV) to measure self-reported physical health, neuropsychological tests to measure psychomotor and cognitive processing speed (Delis-Kaplan Executive Function System Trail Making Test, Grooved Pegboard Test, letter and category fluency), and a test of the foreperiod effect to measure reaction time under increasing attentional load. Results indicated that aging and worse physical health each independently contributed to slowing on different processing speed measures, while the interaction between aging and physical health did not contribute to processing speed. These findings highlight the importance of considering physical health separately from age when measuring cognitive function in HIV+ adults.
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Affiliation(s)
- Kathleen Van Dyk
- a Department of Psychology , The Graduate Center, City University of New York , USA.,b Department of Psychology , Queens College, City University of New York , USA
| | - Sarit A Golub
- a Department of Psychology , The Graduate Center, City University of New York , USA.,c Department of Psychology , Hunter HIV/AIDS Research Team, Hunter College, City University of New York , New York , NY , USA
| | - James B Porter
- c Department of Psychology , Hunter HIV/AIDS Research Team, Hunter College, City University of New York , New York , NY , USA
| | - Kevin J Robin
- c Department of Psychology , Hunter HIV/AIDS Research Team, Hunter College, City University of New York , New York , NY , USA
| | - William J Kowalczyk
- a Department of Psychology , The Graduate Center, City University of New York , USA.,b Department of Psychology , Queens College, City University of New York , USA.,c Department of Psychology , Hunter HIV/AIDS Research Team, Hunter College, City University of New York , New York , NY , USA
| | - Julia C Tomassilli
- c Department of Psychology , Hunter HIV/AIDS Research Team, Hunter College, City University of New York , New York , NY , USA
| | - Jenny J Ly
- a Department of Psychology , The Graduate Center, City University of New York , USA.,b Department of Psychology , Queens College, City University of New York , USA
| | - Nancy S Foldi
- a Department of Psychology , The Graduate Center, City University of New York , USA.,b Department of Psychology , Queens College, City University of New York , USA
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Estrella P, Yeh MC, Tan Y, Fang CY, Golub SA, Ma GX. Abstract 5288: Perception of barriers and facilitators to hepatitis B virus screening, vaccination, and treatment care among Asian American physicians. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: To examine practices and factors affecting Hepatitis B Virus (HBV) screening, vaccination, and treatment among Asian-American physicians in New York City.
Methods: Members of the Chinese American Independent Practice Association (CAIPA) will be recruited to participate in a comprehensive survey, developed based on prior research, to assess physicians’ practice in HBV screening, vaccination and treatment. This study will also examinebarriers/facilitators toward HBV prevention and treatment in knowledge, familiarity or awareness of guidelines, perception, attitude/behaviors, self-efficacy, motivation, patient factors, cultural, and environmental factors. A bivariate analysis and multivariate regressions will be conducted to evaluate factors that predict study outcomes.
Results: We hypothesize that Asian American physicians are more likely to screen for HBV, but are experiencing many barriers unique to the Asian American physicians that are leading them improperly perceive certain patients not at risk for HBV infection. Furthermore, we anticipate finding significant key barriers and facilitators among Asian American physicians for HBV screening and vaccination and treatment towards Asian patients. Preliminary findings will be presented at the conference.
Conclusions & Implications: Asian/Pacific Islanders (APIs) are disproportionally affected by chronic hepatitis B. Therefore, identifying chronically infected persons and linking them to care is crucial. As a result of the reverence of the doctors, a cultural norm prevalence within the Asian community, physicians are uniquely positioned to improve HBV screening and vaccination rates and if necessary, recommend linkage to care. This study will fill in an important gap in creating a culturally-relevant, physician-focused intervention to improve HBV care and reduce the burden of HBV infection within the Asian community.
Citation Format: Patricia Estrella, Ming Chin Yeh, Yin Tan, Carolyn Y. Fang, Sarit A. Golub, Grace X. Ma. Perception of barriers and facilitators to hepatitis B virus screening, vaccination, and treatment care among Asian American physicians [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5288. doi:10.1158/1538-7445.AM2017-5288
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Affiliation(s)
| | | | - Yin Tan
- 2Temple University, Philadelphia, PA
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32
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Abstract
The Condom Barriers and Motivations Scale (CBMS) was developed to measure four distinct categories of barriers and motives to condom use, including: risk reduction motivations, pleasure reduction barriers, intimacy interference barriers, and partner pressure barriers. The CBMS is a 16-item scale with four items that correspond to each of these subscales. The CBMS was tested in two samples of gay and bisexual men. Results support the reliability and validity of the scale and its structure. Results also indicate that CBMS subscales are distinct from general measures of sexual wellbeing, personality factors, or relationship quality (i.e., discriminant validity) and are associated with self-reported condom use with different partner types (i.e., construct validity). The CBMS can be helpful in better understanding the dynamics of condom use in the context of pre-exposure prophylaxis decision-making, and can shed light on innovative approaches to enhance condom use as part of comprehensive HIV prevention and sexual health goals.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
- Basic and Applied Social Psychology PhD Program, The Graduate Center of the City University of New York, New York, NY, USA.
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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Abstract
Despite demonstrated efficacy, uptake of pre-exposure prophylaxis (PrEP) remains low, especially among highest priority populations. This study examined four PrEP messaging factors hypothesized to impact comprehension of PrEP educational information: (1) modality (video versus in-person message delivery); (2) frame (risk versus health focus); (3) specificity (gist versus verbatim efficacy information); and (4) sexual history (administered either before or after PrEP education). We examined message comprehension among 157 young people of color (YPoC) eligible for PrEP, using a series of multiple choice questions. Overall, 65.6 % (n = 103) got all message comprehension questions correct. In multivariate analyses, engaging in a sexual history before receiving PrEP education was associated with increased odds of message comprehension (aOR 2.23; 95 % CI 1.06-4.72). This effect was even stronger among those who received PrEP education via video (aOR 3.53; 95 % CI 1.16-10.81) compared to via health educator. This research underscores the importance of sexual history-taking as part of PrEP education and clinical practice for YPoC, and suggests that engaging patients in a sexual history prior to providing them with PrEP education may be key to increasing comprehension.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of CUNY, New York, NY, USA.
- Department of Psychology, Graduate Center of CUNY, New York, NY, USA.
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Abstract
Qualitative interviews about pre-exposure prophylaxis (PrEP) stereotypes were conducted with a subsample of 160 MSM who participated in a PrEP messaging study. Negative stereotypes about PrEP users were identified by 80 % of participants. Two types of stereotypes were most common: PrEP users are HIV-infected (and lying about it), and PrEP users are promiscuous and resistant to condom use. Participants' identification of these stereotype categories differed significantly by demographic factors (i.e., race/ethnicity, education). Expanding access to PrEP requires recognizing potential differences in the experience or anticipation of PrEP-related stereotypes that might impact willingness to discuss PrEP with providers, friends, or partners.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Surace
- Hunter HIV/AIDS Research Team (HART), Hunter College of the City of New York (CUNY), New York, NY, USA
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35
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Ma GX, Fang CY, Seals B, Feng Z, Tan Y, Siu P, Yeh MC, Golub SA, Nguyen MT, Tran T, Wang M. A Community-Based Randomized Trial of Hepatitis B Screening Among High-Risk Vietnamese Americans. Am J Public Health 2017; 107:433-440. [PMID: 28103075 PMCID: PMC5296686 DOI: 10.2105/ajph.2016.303600] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B virus (HBV) screening among low-income, underserved Vietnamese Americans at high risk. METHODS We conducted a cluster randomized trial involving 36 Vietnamese community-based organizations and 2337 participants in Pennsylvania, New Jersey, and New York City between 2009 and 2014. We randomly assigned 18 community-based organizations to a community-based multilevel HBV screening intervention (n = 1131). We randomly assigned the remaining 18 community-based organizations to a general cancer education program (n = 1206), which included information about HBV-related liver cancer prevention. We assessed HBV screening rates at 6-month follow-up. RESULTS Intervention participants were significantly more likely to have undergone HBV screening (88.1%) than were control group participants (4.6%). In a Cochran-Mantel-Haenszel analysis, the intervention effect on screening outcomes remained statistically significant after adjustment for demographic and health care access variables, including income, having health insurance, having a regular health provider, and English proficiency. CONCLUSIONS A community-based, culturally appropriate, multilevel HBV screening intervention effectively increases screening rates in a high-risk, hard-to-reach Vietnamese American population.
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Affiliation(s)
- Grace X Ma
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Carolyn Y Fang
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Brenda Seals
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Ziding Feng
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Yin Tan
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Philip Siu
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Ming Chin Yeh
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Sarit A Golub
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Minhhuyen T Nguyen
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Tam Tran
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Minqi Wang
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
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Abstract
Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ2(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.
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Affiliation(s)
- Brooke E Wells
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Tyrel J Starks
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Erika Robel
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Brian C Kelly
- Hunter College and Graduate Center of the City University of New York, NY, USA
- Purdue University, West Lafayette, IN, USA
| | - Jeffrey T Parsons
- Hunter College and Graduate Center of the City University of New York, NY, USA
| | - Sarit A Golub
- Hunter College and Graduate Center of the City University of New York, NY, USA
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Golub SA, Thompson LI, Kowalczyk WJ. Affective differences in Iowa Gambling Task performance associated with sexual risk taking and substance use among HIV-positive and HIV-negative men who have sex with men. J Clin Exp Neuropsychol 2016; 38:141-57. [PMID: 26745769 DOI: 10.1080/13803395.2015.1085495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.
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Affiliation(s)
- Sarit A Golub
- a Department of Psychology , Hunter College of the City University of New York (CUNY) , New York , NY , USA.,b Doctoral Program in Psychology , The Graduate Center of the City University of New York (CUNY) , New York , NY , USA
| | - Louisa I Thompson
- b Doctoral Program in Psychology , The Graduate Center of the City University of New York (CUNY) , New York , NY , USA
| | - William J Kowalczyk
- c Clinical Pharmacology & Therapeutics Branch , Intramural Research Program, National Institute on Drug Abuse , Baltimore , MD , USA
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Klein A, Golub SA. Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults. LGBT Health 2016; 3:193-9. [DOI: 10.1089/lgbt.2015.0111] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Augustus Klein
- Department of Social Welfare, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Sarit A. Golub
- Basic and Applied Social Psychology PhD Program, The Graduate Center of the City University of New York (CUNY), New York, New York
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York
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39
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Abstract
Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics. To better target interventions aimed at alcohol-related sexual risk behavior, our analyses simultaneously examine demographic predictors of both day- and event-level associations between alcohol consumption and sexual behavior in a sample of young adults (N = 301) who are sexually active and consume alcohol. Young adults (aged 18-29) recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants. During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.
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Affiliation(s)
- Brooke E Wells
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
- Center for Human Sexuality Studies, Widener University, One University Place, Chester, PA, 19013, USA
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
| | - Brian C Kelly
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
- Department of Sociology, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY, 10065, USA
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA.
- Doctoral Program in Public Health, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA.
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Lelutiu-Weinberger C, Pollard-Thomas P, Pagano W, Levitt N, Lopez EI, Golub SA, Radix AE. Implementation and Evaluation of a Pilot Training to Improve Transgender Competency Among Medical Staff in an Urban Clinic. Transgend Health 2016; 1:45-53. [PMID: 29159297 PMCID: PMC5685252 DOI: 10.1089/trgh.2015.0009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender individuals (TGI), who identify their gender as different from their sex assigned at birth, continue facing widespread discrimination and mistreatment within the healthcare system. Providers often lack expertise in adequate transgender (TG) care due to limited specialized training. In response to these inadequacies, and to increase evidence-based interventions effecting TG-affirmative healthcare, we implemented and evaluated a structural-level intervention in the form of a comprehensive Provider Training Program (PTP) in TG health within a New York City-based outpatient clinic serving primarily individuals of color and of low socioeconomic status. This pilot intervention aimed to increase medical staff knowledge of TG health and needs, and to support positive attitudes toward TGI. Methods: Three 2-h training sessions were delivered to 35 clinic staff across 4 months by two of the authors experienced in TG competency training; the training sessions included TG-related identity and barriers to healthcare issues, TG-specialized care, and creating TG-affirmative environments, medical forms, and billing procedures. We evaluated changes through pre-post intervention surveys by trainees. Results: Compared to pre-training scores, post-training scores indicated significant (1) decreases in negative attitudes toward TGI and increases in TG-related clinical skills, (2) increases in staff's awareness of transphobic practices, and (3) increases in self-reported readiness to serve TGI. The clinic increased its representation of general LGBT-related images in the waiting areas, and the staff provided highly positive training evaluations. Conclusion: This PTP in TG health shows promise in leading to changes in provider attitudes and competence, as well as clinic systems, especially with its incorporation in continuing education endeavors, which can, in turn, contribute to health disparities reductions among TG groups.
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Affiliation(s)
| | | | | | | | | | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York
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Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med 2015; 49:177-86. [PMID: 25124457 DOI: 10.1007/s12160-014-9646-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND In the USA, men who have sex with men (MSM) in primary partnerships are at elevated risk for human immunodeficiency virus (HIV) infection. Pre-exposure prophylaxis (PrEP), a new biomedical prevention strategy, has potential to reduce HIV transmission. This study examined predictors of PrEP adoption intentions among HIV-negative MSM in primary partnerships. METHODS The sample included HIV-negative MSM (n = 164) who participated in an ongoing cross-sectional study with an in-person interview examining PrEP adoption intentions. RESULTS Higher HIV risk perception, intimacy motivations for condomless sex, recent condomless anal sex with outside partners, education, and age were each independently associated with PrEP adoption intentions. In a multivariate model, only age, education, and intimacy motivations for condomless sex were significantly associated with PrEP adoption intentions. CONCLUSIONS Intimacy motivations may play a central role in PrEP adoption for MSM couples. Incorporating relationship dynamics into biomedical strategies is a promising avenue for research and intervention.
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Affiliation(s)
- Kristi E Gamarel
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
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Lelutiu-Weinberger C, Pachankis JE, Gamarel KE, Surace A, Golub SA, Parsons JT. Feasibility, Acceptability, and Preliminary Efficacy of a Live-Chat Social Media Intervention to Reduce HIV Risk Among Young Men Who Have Sex With Men. AIDS Behav 2015; 19:1214-27. [PMID: 25256808 PMCID: PMC4375068 DOI: 10.1007/s10461-014-0911-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Given the popularity of social media among young men who have sex with men (YMSM), and in light of YMSM's elevated and increasing HIV rates, we tested the feasibility, acceptability and preliminary efficacy of a live chat intervention delivered on Facebook in reducing condomless anal sex and substance use within a group of high risk YMSM in a pre-post design with no control group. Participants (N = 41; 18-29 years old) completed up to eight one-hour motivational interviewing and cognitive behavioral skills-based online live chat intervention sessions, and reported on demographic, psychosocial, and behavioral characteristics at baseline and immediately post-intervention. Analyses indicated that participation in the intervention (n = 31) was associated with reductions of days of drug and alcohol use in the past month and instances of anal sex without a condom (including under the influence of substances), as well as increases in knowledge of HIV-related risks at 3-month follow-up. This pilot study argues for the potential of this social media-delivered intervention to reduce HIV risk among a most vulnerable group in the United States, in a manner that was highly acceptable to receive and feasible to execute. A future randomized controlled trial could generate an intervention blueprint for providers to support YMSM's wellbeing by reaching them regardless of their geographical location, at a low cost.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA, URL: http://cunyhart.org/
| | - John E. Pachankis
- Chronic Disease Epidemiology, Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Kristi E. Gamarel
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Alpert Medical School of Brown University, 167 Point Street, Providence, RI 023093, USA
| | - Anthony Surace
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Health Psychology and Basic and Applied Social Psychology Doctoral Programs, the Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter AIDS Research Team (HART), Hunter College, City University of New York (CUNY), 695 Park Avenue, HN Room 1209, New York, NY 10065, USA
- Health Psychology and Basic and Applied Social Psychology Doctoral Programs, the Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY 10018, USA
- CUNY School of Public Health at Hunter College, 2180 Third Avenue, New York, NY 10035, USA
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Kelly BC, Trimarco J, LeClair A, Pawson M, Parsons JT, Golub SA. Symbolic boundaries, subcultural capital and prescription drug misuse across youth cultures. Sociol Health Illn 2015; 37:325-339. [PMID: 25529457 PMCID: PMC4390398 DOI: 10.1111/1467-9566.12193] [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] [Indexed: 06/04/2023]
Abstract
Prescription drug misuse among young adults has surged over the past decade. Yet the contexts surrounding this misuse remain unclear, particularly the subcultural contexts. Many young urban adults participate in youth cultures. This article describes the subcultural contexts of prescription drug misuse in youth subcultures. Drawing on ethnographic data collected over 12 months from different youth cultural scenes, the authors describe the subcultural bases of prescription drug misuse. The symbolic boundaries and subcultural capital inherent in these scenes shape the ways youth think about drugs and behave accordingly. While young adults are often lumped together by theorists, ethnographic data show considerable variation across these subcultures with regard to what may enable or inhibit prescription drug misuse. The broader subcultural ethos in each scene, as well as attitudes towards other types of drugs, frame the ways that prescription drugs are perceived and used in each of these settings. The findings highlight the role of symbolic boundaries and subcultural capital in shaping routine practices of drug use among young adults. These data show that education campaigns about prescription drug misuse should take into account the variability in youth cultural scenes to maximise the efficacy of these messages aimed at young adults.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, Purdue University; Center for HIV Educational Studies and Training, CUNY
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Pantalone DW, Tomassilli JC, Starks TJ, Golub SA, Parsons JT. Unprotected Anal Intercourse With Casual Male Partners in Urban Gay, Bisexual, and Other Men Who Have Sex With Men. Am J Public Health 2015; 105:103-110. [PMID: 25393176 DOI: 10.2105/ajph.2014.302093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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 investigated trends in, and predictors of, unprotected anal intercourse (UAI) with casual male partners of gay, bisexual, and other men who have sex with men (GBMSM). Methods. We analyzed data from cross-sectional intercept surveys conducted annually (2003-2008) at 2 large lesbian, gay, and bisexual community events in New York City. Survey data covered GBMSM's highest-risk behaviors for HIV acquisition (HIV-negative or unknown status GBMSM, any UAI) and transmission (HIV-positive GBMSM, any serodiscordant unprotected UAI). Results. Across years, 32.3% to 51.5% of the HIV-negative or unknown status men endorsed any UAI, and 36.9% to 52.9% of the HIV-positive men endorsed serodiscordant UAI. We observed a few statistically significant fluctuations in engagement in high-risk behavior. However, these do not appear to constitute meaningful trends. Similarly, in some years, one or another demographic predictor of UAI was significant. Across years, however, no reliable pattern emerged. Conclusions. A significant proportion of urban GBMSM engage in high-risk sex, regardless of serostatus. No consistent demographic predictors emerged, implying a need for broad-based interventions that target all GBMSM.
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Affiliation(s)
- David W Pantalone
- David W. Pantalone is with the Department of Psychology, University of Massachusetts, Boston, and the Fenway Institute, Fenway Health, Boston, MA. Julia C. Tomassilli is with the Fenway Institute, Fenway Health. Tyrel J. Starks is with Pace University and the Center for HIV/AIDS Educational Studies and Training, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with Hunter College and the Graduate Center, City University of New York. Jeffrey T. Parsons is with the Center for HIV/AIDS Educational Studies and Training, Hunter College, and the Graduate Center, City University of New York
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Lelutiu-Weinberger C, Gamarel KE, Golub SA, Parsons JT. Race-based differentials in the impact of mental health and stigma on HIV risk among young men who have sex with men. Health Psychol 2014; 34:847-56. [PMID: 25545041 DOI: 10.1037/hea0000192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the U.S., young men who have sex with men (YMSM) are disproportionately affected by HIV, with YMSM of color being the most impacted by the epidemic. METHOD To advance prevention research, we examined race-based differences in gay-related stress in conjunction with the moderating role of mental health on substance use and sexual risk among 206 high-risk YMSM, recruited September, 2007-2010. RESULTS Negative binomial regressions and 3-way interaction graphs indicated that psychological distress and acute gay-related stigma placed all participants at most risk for HIV acquisition. Low psychological distress appeared to "buffer" all YMSM against HIV risk, whereas the reverse was evidenced for those reporting low gay-related stigma and psychological distress. YMSM of color reported more risk behavior, and less decreases in risk with attenuated psychological distress, compared with White YMSM. We hypothesize these trends to be associated with experiencing multiple stigmatized identities, indicating points of intervention for YMSM of color to achieve positive identity integration. There were sharper increases in HIV risk behavior for White YMSM with increasing gay-related stigma than for YMSM of color, which could be attributed to the latter's prolonged exposure to discrimination necessitating building coping skills to manage the influx of adversity. CONCLUSIONS Emphases on: (a) identity-based interventions for YMSM of color; and (b) skills-based interventions for White YMSM should supplement existing successful HIV risk-reduction programs. Lastly, mental health needs to be a target of intervention, as it constitutes a protective factor against HIV risk for all YMSM.
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Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol 2013; 82:9-18. [PMID: 24364800 DOI: 10.1037/a0035311] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Young gay and bisexual men (YGBM) are disproportionally at risk of HIV infection due to sexual risk behaviors, which are often exacerbated by recreational drug use. However, there have been no evidence-based interventions targeting substance-using YGBM. This study was designed to test a brief motivational interviewing (MI) intervention to reduce both risky sex and drug use among HIV-negative YGBM. METHOD A total of 143 non-treatment-seeking YGBM (ages 18-29 years) who reported recent unprotected anal intercourse (UAI) and recreational drug use were randomized to 4 sessions of MI or 4 sessions of content-matched education. Participants were followed every 3 months for 1 year, and behavior change was examined across conditions and time for aggregated and day-level drug use and UAI. RESULTS Regardless of condition, participants reported significant reductions in UAI and substance use over time. However, YGBM in the MI condition were 18% less likely to use drugs and 24% less likely to engage in UAI than YGBM in the education condition. CONCLUSIONS The results support the utility of MI, compared with a content-matched education condition, to significantly reduce both UAI and drug use among YGBM. Interventions may benefit from an emphasis on substance use reductions, which might indirectly lead to less frequent UAI. Future research efforts should examine whether this type of brief MI intervention is effective when delivered by clinic or community settings utilized by YGBM.
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Affiliation(s)
- Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Corina Lelutiu-Weinberger
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Michael Botsko
- Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York
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Golub SA, Gamarel KE, Rendina HJ. Loss and growth: identity processes with distinct and complementary impacts on well-being among those living with chronic illness. PSYCHOL HEALTH MED 2013; 19:572-9. [PMID: 24228907 DOI: 10.1080/13548506.2013.855318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The diagnosis and treatment of any chronic illness are a major source of stress for most individuals. Although many individuals living with chronic illness report experiencing growth that arises from this experience, studies have revealed mixed results regarding the association between reported growth and other aspects of psychological well-being. This pilot study examines the complementary and buffering influences of self-growth on self-loss in perceptions of physical and mental health among individuals living with HIV (N = 60). The sample was comprised of a racially/ethnically diverse sample of men and women ranging in age from 27 to 62. Measures included impact of illness on Self-Concept Scale, the Medical Outcomes Study HIV Health Survey, the HIV Symptom Index, and the Center for Epidemiological Studies Depression Scale. Regression analyses were conducted to examine the impact of self-growth and self-loss on self-reported bothersome symptoms and depression, controlling for demographic covariates and physical health. Self-loss accounted for a significant proportion of variance in both bothersome symptom reports and depression, after controlling for physical health. In multivariate analysis, self-growth appeared to buffer the negative impact of self-loss on bothersome symptoms, but not on depression. These data suggest that self-loss is a critical construct in understanding adaptation to chronic illness, and that identity processes may influence symptom perception and mental health outcomes above and beyond the impact of traditional measures of health status.
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Affiliation(s)
- Sarit A Golub
- a Department of Psychology , Hunter College of the City University of New York , New York , NY , USA
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Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS 2013; 27:621-7. [PMID: 24138486 PMCID: PMC3820140 DOI: 10.1089/apc.2013.0245] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment as prevention (TaSP) is a critical component of biomedical interventions to prevent HIV transmission. However, its success is predicated on testing and identifying undiagnosed individuals to ensure linkage and retention in HIV care. Research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored how anticipated HIV stigma-the expectation of rejection or discrimination against by others in the event of seroconversion-may serve as a barrier to HIV testing behaviors. This study examined the association between anticipated stigma and HIV testing behaviors among a sample of 305 men who have sex with men (MSM) and transgender women living in New York City. Participants' mean age was 33.0; 65.5% were racial/ethnic minority; and 50.2% earned <$20,000 per year. Overall, 32% of participants had not had an HIV test in the past 6 months. Anticipated stigma was negatively associated with risk perception. In multivariate models, anticipated stigma, risk perception, and younger age were significant predictors of HIV testing behaviors. Anti-HIV stigma campaigns targeting HIV-negative individuals may have the potential to significantly impact social norms around HIV testing and other biomedical strategies, such pre-exposure prophylaxis, at a critical moment for the redefinition of HIV prevention.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York
- Doctoral Program in Psychology, The Graduate Center of the City University of New York, (CUNY), New York, New York
| | - Kristi E. Gamarel
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York
- Doctoral Program in Psychology, The Graduate Center of the City University of New York, (CUNY), New York, New York
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Abstract
Young gay and bisexual men continue to experience increases in HIV incidence in the US highlighting a need for competent health services, while the prominence of the internet in their social and sexual lives calls for novel preventive modalities. Toward this goal, we adapted an efficacious in-office HIV risk reduction intervention for online delivery. This paper describes the development of the online intervention and highlights the results of interviews and focus groups with the original intervention participants regarding effective adaptation and online delivery recommendations. The final intervention incorporates strategies for overcoming barriers to online intervention with this population and capitalizes on the unique strengths of online intervention delivery. The systematic process described in this paper can be used as a template for other researchers to develop online risk reduction programs and fills an important gap in the field's ability to maximally reach a critical risk group.
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Affiliation(s)
- John E Pachankis
- Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,
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Abstract
Much research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored its impact on HIV-negative persons. However, many gay and bisexual men may imagine the stigma they would experience upon seroconverting, and this anticipated stigma may be associated with negative mental health. Such concerns may be exacerbated among men who identify with the receptive role during anal sex, because of greater risk for infection. This study examined the association between anticipated HIV stigma and negative affect among 683 HIV-negative gay and bisexual men living in New York City. Anticipated HIV stigma predicted negative affect over and above internalized homonegativity. Sexual role identity was associated directly with anticipated stigma and indirectly with negative affect. Results suggest that anticipated HIV stigma may be an important mental health issue for gay and bisexual men. Public health messaging discussing sexual positioning should be sensitive to the potential for exacerbating anticipated HIV stigma among bottom-identified men.
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Affiliation(s)
- Tyrel J Starks
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
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