ArticleLiterature Review

Running Backwards: Consequences of HIV Incidence Rates for the Next Generation of Black MSM in the United States

January 2016
AIDS and Behavior 20(1):7-16

January 2016
20(1):7-16

DOI:10.1007/s10461-015-1158-z

Authors:

Derrick D Matthews

University of North Carolina at Chapel Hill

Robert W.S. Coulter

University of Pittsburgh

M. Reuel Friedman

Rutgers, The State University of New Jersey

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Black men who have sex with men (MSM) in the United States are disproportionately impacted by HIV. To better understand this public health problem, we reviewed the literature to calculate an estimate of HIV incidence among Black MSM. We used this rate to model HIV prevalence over time within a simulated cohort, which we subsequently compared to prevalence from community-based samples. We searched all databases accessible through PubMed, and Conference on Retroviruses and Opportunistic Infections abstracts for HIV incidence estimates among Black MSM. Summary HIV incidence rates and 95 % confidence intervals (CIs) were calculated using random effects models. Using the average incidence rate, we modeled HIV prevalence within a simulated cohort of Black MSM (who were all HIV-negative at the start) from ages 18 through 40. Based on five incidence rates totaling 2898 Black MSM, the weighted mean incidence was 4.16 % per year (95 % CI 2.76–5.56). Using this annual incidence rate, our model predicted that 39.94 % of Black MSM within the simulated cohort would be HIV-positive by age 30, and 60.73 % by 40. Projections were similar to HIV prevalence found in community-based samples of Black MSM. High HIV prevalence will persist across the life-course among Black MSM, unless effective prevention and treatment efforts are increased to substantially reduce HIV transmission among this underserved and marginalized population.

HIV prevention and care among Black cisgender sexual minority men and transgender women in Chicago: Protocol for an HIV status neutral cohort study using an observational-implementation hybrid approach (Preprint)

Article

Full-text available

May 2023

Background Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. Objective This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. Methods Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). Results The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. Conclusions The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status–neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. International Registered Report Identifier (IRRID) DERR1-10.2196/48548

Latent Profile Patterns of Network-Level Norms and Associations with Individual-Level Sexual Behaviors: The N2 Cohort Study in Chicago

Article

Full-text available

Mar 2023
ARCH SEX BEHAV

Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individual’s social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members’ (alters’) injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters’ approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters’ engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGM’s HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.

A Mobile App to Assist the Mentors of African American Young Men Who Have Sex With Men: Usability Study

Article

Full-text available

Oct 2023

Background Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. Objective This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors’ knowledge of and confidence in talking about HIV prevention and related topics with mentees. Methods Following consent, eligible and naturally occurring mentoring pairs involving African American YMSM in Baltimore; Philadelphia; and Washington, District of Columbia, tested the app, UrbanMentorHub, for usability. Participants downloaded the app and used it for 1 month, completed pre- and postintervention surveys, and participated in a follow-up focus group discussion. Participants’ sociodemographic characteristics and HIV- and mentorship-related measures were characterized using descriptive statistics. Wilcoxon signed rank tests were used to test for pre- and postintervention differences in knowledge, confidence, and outcome expectancy measures. Focus group discussions were audio recorded and transcribed. Transcripts were thematically coded and analyzed to identify ways that UrbanMentorHub could be improved in the mentoring context. Results Nine mentorship pairs participated in this usability study (N=18). Mentors obtained high scores on knowledge, confidence, outcome expectancies, skills, and intentions related to HIV and mentoring. No pre- or postintervention changes were observed in these measures. Mentors reported usually initiating conversations around HIV testing and pre-exposure prophylaxis; mentees and mentors equally initiated conversations on sexual practices and same-sex relationships. Mentors reported sexual practices as the most frequently discussed topic in the past month and pre-exposure prophylaxis being the least discussed. Mentees reported high comfort with HIV-related conversations. No pre- or postintervention change was observed regarding HIV knowledge. Most mentees reported having discussed most HIV-related topics with their mentor in the past month. Mentor feedback on the app was mostly neutral, although they reported positive perceptions of the idea of the app, indicating the potential for addressing a need in their communities. Mentors suggested ways to improve the app content and design elements. Conclusions Although there was no observed statistical change in measured outcomes, and qualitative feedback was overall neutral, the results of this usability study can inform future work to design and promote interventions and resources that support mentoring relationships for African American YMSM.

Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019

Article

Jun 2022
AM J PUBLIC HEALTH

Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22–84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452–S462. https://doi.org/10.2105/AJPH.2022.306735 )

Intersectional Experienced Stigma and Psychosocial Syndemic Conditions in a Sample of Black Men Who Have Sex with Men Engaged in Sex Work (BMSM-SW) from Six US Cities

Article

May 2022

Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and "other" attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6-50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.

Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA

Article

Full-text available

Aug 2022
AIDS BEHAV

We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11–8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.

Recruiting Black men who have sex with men (MSM) couples via dating apps: Challenges and successes (Preprint)

Article

Full-text available

Jul 2021

Background: HIV disproportionately impacts Black men who have sex with men (MSM), and targeting the primary relationship (ie, couples) using mobile technology for health holds promise for HIV prevention. Web-based recruitment of MSM is commonly employed in HIV prevention and intervention research. However, little known about recruiting Black MSM couples on the internet in the United States. Objective: This study describes the process of recruiting Black MSM couples over social networking and dating apps frequented by MSM. We describe the activities for recruiting, screening, and enrolling participants as part of a randomized trial employing a multipronged recruitment approach. Methods: Black MSM in couples were recruited via three apps (ie, Jack'd, Adam4Adam, and Growlr) between May 2020 and March 2021 during the COVID-19 pandemic in the United States. Black MSM couples were eligible if one or both partners are Black, MSM, and living with HIV, and if both partners were 18 years or older, and have been together for at least 2 months in what they both consider a primary relationship (ie, one in which both partners reported feeling most committed to over any other partner or relationship). Results: A total of 10 Black MSM couples (n=20) were enrolled via social networking apps. App recruitment activities were a combination of passive (eg, in-app advertisements) and active (eg, direct messaging of users) engagement. Recruitment approaches varied by the social networking app owing to differences in app features. A full-time recruiter experienced challenges such as bugs (ie, technical errors in computer program or system), navigating technical requirements specific to each app, and web-based harassment. Conclusions: Despite challenges, it was possible to recruit Black MSM couples virtually into research as part of a multipronged recruitment strategy. We identify tips for using web-based dating and other social networking apps as part of a recruitment strategy in future research with Black MSM couples.

The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South?

Article

Full-text available

Dec 2021
AIDS BEHAV

Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.—particularly in the southern U.S.—despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population’s unique risks and needs to inform the development of tailored interventions.

Is Where Same-Sex Couples Live a Valid Measure for Where Single Lesbian, Gay, and Bisexual People Live in Population Health Research? Results from a National Probability Phone Survey, 2017, United States

Article

Jun 2020

Emerging evidence using the concentration of same-sex couples from the U.S. Census suggests lesbian, gay, bisexual (LGB), and transgender (LGBT; i.e., sexual and gender minority [SGM]) people living as a same-sex couple are concentrated in less healthful neighborhoods. However, it is unclear if findings would be different if based on where LGBT individuals live. Thus, we sought to assess differences in neighborhood, county, and state characteristics between same-sex couples and LGBT individuals to inform population health research and policy interventions on LGBT health inequities. In 2017, we conducted a cross-sectional national, probability survey of LGBT adults in the U.S. and geocoded addresses ( N = 407). We linked locations with census tract, county, and state characteristics selected based on health inequities theories. In 2019, we used weighted analysis to calculate descriptive statistics and conducted planned contrasts of location characteristics by both cohabitation status and gender. Many location characteristics were similar by cohabitation status and gender. However, the tract proportion of Black residents and county crime rate were lower for cohabitating than non-cohabitating men. State smoke-free air score was weaker for cohabitating than non-cohabitating women. The use of same-sex couples to determine the geographical clustering of LGBT lives in the U.S. may give a reasonable indication of overall spatial characteristics but can underestimate some important determinants of health. Care should be taken using same-sex couples as a proxy for LGBT concentration when racial segregation is a potential confounder.

Factors associated with awareness and use of pre-exposure prophylaxis (PrEP) among Black men who have sex with men with a recent STI diagnosis

Article

Jun 2020

Black men who have sex with men (BMSM) with a recent STI diagnosis are at particularly high risk for HIV infection and, as such, are a population for whom we must focus our antiretroviral pre-exposure prophylaxis (PrEP) implementation efforts. Understanding the factors that are associated with awareness and use of PrEP among BMSM with a recent STI diagnosis is a critical component of meeting our HIV prevention goals. For the current study, BMSM (N = 209) diagnosed with a STI in the past year residing in the Atlanta, Georgia metropolitan and surrounding areas were assessed on PrEP awareness and use, HIV risk behaviors (e.g., condomless anal intercourse) HIV risk perceptions, HIV treatment optimism, and HIV status communication self-efficacy. BMSM aware of PrEP (n = 152, 72.7%) were younger in age (OR = 0.96, 95% CI: 0.93-0.98, p = 0.030) and had significantly higher educational attainment (OR = 1.96, 95% CI: 1.28-3.02, p = 0.027) than PrEP unaware participants. In addition, participants who were aware of PrEP had significantly higher levels of HIV risk perceptions (OR = 1.27, 95% CI: 1.04-1.56, p = 0.019) than PrEP unaware participants. Finally, participants who had ever used PrEP (n = 15, 7.1%) had significantly higher HIV treatment optimism (OR = 1.55, 95% CI: 1.05-2.96, p = 0.034) than PrEP non-users. The present study showed that, while nearly three-fourths of the sample were PrEP aware, PrEP use among BMSM with STI diagnoses was limited and that PrEP is utilized less often by individuals who have less HIV treatment optimism. These findings call attention to the need to better understand how to effectively target PrEP uptake strategies for key populations.

Determinants of an HIV Preventive Vaccine among a Highly Vulnerable Population: African American Men Who Have Sex with Men

Article

Full-text available

Mar 2024

African American men who have sex with men (MSM) are disproportionately impacted by HIV and may benefit from the development of an HIV vaccine. African American MSM are adversely affected by discrimination as a function of both their race and sexual behaviors. This may further increase the challenges associated with persuading them to adopt an HIV vaccine. Developing a knowledge base characterizing African American MSM HIV vaccine perceptions, attitudes, and concerns may help strengthen how healthcare providers and other health stakeholders describe and discuss the advent of an HIV vaccine. This study assessed the knowledge, attitudes, beliefs, and intentions related to HIV vaccination among African American MSM. This study comprised 432 African American MSM, 18–64 years, residing in the United States. Vaccine intention was defined as how likely it is that an individual would adopt an HIV vaccine if a vaccine was available and it was 90% effective against HIV, easy to obtain, free, and had few side effects. Relative to African American MSM who intend to delay receiving an HIV vaccination, controlling for age, education, and income, early vaccine adopters who had received ≥ 2 COVID-19 vaccinations and who had high WHO HIV Vaccine Positive Attitude Scale scores were, respectively, 3.2 times and 2.4 times more likely to report the intention to vaccinate within one year. Early vaccine adopters were also 2.4 times more likely to feel that HIV prevention support discriminates against African American MSM. Those reporting three or more sexual partners and medical mistrust were, respectively, 60% and 59% more likely to report the intention to delay HIV vaccination. The lack of a knowledge base on HIV vaccine perceptions and acceptability is a missed opportunity to provide guidance on how stakeholders, such as health providers and policymakers, should address HIV vaccine hesitancy once this crucial vaccine is licensed. The key factors affecting vaccine adoption are valuable in developing and implementing campaigns to enhance the HIV vaccine coverage in this vulnerable population.

What’s in Your Dataset? Measuring Engagement in HIV Care Using Routinely Administered Items with a Population Disproportionately Burdened by HIV

Article

Full-text available

Dec 2023
AIDS BEHAV

We evaluated the psychometric properties of a measure consisting of items that assess current HIV care continuum engagement based on established definitions in the United States. At baseline, participants in this longitudinal study, which included three time points from 2015 to 2020, were 331 young Black sexual minority men ages 18–29 living with HIV in the southern United States residing in two large southern cities. Self-report items reflected four aspects of HIV care continuum engagement as binary variables: seeing a healthcare provider for HIV care, being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. Of these, the following three variables loaded onto a single factor in exploratory factor analysis: being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. A one-dimensional factor structure was confirmed using confirmatory factor analyses at separate time points. Additionally, the three items collectively showed measurement invariance by age, education level, employment status, and income level. The three-item measure also showed reliability based on coefficient omega and convergent validity in its associations with indicators of socioeconomic distress, depression, resilience, and healthcare empowerment. In sum, the items performed well as a single scale. The study demonstrated the potential psychometric strength of simple, feasible, commonly administered items assessing engagement in the HIV care continuum.

Associations of Past-Year Stigma and Psychosocial Syndemic Conditions: Considerations for Intersectional Stigma Measures Among Black Sexual Minority Men

Article

Full-text available

Jan 2023

This secondary analysis of a mixed-serostatus sample of Black sexual minority men (BSMM) used conditional inference tree methods to explore associations of past-year experienced stigma and psychosocial syndemic conditions. Experienced stigmas were attributed to race, sexuality, socioeconomic status, HIV status, or some “other” reason. Psychosocial syndemic conditions studied included physical assault, intimate partner violence, polysubstance use, and depression symptomology. Data are from Promoting Our Worth, Equality, and Resilience (POWER), a serial, cross-sectional study conducted between 2014 and 2017 (N = 4,430). Experiences of multiple stigmas were reported by n = 938 (22.1%) of BSMM. Conditional inference tree results revealed that HIV-related stigma and its intersection with “other” stigma showed the greatest variance in psychosocial condition prevalence. Our findings suggest that when developing intercategorical intersectional analyses with BSMM, there are important stigmas for BSMM beyond those attributed to race, sexuality, and socioeconomic status (SES), particularly intersecting with HIV-related stigma. Conditional inference tree analysis shows promise in quantitative explorations of intersectional stigma with BSMM but will benefit from the inclusion of additional forms of stigma, which should be considered by the field moving forward.

HIV testing among LGBTQIA+ individuals: the impact of outness and peer openness

Article

Full-text available

Dec 2022

This study focused on individuals who classify themselves as lesbian, gay, bisexual, transgender, queer, intersex, asexual and any other non-heterosexual orientations (LGBTQIA+) and their general attitude towards HIV testing. The hypothesis for this study is that LGBTQIA+ individuals with lower levels of predictor variables (lower level of outness and peer openness) have significantly different attitudes towards HIV testing than those with higher levels of predictor variables. A three-part survey was passed out via quota sampling method, and 121 participants answered the survey. The result showed that there is a statistical significance between a LGBTQIA+ individual’s level of outness and their attitude towards HIV testing (p < 0.05), which leads to the conclusion that level of outness may be an indicator that predicts a LGBTQIA+ individual’s attitude towards HIV testing. Findings of this study may help understand the relationship between LGBTQIA+ individuals’ psychological barrier factors and attitudes towards HIV testing, which may inform future research and practices.

Co-occurring Epidemic Conditions Among Southern U.S. Black Men Who Have Sex with Men in an Online eHealth Intervention

Article

Full-text available

Aug 2022
AIDS BEHAV

Black men who have sex with men (BMSM) face disproportionately higher risks for adverse sexual health outcomes compared to their non-Hispanic White counterparts. This disparity can be attributable to overlapping and intersecting risk factors at the individual and structural levels and can be understood through syndemic theory. Using longitudinal data from the HealthMPowerment trial (n = 363), six conditions related to stigma syndemics were indexed as a cumulative risk score: high alcohol use, polydrug use, depression and anxiety symptomology, and experiences of racism and sexual minority stigma. Using Poisson regression, we found a positive association between baseline risk scores and sexual risk behavior (b: 0.32, SE: 0.03, p < 0.001). Using a Generalized Estimating Equation, we also found a 0.23 decrease in the within-participant risk scores at 3-month follow-up (SE: 0.10, p < 0.020). Future work examining how care and prevention trials improve health outcomes in this population is needed.

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073

Article

Aug 2022

Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.

Uptake and Acceptability of MyChoices: Results of a Pilot RCT of a Mobile App Designed to Increase HIV Testing and PrEP Uptake Among Young American MSM

Article

Full-text available

Jul 2022
AIDS BEHAV

Young men who have sex with men (YMSM) remain at disproportionate risk for HIV acquisition in the United States (US), yet use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remain low. Smartphones and mobile app usage are nearly ubiquitous in this population. Given the potential for scalability, a mobile app to increase HIV testing and PrEP use among YMSM has the potential to make an extraordinary public health impact if efficacious. Based on extensive formative, community-engaged research, we developed a theory-driven mobile app-MyChoices-to increase HIV testing and PrEP uptake among YMSM. In a pilot randomized controlled trial (RCT), participants (n = 60) were randomized 2:1 to receive MyChoices or standard of care (SOC). Data from 3 to 6-month post-baseline assessments demonstrate that the app was highly acceptable (System Usability Score; mean = 75.8, SD = 10.7) and feasible (94% used the MyChoices app at least once; mean = 15.3 sessions, SD = 9.8). While not powered to assess efficacy, those in the MyChoices arm had 22% higher prevalence of HIV testing over follow-up compared to those in the SOC arm (NS). There was no difference in PrEP uptake. A fully-powered efficacy trial is warranted; if efficacy is demonstrated, the MyChoices app could be easily scaled to reach YMSM across the US.

The question of the question : impactful implementation science to address the HIV epidemic

Article

Full-text available

Apr 2022

Introduction: Questions about the implementation of evidence-based intervention to treat and prevent HIV have risen to the top of the field's scientific priorities. Despite the availability of highly efficacious treatment and prevention interventions, impact has fallen short of targets because these interventions are used with insufficient reach, consistency, sustainability and equity in diverse real-world settings. At present, substantial excitement for implementation science - defined as research methods and strategies to improve use of evidence-based interventions - has focused on developing and disseminating methods to conduct rigorous research. Yet, impactful answers depend on a sometimes less visible, but even more important, step: asking good questions about implementation. Discussion: In this commentary, we offer several considerations for researchers formulating implementation research questions based on several distinctive features of the field. First, as findings are used not only by other researchers but by implementers, scientific questions must incorporate a range of stakeholder and community perspectives to be most relevant. Second, real-world settings are contextually diverse, and the most relevant scientific questions must position answers to make sense within these contexts (whether geographical, organizational and sociological), rather than apart from them. Third, implementation is complex and dynamic; consequently, research questions must make use of emerging standards in describing implementation strategies and their effects whenever possible. Finally, the field of implementation science continues to evolve, so framing problems with a diverse disciplinary lens will enable researchers to pose insightful and impactful questions. Conclusions: We are now at a juncture marked by both rich evidence-based interventions and a persistent global pandemic. To achieve continued scientific progress against the HIV epidemic, asking the right questions might be part of the answer itself.

Burden and Correlates of Mental Health Symptoms Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Engaged in HIV Care in Atlanta

Article

Full-text available

Sep 2022
AIDS BEHAV

Mental health comorbidities are prevalent among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV and can adversely impact HIV-related outcomes. We conducted a cross-sectional survey study with 100 YB-GBMSM recruited from two HIV care centers in Atlanta, and constructed multivariable logistic and linear regression models to examine correlates of depression, anxiety, trauma symptoms, and general well-being. In adjusted models, full-time employment was associated with fewer depressive symptoms, while HIV stigma and substance use were associated with higher levels of depressive symptoms. Younger age and full-time employment were negatively associated with severe anxiety, while HIV stigma was positively associated with severe anxiety and trauma symptoms. Trust in physicians, lower HIV stigma, full-time employment, and lack of substance use were associated with higher average general well-being scores. In conclusion, we found high frequency of depressive, anxiety, and trauma-related symptoms among this sample of YB-GBMSM living with HIV. Unemployment, substance use, and HIV stigma emerged as particularly salient correlates of psychological morbidity, suggesting a need for structural and community-level interventions to address mental health in this population.

Assessing the Information-Motivation-Behavioral Skills Model to Predict Pre-exposure Prophylaxis Adherence Among Black Men Who have Sex with Men and Transgender Women in a Community Setting in New York City

Article

Full-text available

Jul 2022
AIDS BEHAV

The Information-Motivation-Behavioral Skills (IMB) Model has been used to understand adherence to medications and intentions to uptake pre-exposure prophylaxis (PrEP) to prevent HIV infection. In the current study, the IMB Model was used to understand factors that predict adherence to PrEP among a community-based cohort of 204 Black men who have sex with men (MSM) and transgender women (TGW) using structural equation modeling. PrEP motivation was directly associated with PrEP behavioral skills (β = 0.320, p = 0.009), and PrEP behavioral skills were directly associated with PrEP adherence (β = 0.416, p = 0.001). PrEP knowledge and PrEP motivation were not associated with PrEP adherence, directly or indirectly. The analysis identified intervenable factors that predicted PrEP adherence. Screening for motivation and behavioral skills could be used to identify where additional support to improve PrEP adherence is needed, or whether to offer alternative PrEP modalities or delivery strategies.

Client-Centered Care Coordination (C4™) for HIV/STI Prevention: a Theoretical, Conceptual, and Methodological Overview—HIV Prevention Trials Network (HPTN) 073

Article

Full-text available

Jan 2022
Sex Res Soc Pol

Introduction There are few culturally informed, theory-driven evidence-based strategies to support PrEP use among Black MSM. This paper describes the theoretical foundation and conceptual development of C4™ to support the prevention of HIV and other STIs. Methods C4™ integrates self-determination theory with comprehensive risk counseling and services using an integrative anti-racism lens. C4™ was implemented in a 52-week HIV prevention demonstration project to facilitate PrEP use and adherence among Black MSM (N = 226) in three US cities from 2014 to 2017. Results PrEP use was 79%, with 91% of PrEP users starting within 30 days. Twelve-month retention in C4™ was 92%. Care coordination encounters focused primarily on clients’ needs related to PrEP adherence (43%) and sexual health (19%). Over the 12-month period, a substantial proportion of the men made progress towards their PrEP adherence goals at the 8-week (83%), 26-week (75%), and 52-week (81%) study visits. Conclusions C4™ is a multi-level, multi-component intervention that dually targets individual-level motivations and capacities of Black MSM and the healthcare facility-level attitudes, behaviors and processes that characterize the climates where Black MSM receive services. Policy Implications. Public health policy efforts to scale-up PrEP may consider C4™ as a tool to optimize the use of PrEP and PrEP program retention with Black MSM. C4™ is also a tool for healthcare facilities to transform their models of service delivery towards improving the implementation PrEP services, including ensuring racial equity in the prevention impact of novel PrEP formulations such as long-acting injectable and potential future long-acting oral regimens.

Risk Behaviors Associated with Patterns of Sexualized Stimulant and Alcohol Use among Men Who Have Sex with Men: a Latent Class Analysis

Article

Jan 2022

Substance use during sexual encounters (sexualized substance use) is an important driver of HIV and sexually transmitted infection (STI) disparities that are experienced by men who have sex with men (MSM). This analysis aimed to identify patterns of sexualized substance use and their associations with HIV risk behaviors. We utilized visit-level data from a longitudinal cohort of predominantly Black/Latinx MSM, half with HIV and half with substance use in Los Angeles, California. Every 6 months from 8/2014 to 3/2020, participants underwent STI testing and completed surveys on demographics, sexualized substance use (stimulant and/or alcohol intoxication during oral sex, receptive anal intercourse [RAI] and/or insertive anal intercourse [IAI]), transactional sex, biomedical HIV prevention (pre-/post-exposure prophylaxis use or undetectable viral load), and depressive symptoms. Latent class analysis was used to identify patterns of sexualized substance use. Multinomial logit models evaluated risk behaviors associated with latent classes. Among 2386 study visits from 540 participants, 5 classes were identified: no substance use, sexualized stimulant use, sexualized alcohol use, sexualized stimulant and alcohol use, and stimulant/alcohol use during oral sex and RAI. Compared to the no sexualized substance use class, sexualized stimulant use was associated with transactional sex, current diagnosis of STIs, not using HIV biomedical prevention, and depressive symptoms. Sexualized alcohol use had fewer associations with HIV risk behaviors. Patterns of sexual activities, and the substances that are used during those activities, confer different risk behavior profiles for HIV/STI transmission and demonstrate the potential utility of interventions that combine substance use treatment with HIV prevention.

Understanding social capital among young black gay and bisexual men living with HIV: a qualitative exploration

Article

Full-text available

Sep 2021

Social capital, defined as the sum of an individual’s resource-containing, reciprocal and trustworthy social network connections, has been associated with improved engagement in care among people living with HIV globally. We conducted a qualitative interview study of social capital among 28 young Black gay, bisexual and other men who have sex with men ages 18–29 living with HIV in Atlanta, Georgia. We asked participants about bonding capital (relationships between individuals with similar demographic characteristics), bridging capital (relationships with individuals of different backgrounds), collective efficacy (involvement with community organisations) and satisfaction with their social networks. We found that participants described bonding capital from friends and family in depth, while more gaps were noted in bridging capital and collective efficacy. Bonding capital derived from families was especially critical to participants’ satisfaction with their social capital. Findings suggest that interventions targeting young Black gay, bisexual and other men who have sex with men should build upon strong bonds with family and friends, and/or fill gaps in bridging capital and collective efficacy by connecting young men to mentors and organisations.

Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study

Article

Full-text available

Aug 2021

Background Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. Objective This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. Methods The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. Results The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. Conclusions The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. International Registered Report Identifier (IRRID) PRR1-10.2196/30987

Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study (Preprint)

Preprint

Jun 2021

BACKGROUND Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are . These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. OBJECTIVE This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. METHODS The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. RESULTS The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. CONCLUSIONS The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/30987

High levels of undiagnosed rectal STIs suggest that screening remains inadequate among Black gay, bisexual and other men who have sex with men

Article

Mar 2021

Objective To better understand rectal STI screening practices for Black gay, bisexual and other men who have sex with men (BGBMSM). Findings Although 15% of BGBMSM lab tested positive for a rectal STI, the majority of these (94%) were asymptomatic. Though all participants reported their status as HIV negative/unknown, 31 of 331 (9.4%) tested positive on HIV rapid tests. Neither condomless anal intercourse nor the number of male sex partners was associated with rectal STI or HIV diagnosis, although rectal STI diagnosis was positively related to testing HIV positive. Conclusions Findings suggest that substantial numbers of BGBMSM have asymptomatic STIs but are not tested—an outcome that is likely a strong driver of onward HIV acquisition. Therefore, we must address the asymptomatic STI epidemic among GBMSM in order to reduce HIV transmission, as well as temper STI transmission, among this key population.

HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075

Article

Full-text available

Feb 2021
PLOS ONE

Few studies have assessed HIV incidence in men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA). We assessed HIV incidence and its correlates among MSM and TGW in SSA enrolled in the prospective, multi-country HIV Prevention Trials Network (HPTN) 075 study, conducted from 2015 to 2017. Participants were enrolled at four sites in SSA (Kisumu, Kenya; Blantyre, Malawi; Cape Town and Soweto, South Africa). Eligible participants reported male sex assignment at birth, were 18 to 44 years of age, and had engaged in anal intercourse with a man in the preceding three months. Participation involved five study visits over 12 months. Visits included behavioral assessments and testing for HIV and sexually transmitted infections. Twenty-one of 329 persons acquired HIV during the study [incidence rate: 6.96/100 person-years (PY) (95% CI: 4.3, 10.6)]. Among TGW, HIV incidence was estimated to be 8.4/100 PY (95% CI: 2.3, 21.5). Four participants were found to have acute HIV infection at their first HIV-positive visit. HIV incidence varied among the four study sites, ranging from 1.3/100 PY to 14.4/100 PY. In multivariate longitudinal analysis, factors significantly associated with HIV acquisition were engagement in unprotected receptive anal intercourse [adjusted hazard ratio (AHR) 5.8, 95% confidence interval (CI): 2.4, 14.4] and incident rectal gonorrhea and/or chlamydia (AHR: 2.7, 95% CI: 1.1, 6.8). The higher HIV incidence in Cape Town compared to Blantyre could be explained by the higher prevalence of several risk factors for HIV infection among participants in Cape Town. Annual HIV incidence observed in this study is substantially higher than reported HIV incidence in the general populations in the respective countries and among MSM in the United States. Intensification of HIV prevention efforts for MSM and TGW in SSA is urgently needed.

Characterizing Biomedical HIV Prevention Awareness and Use Among Black Transgender Women in the United States

Article

Full-text available

Feb 2021
AIDS BEHAV

Black transgender women (BTW) in the United States experience disproportionate rates of HIV despite biomedical prevention interventions such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP). Using a sample of 490 BTW collected from 2014 to 2017, bivariate, multivariable, and multinomial analyses were conducted to determine factors associated with awareness and use of PrEP and nPEP. BTW living with HIV were more aware of PrEP than HIV-negative BTW. Structural, demographic, and trans-specific factors (e.g., experiences of homelessness, violence, and current hormone use) related to HIV risk were associated with PrEP and nPEP awareness. PrEP use was associated with behavioral HIV risks (e.g., STI diagnosis, having an HIV-positive partner, and needle-sharing) and may demonstrate risk recognition among BTW. Knowing someone using PrEP was significantly positively associated with PrEP use. Development of guidelines for PrEP and nPEP use for BTW should leverage the strengths of guidelines for other populations, while also acknowledging the unique risks for this population.

HIV Information Acquisition and Use among Young Black Men Who Have Sex with Men Who Use the Internet: A Mixed Methods Study (Preprint)

Article

Full-text available

Jul 2020
J MED INTERNET RES

BackgroundHIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM. Objective This study aims to investigate HIV information acquisition and use among YBMSM who use the internet. MethodsA web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies. ResultsAmong the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet. ConclusionsYBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.

Exploring influences on methamphetamine use among Black gay, bisexual and other men who have sex with men in Atlanta: A focus group study

Article

Apr 2021
INT J DRUG POLICY

Background Methamphetamine use is a contributor to HIV risk and poor health outcomes among gay, bisexual and other men who have sex with men (GBMSM). There is a paucity of research examining methamphetamine use and its social context specifically among Black GBMSM. We therefore sought to: (1) describe trends in methamphetamine use among Black GBMSM in Atlanta, Georgia, and (2) examine the risk environment (micro-, meso‑ and macro-level factors operating in the political, social, physical, economic, and healthcare environments) that might elevate risk for methamphetamine use in this population. Methods We conducted a qualitative study consisting of eight focus groups with 54 key informants between December 2019 and March 2020. Participants represented community-based and healthcare organizations that work closely with Black GBMSM. Our thematic analysis included an iterative, team coding approach combining deductive and inductive elements. Results Participants unanimously agreed that methamphetamine use was increasingly prevalent among Black GBMSM in Atlanta, with many describing a historical arc in which methamphetamine use – previously associated with predominantly white, affluent GBMSM – was now common among younger, lower socioeconomic status Black GBMSM. At the micro-level, participants described contributors to increasing methamphetamine use including use as a sex drug, and the interrelated burdens of stress and mental illness, housing instability, geographic mobility and poverty. At the meso‑level, participants described virtual and physical sex scenes including use of geosocial networking apps that facilitated the spread of methamphetamine use in the Black GBMSM community. At the macro-level, participants described how policies prioritizing other concerns (e.g., HIV, opioids) seemed to limit resources available for methamphetamine prevention and treatment programming. Conclusion Multi-level environmental influences are working together to elevate risk for methamphetamine use among Black GBMSM in Atlanta, with potential to adversely impact health and well-being and undermine HIV prevention and treatment efforts.

A Multidimensional Model of Sexual Empowerment Among Young Black Men Who have Sex with Men: A Latent Profile Analysis

Article

Full-text available

Mar 2021
AIDS BEHAV

Sexual empowerment is a key strategy in HIV prevention intervention design, yet its measurement has been conceptualized as homogeneous. To date, no studies have examined whether young Black men who have sex with men (YBMSM) exhibit heterogeneity across sexual empowerment. Using baseline data from a randomized controlled trial (N = 275, HIV-negative YBMSM), we classified YBMSM into sexual empowerment profiles based on five indicators using a latent profile analysis and assessed the associations between the sexual empowerment profiles and stigma-related experiences using multinomial logistic regression. Three profiles were identified: psychologically empowered with safer sex intentions (profile 1); psychologically disempowered with safer sex intentions (profile 2); and psychologically disempowered without safer sex intentions (profile 3). YBMSM reporting fewer stigma-related experiences were more likely to be profile 1 than profile 2 and profile 3. To empower YBMSM, interventions based on sexual empowerment profile targeting the psychological/behavioral aspects of empowerment and addressing stigma are needed.

Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM)

Article

Aug 2020

We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87%; p < .001) and STI (28% to 80%; p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black MSM along the HIV prevention continuum.

Intersecting Barriers to PrEP Awareness and Uptake in Black Men Who Have Sex with Men in Atlanta, GA: a Syndemic Perspective

Article

Aug 2020

Background Pre-exposure prophylaxis (PrEP) can sharply reduce HIV transmission risk, yet has not been widely adopted among those at highest risk for HIV, including Black men who have sex with men (BMSM). To better understand the evolving landscape of PrEP uptake in this at-risk population, we sought to examine psychosocial factors associated with PrEP uptake in a sample of BMSM residing in the Atlanta, GA, area.MethodBMSM were recruited through online social media, LGBT venues, and participant referral, and self-reported demographic and psychosocial information via computer-assisted self-interview. Multivariate logistic regression was used to examine psychosocial factors associated with PrEP uptake.ResultsIn 293 BMSM, most (N = 260; 88.7%) reported awareness of PrEP yet few (N = 30; 10.1%) reported ever having taken PrEP. BMSM reporting more syndemic conditions were less likely to be current PrEP users (OR = 0.59; 95% CI: 0.36, 0.96). BMSM reporting recent condomless anal sex (CAS) with a partner met online (adjusted odds ratio (aOR) = 2.53; 95% CI: 1.07, 5.93), or who reported having chlamydia (aOR = 8.21; 95% CI: 1.42, 47.67) or STI-related symptoms (aOR = 4.35; 95% CI: 1.32, 14.37) in the past 3 months, or genital warts in their lifetime (aOR = 7.74; 95% CI: 2.47, 24.21) were more likely to have ever used PrEP. Sexual orientation stigma from health care providers was negatively associated with PrEP uptake (OR = 0.81, 95% CI: 0.68, 0.95) among BMSM reporting recent CAS and multiple partners.Conclusion Syndemic and stigma theories may inform strategies for improving PrEP uptake in BMSM.

Masculine ideology and Black men who have sex with men’s interest in HIV pre-exposure prophylaxis (PrEP)

Article

Jul 2020

We examined how traditional masculinity and stigma surrounding HIV pre-exposure prophylaxis (PrEP) affect PrEP interest among Black men who have sex with men (BMSM). One hundred twenty-three men attending a Black Gay Pride event completed measures assessing traditional masculinity, PrEP stigma, and PrEP interest along with two behavioral measures of interest in PrEP. Results demonstrated that avoidance of femininity directly related to interest in PrEP and indirectly through conformity to heterosexual self-presentation. Further, PrEP stigma differentially moderated both of these relationships. Interventions designed to improve engagement of PrEP for BMSM should be attentive to traditional masculinity as a barrier.

The importance of developmental assets in HIV prevention behaviors among young black men who have sex with men (MSM)

Article

Full-text available

May 2024

Developmental assets are critical to the health and wellbeing of youth. The current study examines the influence of developmental assets on PrEP use and HIV testing among YBMSM ages 18–24. Using a cross-sectional survey of YBMSM (N = 225), this study explored the role of external (e.g., family support, other adult support) and internal (e.g., personal responsibility) assets in explaining HIV prevention behaviors. Participants were recruited from Mechanical Turk (M-Turk) internet-based platform, social media sites, and community-based organizations. A path analysis was conducted to investigate the direct/indirect effects of internal and external assets on PrEP use and HIV testing. Family support (β = 0.40, p < 0.001) and other adult support (β = 0.22, p = 0.004) were both associated with personal responsibility. Personal Responsibility (β = 0.15, p = 0.03) and positive identity (β = 0.28, p < 0.001) were both associated with an increase HIV testing. Personal responsibility was positively associated with increased PrEP use (β = 0.30, p < 0.001). Our study results indicated that external assets play a role in helping to build internal assets that support increased HIV testing and PrEP use among YBMSM. Our findings suggest the need for strength-based interventions that help YBMSM build assets and increase HIV prevention behaviors.

HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review

Article

Full-text available

Jan 2024

Background Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored. Objective This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada. Methods We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed. Results Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV. Conclusions Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider’s capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-043055

Understanding and Addressing LGBTQ Health Disparities: A Power and Gender Perspective

Chapter

Dec 2023

Alyssa N. Zucker

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people experience worse mental and physical health than their heterosexual cisgender peers. Research shows that stigma and discrimination are consistent predictors of these negative health outcomes. Using a critical, intersectional, feminist perspective, this chapter reviews the literature on stress processes and how they are applied to understanding LGBTQ health disparities, primarily in the U.S. context. An analysis of power is central to understanding and intervening on systems of oppression that produce worse health outcomes. Research demonstrates that LGBTQ people who live in places with protective structures such as laws enforcing marriage equality and anti-bullying policies in schools have better health outcomes. Thus, this chapter concludes with suggestions for broad structural change as well as concrete actions scholars can take in the domains of research (e.g., collecting quality data on gender and sexual orientation and analyzing it appropriately) and teaching (e.g., offering evidence-based perspectives on LGBTQ experiences to students and trainees) to improve LGBTQ health.

Structural Inequities, Syndemics, and Resilience: The Critical Role of Social Support in Overcoming Barriers and Empowering Engagement in HIV Care for Young Black Sexual-Minority Men in the US South

Article

Dec 2023

Young Black sexual minority men (YBSMM) living in the US South are among those most disproportionately impacted by HIV in the USA. This health inequity is, in part, due to lower rates of sustained engagement in the HIV care continuum, resulting in a lower prevalence of viral suppression and higher overall community-level viral load. Social, structural, and economic inequities have previously been linked with poorer HIV care engagement among YBSMM. HIV-related social support, individual-level resilience, and healthcare empowerment have been shown to be independently associated with improved HIV care engagement. The current study sought to assess the relative contribution of individual, structural, and economic factors on engagement in HIV care and to elucidate the potentially mediating role of healthcare empowerment. Data from 224 YBSMM with HIV in the US South indicated that greater levels of socioeconomic distress, intimate partner violence, and depressive symptoms were associated with lower levels of engagement in HIV care, while greater levels of individual-level resilience and healthcare empowerment were associated with higher levels of HIV care engagement. Importantly, healthcare empowerment mediated the association between resilience and engagement in HIV care and the association between social support and engagement in HIV care. Findings emphasize the critical role that HIV-related social support plays in fostering resilience and overcoming syndemic factors to promote empowerment and engagement in HIV care for YBSMM in the USA.

Multidisciplinary providers’ perspectives on engaging young black, gay, bisexual and other men who have sex with men living with HIV in mental health care services

Article

Sep 2022

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV are at high risk for psychological stressors and comorbidities. We sought to gain the perspectives of multidisciplinary providers (including HIV care, mental health care, and social service providers) on their experiences with engaging YB-GBMSM in mental health care within comprehensive HIV primary care centers that included both types of services on-site. We conducted qualitative in-depth interviews with fifteen providers in two clinics, and analyzed the qualitative data using a thematic analysis approach. Our participants described high levels of need for mental health services among YB-GBMSM living with HIV, due to psychological challenges related to living with HIV as well as other frequently occurring life stressors. At the same time, barriers to accessing these services were identified, with mental health stigma, under-recognition of symptoms and confidentiality concerns being the most commonly cited. Strategies to improve mental health service uptake in light of these needs and barriers were discussed, including re-framing of mental health services, addressing logistical barriers, and utilization of a biopsychosocial perspective.

Sources of Information about Pre-Exposure Prophylaxis (PrEP) and Associations with PrEP Stigma, Intentions, Provider Discussions, and Use in the United States

Article

Aug 2022

The amount and type of information individuals receive about HIV pre-exposure prophylaxis (PrEP) may influence PrEP uptake. We surveyed 331 HIV-negative sexual and gender minorities who have sex with men at a Midwestern Pride festival in 2018 (Mage = 32, 68% White, 87% cisgender men) to assess sources and perceived tone of PrEP information and associated outcomes. Most participants (88%) had heard about PrEP. The most common sources were the internet (70%), social media (59%), and friends (54%). Messages from health campaigns were perceived as most positive and those from religious institutions as least positive. Sources differed based on demographics. Controlling for indications for PrEP use, those who heard about PrEP from health campaigns and those who heard more positive messages reported lower levels of PrEP stigma, βs = −0.27––0.23, ps < .05. Non-users who heard about PrEP from the internet had stronger intentions to use PrEP, β = 0.28, p < .05. Those who heard about PrEP from sexual partners and health campaigns were more likely to discuss PrEP with providers, PRs = 1.60–1.80, ps < .01. Finally, those who heard about PrEP from friends and partners were more likely to use PrEP, PRs = 2.01–2.24, ps < .05. Leveraging sexual partners, social network members, and health campaigns are promising avenues to advance PrEP implementation.

Substance use experiences of HIV-positive and HIV-negative black, non-hispanic men who have sex with men (msm) ages 18–34 in the Bay Area: A qualitative narrative perspective

Article

Jun 2022

Objective: Young Black men who have sex with men (MSM) represent the majority of individuals with new HIV infections in the U.S. Substance use is related to risk and acquisition t of HIV. The purpose of this study was to explore the perceptions and experiences about the role substance use plays in the lives HIV-positive and HIV-negative young Black MSM between the ages of 18-34. Methods: Using a qualitative, narrative perspective, we recruited and then interviewed participants in partnership with AIDS Service Organizations. Narrative and thematic analysis was used to analyze these Black men's personal stories with harm reduction used as the conceptual approach. Results: Nine HIV-positive and 3 HIV-negative participants(n = 12) shared stories about their own personal experiences with family relationships and substance use. Themes related to family included early exposure and initiation of substance use, substance use as a response to stigma around sexual orientation, kicked out of house, asked to leave or left home so they could be themselves and perceived benefits and advantages of methamphetamine. Conclusions: The participants are subjected to adverse and stressful childhood experiences. These are important stories to understand if we expect to mount an adequate response, utilizing harm reduction, to the growing number of young Black MSM at-risk for HIV.

“Wellness is wholeness”: Explorations of wellness among Black gay men

Article

Jun 2022

The Indivisible Self Model of Wellness undergirded this mixed methods phenomenological exploration of the conceptualizations and experiences of wellness among nine Black gay men who had not tested positive for HIV. Data sources included in‐depth semistructured interviews and participant responses on the Five Factor Wellness Inventory. The following themes emerged from the thematic analysis of the interview transcripts: holistic self‐love, spiritual journey, kinship, social responsibility, sexual literacy, and approaches to HIV prevention. Additionally, cross‐validation of the qualitative and quantitative data revealed the central roles that social connectedness and spirituality played in these men's lives. Findings from this study provide a detailed picture of wellness within this sample and indicate considerations for expanding wellness to account for sexual health and wellness practices.

Project Silk: A youth-centered structural HIV intervention model for Black men who have sex with men and transgender women

Article

Oct 2021

A Cross-sectional Study of Parenting Intentions and Desires Among Young Black Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV in Atlanta, Georgia

Article

Aug 2021
J ASSOC NURSE AIDS C

Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women

Article

Feb 2021
JAIDS-J ACQ IMM DEF

Background: Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remains rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. Methods: Data for this study from a longitudinal cohort study of young men who have sex with men (MSM) and transgender women in Chicago. Participants provided sexual network data every 6-months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. Results: Results indicated substantial between and within person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively association with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. Conclusions: Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young MSM and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should utilize these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.

Factors Associated With Condom Failure in a Longitudinal Cohort of Men Who Have Sex With Men and Transgender Women in Abuja and Lagos, Nigeria

Article

Full-text available

Nov 2020
JAIDS-J ACQ IMM DEF

Background: Effective condom use is a critical intervention to limit the spread of HIV and other sexually transmitted infections (STIs), particularly among individuals in high-risk networks who practice anal sex. We characterized condom failures in cisgender men who have sex with men (MSM) and transgender women (TGW) in Nigeria. Setting: The TRUST/RV368 cohort provided condoms, compatible lubricants, and safer sex education to MSM and TGW at community-engaged health centers in Abuja and Lagos, Nigeria. Methods: Participants completed structured interview questions about condom usage and failure every 3-6 months. Robust Poisson regression models with generalized estimating equations were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for pre-specified factors potentially associated with condom failure in the previous month. Results: From September 2013 to September 2019, 2221 (81.1%) of 2737 participants reported condom use for anal sex with a male partner in the last month and 305 (13.7%) reported condom failure during this time. Multivariate analyses demonstrated an increased risk of condom failure at post-enrollment visits, as well as in participants who reported frequent internet use, two or more casual sexual partners, and 2-4 main sexual partners. Those who cohabited with a woman had reduced risk. Conclusion: Condom failure was common in this population despite freely available condoms, compatible lubrication and education. Increased risk of condom failure over time could reflect message fatigue or a ceiling for effective condom use, or new uptake of condoms by inexperienced users.

Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S

Article

Full-text available

May 2021
ARCH SEX BEHAV

Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.

Trajectories of and Disparities in HIV Prevalence among Black, White, and Hispanic/Latino Men who Have Sex with Men in 86 Large U.S. Metropolitan Statistical Areas, 1992-2013

Article

Sep 2020

Purpose The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas. Methods This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States. Results Our estimates indicate that HIV prevalence among MSM increased, from an across–metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions. Conclusions The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.

Risk compensation in HIV PrEP adherence among Black men who have sex with men in HPTN 073 study

Article

Full-text available

Aug 2020

While HIV infections among men who have sex men (MSM) have started to decline in the United States, Black MSM continue to experience disproportionate rates of HIV infection. The purpose of this secondary analysis is to examine risk perception and its influence on PrEP adherence among Black MSM from HPTN 073. Risk perception was measured using the adapted Perceived Vulnerability to HIV Scale. The associations between risk perception and PrEP adherence were tested using generalized estimation equation model for time-variant repeated measures. Risk perception was not significantly associated with PrEP adherence. These findings suggest an there was no risk compensation among PrEP users, and inconsistency in perceived risk for HIV. Future studies should investigate the rationale for long term adherence to PrEP among Black MSM.

Examining HIV/AIDS complacency, substance use and sexual risk among MSM in a bathhouse setting

Article

Aug 2020

Men who have sex with men (MSM) continue to account for a large number of new HIV infections across the United States. While numerous studies have focused on MSM sexual risk behavior and substance use, some research has also examined how public and private environments, such as a bathhouse setting, may play an important role. This cross-sectional study analyzed data surrounding HIV/AIDS complacency, substance use, and sexual risk behavior among a sample of 168 MSM in a bathhouse located within a major urban city. Of the sample, 73.2% had completed at least college, 67.9% were single, 56.5% were identified as Caucasian (both Hispanic and Non-Hispanic), 76.2% identified as gay, and 77.4% were HIV negative. Results demonstrated an association between complacency and sexual risk behavior among participants. Being Black (both Hispanic and Non-Hispanic), HIV-positive, or those reporting drug and/or alcohol usage influenced their safe sex practices and was found to be associated with sexual risk behavior. Implications are examined related to HIV education and prevention efforts among MSM as well as affirming practice and service delivery efforts.

The Role of Geographic and Network Factors in Racial Disparities in HIV Among Young Men Who have Sex with Men: An Egocentric Network Study

Article

Full-text available

Nov 2014
AIDS BEHAV

The objective of this study was to characterize and compare individual and sexual network characteristics of Black, White, and Latino young men who have sex with men (YMSM) as potential drivers of racial disparities in HIV. Egocentric network interviews were conducted with 175 diverse YMSM who described 837 sex partners within 167 sexual-active egos. Sexual partner alter attributes were summarized by ego. Descriptives of ego demographics, sexual partner demographics, and network characteristics were calculated by race of the ego and compared. No racial differences were found in individual engagement in HIV risk behaviors or concurrent sexual partnership. Racial differences were found in partner characteristics, including female gender, non-gay sexual orientations, older age, and residence in a high HIV prevalence neighborhood. Racial differences in relationship characteristics included type of relationships (i.e., main partner) and strength of relationships. Network characteristics also showed differences, including sexual network density and assortativity by race. Most racial differences were in the direction of effects that would tend to increase HIV incidence among Black YMSM. These data suggest that racial disparities in HIV may be driven and/or maintained by a combination of racial differences in partner characteristics, assortativity by race, and increased sexual network density, rather than differences in individual's HIV risk behaviors.

Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy: UK cohort study.

Article

Full-text available

Feb 2014
AIDS

The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). Patients aged more than 20 years who started ART during 2000-2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4 cell count and viral load before ART and in each of years 1-5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4 cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20-85 years. Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years.At start of ART, expected age at death [95% confidence interval (95% CI)] of 35-year-old men with CD4 cell count less than 200, 200-349, at least 350 cells/μl was 71 (68-73), 78 (74-82) and 77 (72-81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five year old men who increased their CD4 cell count in the first year of ART from less than 200 to 200-349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48-61) (CD4 cell count <200 cells/μl and no viral suppression) to 80 (76-83) years (CD4 cell count ≥350 cells/μl and viral suppression). Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4 cell count significantly improve their life expectancy if they have a good CD4 cell count response and undetectable viral load.

'Triply cursed': Racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men

Article

Full-text available

May 2014
CULT HEALTH SEX

In the USA, young Black gay men are disproportionately impacted upon by HIV. In this qualitative study consisting of in-depth interviews with 31 young Black gay men and nine service providers, where we used thematic analysis to guide our interpretations, we found that HIV-related stigma and homophobia, within the larger societal context of racism, were related to sexual risk behaviour, reluctance to obtain HIV testing or care, lower adherence to treatment medication, and non-disclosure of a positive HIV status to sexual partners. Participants experienced homophobia and HIV-related stigma from churches and families within the Black community and from friends within the Black gay community, which otherwise provide support in the face of racism. Vulnerability to HIV was related to strategies that young Black gay men enacted to avoid being stigmatised or as a way of coping with alienation and rejection.

Correlates of HIV Acquisition in a Cohort of Black Men Who Have Sex with Men in the United States: HIV Prevention Trials Network (HPTN) 061

Article

Full-text available

Jul 2013
PLOS ONE

Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts. From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional hazards modeling with time-dependent covariates was used to identify correlates of HIV acquisition. Of 1,553 Black MSM enrolled, 1,164 were HIV-uninfected at baseline and included in follow-up. Overall annual HIV incidence was 3.0% (95% confidence interval (CI): 2.0, 4.4%) and 5.9% among men ≤30 years old (95% CI: 3.6, 9.1%). Men ≤30 years old reported significantly higher levels of sexual risk and were more likely to have a sexually transmitted infection diagnosed during follow-up. Younger men also were more likely to not have a usual place for health care, not have visited a health care provider recently, and to have unmet health care needs. In multivariate analysis, age ≤30 years (hazard ratio (HR): 3.4; 95% CI: 1.4, 8.3) and unprotected receptive anal intercourse with HIV-positive or unknown status partners (HR: 4.1; 95% CI: 1.9, 9.1) were significantly associated with HIV acquisition. In the largest cohort of prospectively-followed Black MSM in the US, HIV incidence was high, particularly among young men. Targeted, tailored and culturally appropriate HIV prevention strategies incorporating behavioral, social and biomedical based interventions are urgently needed to lower these rates.

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

Article

Full-text available

Feb 2014
AIDS BEHAV

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

HIV Infection and Awareness among Men Who Have Sex with Menâ€“20 Cities, United States, 2008 and 2011

Article

Full-text available

Oct 2013
PLOS ONE

Over half of HIV infections in the United States occur among men who have sex with men (MSM). Awareness of infection is a necessary precursor to antiretroviral treatment and risk reduction among HIV-infected persons. We report data on prevalence and awareness of HIV infection among MSM in 2008 and 2011, using data from 20 cities participating in the 2008 and 2011 National HIV Behavioral Surveillance System (NHBS) among MSM. Venue-based, time-space sampling was used to recruit men for interview and HIV testing. We analyzed data for men who reported $1 male sex partner in the past 12 months. Participants who tested positive were considered to be aware of their infection if they reported a prior positive HIV test. We used multivariable analysis to examine differences between results from 2011 vs. 2008. HIV prevalence was 19% in 2008 and 18% in 2011 (p = 0.14). In both years, HIV prevalence was highest among older age groups, blacks, and men with lower education and income. In multivariable analysis, HIV prevalence did not change significantly from 2008 to 2011 overall (p = 0.51) or in any age or racial/ethnic category (p.0.15 in each category). Among those testing positive, a greater proportion was aware of their infection in 2011 (66%) than in 2008 (56%) (p,0.001). In both years, HIV awareness was higher for older age groups, whites, and men with higher education and income. In multivariable analysis, HIV awareness increased from 2008 to 2011 overall (p,0.001) and for all age and racial/ethnic categories (p,0.01 in each category). In both years, black MSM had the highest HIV prevalence and the lowest awareness among racial/ethnic groups. These findings suggest that HIV-positive MSM are increasingly aware of their infections.

The ‘File Drawer’ Problem and Tolerance for Null Results

Article

Full-text available

May 1979

Robert Rosenthal

For any given research area, one cannot tell how many studies have been conducted but never reported. The extreme view of the "file drawer problem" is that journals are filled with the 5% of the studies that show Type I errors, while the file drawers are filled with the 95% of the studies that show nonsignificant results. Quantitative procedures for computing the tolerance for filed and future null results are reported and illustrated, and the implications are discussed. (15 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Attitudes and Program Preferences of African-American Urban Young Adults About Pre-Exposure Prophylaxis (PrEP)

Article

Full-text available

Oct 2012

We elicited attitudes about, and service access preferences for, daily oral antiretroviral pre-exposure prophylaxis (PrEP) from urban, African-American young men and women, ages 18-24 years, at risk for HIV transmission through their sexual and drug-related behaviors participating in eight mixed-gender and two MSM-only focus groups in Atlanta, Georgia. Participants reported substantial interest in PrEP associated with its perceived cost, effectiveness, and ease of accessing services and medication near to their homes or by public transportation. Frequent HIV testing was a perceived benefit. Participants differed about whether risk-reduction behaviors would change, and in which direction; and whether PrEP use would be associated with HIV stigma or would enhance the reputation for PrEP users. This provides the first information about the interests, concerns, and preferences of young adult African Americans that can be used to inform the introduction of PrEP services into HIV prevention efforts for this critical population group.

HIV risk, prevention, and testing behaviors among men who have sex with men--National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008

Article

Full-text available

Oct 2011

Approximately 1.1 million persons in the United States are living with human immunodeficiency virus (HIV) infection. More than half of those infected are men who have sex with men (MSM). June-December 2008. The National HIV Behavioral Surveillance (NHBS) System collects risk behavior data from three populations at high risk for HIV infection: MSM, injection-drug users, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. NHBS participants must be aged ≥18 years, live in a participating metropolitan statistical area, and be able to complete a behavioral survey in English or Spanish. Men who reported being infected with HIV or who had no male sex partners during the past 12 months were excluded from this analysis. This report summarizes data gathered from 8,175 MSM during the second data collection cycle of NHBS. In addition to having at least one male sex partner, 14% of participants had at least one female sex partner during the past 12 months. Unprotected anal intercourse with a male partner was reported by 54% of the participants; 37% reported having unprotected anal sex with a main male partner (someone with whom the participant had sex and to whom he felt most committed, such as a boyfriend, spouse, significant other, or life partner), and 25% reported having unprotected anal sex with a casual male partner (someone with whom the participant had sex but with whom he did not feel committed, did not know very well, or had sex with in exchange for something such as money or drugs). Noninjection drug use during the past 12 months was reported by 46% of participants. Specifically, 38% used marijuana, 18% cocaine, 13% poppers (amyl nitrate), and 11% ecstasy. Two percent of the participants reported injecting drugs for nonmedical purposes in the past 12 months. Of the participants surveyed, 90% had been tested for HIV during their lifetime, 62% had been tested during the past 12 months, 51% had received a hepatitis vaccination, 35% had been tested for syphilis during the past 12 months, and 18% had participated in an individual- or group-level HIV behavioral intervention. MSM in the United States continue to engage in sexual and drug-use behaviors that increase the risk for HIV infection. Although many MSM had been tested for HIV infection, many had not received hepatitis vaccinations or syphilis testing, and only a small proportion had recently participated in a behavioral intervention. To reduce HIV infection among MSM, additional effort is needed to decrease the number of men who are engaging in risk behaviors while increasing the number who recently have been tested for HIV. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce infections and HIV-related health disparities among MSM and other disproportionately affected groups. NHBS data can be used to monitor progress toward the goals of the national strategy and to guide national and local planning efforts to maximize the impact of HIV prevention programs.

Estimated HIV Incidence in the United States, 2006–2009

Article

Full-text available

Aug 2011
PLOS ONE

Background: The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200-64,500). We updated the 2006 estimate and calculated incidence for 2007-2009 using improved methodology. Methodology: We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups. Principal findings: Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400-54,700) in 2006, 56,000 (95% CI: 49,100-62,900) in 2007, 47,800 (95% CI: 41,800-53,800) in 2008 and 48,100 (95% CI: 42,200-54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%-39.8%; p = 0.017) increase in incidence for people aged 13-29 years, driven by a 34% (95% CI: 8.4%-60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%-83.0%; p<0.001). Among people aged 13-29, only MSM experienced significant increases in incidence, and among 13-29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%. Conclusions/significance: Overall, HIV incidence in the United States was relatively stable 2006-2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence.

Resilience as an Untapped Resource in Behavioral Intervention Design for Gay Men

Article

Full-text available

Feb 2011
AIDS BEHAV

Men who have sex with men experience high rates of psychosocial health problems such as depression, substance use, and victimization that may be in part the result of adverse life experiences related to cultural marginalization and homophobia. These psychosocial health conditions interact to form a syndemic which may be driving HIV risk within this population. However, MSM also evidence great resilience to both the effects of adversity and the effects of syndemics. Investigating and harnessing these natural strengths and resiliencies may enhance HIV prevention and intervention programs thereby providing the additional effectiveness needed to reverse the trends in HIV infection among MSM.

Running in Place: Implications of HIV Incidence Estimates among Urban Men Who Have Sex with Men in the United States and Other Industrialized Countries

Article

Full-text available

Mar 2009
AIDS BEHAV

Attempts to document changing HIV incidence rates among MSM are compromised by issues of generalizability and statistical power. To address these issues, this paper reports annualized mean HIV incidence rates from the entire published incidence literature on MSM from Europe, North America and Australia for the period 1995-2005. Publications that met the entry criteria were coded for region of the world, sampling method and year of study. From these reports, we calculated a mean incidence rate with confidence intervals for these variables. Although no differences in mean incidence rates were found for MSM from 1995 to 2005, HIV incidence rates are lower in Australia than either North America or Europe. We calculated a mean incidence rate of 2.39% for MSM in the United States, which if sustained within a cohort of MSM, would yield HIV prevalence rate of approximately 40% at age 40. These extrapolations overlap published HIV prevalence rates for MSM younger than age 40 in the United States. HIV incidence rates in the 2-3% range will adversely affect the health of gay male communities for decades to come. This analysis suggests that greater attention should be devoted to the question of how best to design prevention interventions that will lower HIV incidence rates among gay men.

The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students

Article

Full-text available

May 2005
JAIDS-J ACQ IMM DEF

Approximately 16 million people are enrolled in institutions of higher learning in the United States. However, college students have not been perceived as at high risk for HIV infection. In early 2003, acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina. We reviewed state surveillance records examining new HIV diagnoses in men 18-30 years old between January 1, 2000 and December 31, 2003, living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male nonenrollees. Of the 735 records available for review, 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with noncollege men, college men were more likely to be African American (odds ratio 3.70, 95% CI = 1.86-7.54), to report meeting sex partners at bars or dance clubs (odds ratio 3.01, 95% CI = 1.77-5.10) or on the Internet/chat lines (odds ratio 4.95, 95% CI = 2.53-9.64), or to report use of "ecstasy" or club drugs (odds ratio 4.51, 95% CI = 1.15-15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges, 61 students, and 8 partners of students. We describe an epidemic of HIV infection occurring in North Carolina college students, primarily involving African American MSM and MSM/W. College students represent an at-risk, accessible population, which deserves further HIV prevention interventions.

Sex Isn't That Simple: Culture and Context in HIV Prevention Interventions for Gay and Bisexual Male Adolescents

Article

Full-text available

Nov 2007

Gary Harper

Gay and bisexual male adolescents and young adults in the United States have been disproportionately impacted by the HIV pandemic. Despite the steadily increasing rise in their HIV infection rates, there has not been a commensurate increase in HIV prevention programs targeted to the unique social and sexual lives of these youths. Programs that address cultural and contextual factors that influence sexual risk and protective behaviors need to be developed, implemented, and rigorously evaluated. These interventions should address the potential influences of sexual and gay culture on the HIV risk/protective behaviors of gay and bisexual adolescents, as well as the influence of more traditional cultural factors related to ethnicity. The influence of contextual developmental factors should also be addressed. This may include an incorporation into prevention programs of the societal-level influences of heterosexism and masculinity ideology and the individual-level influences of sexual identity and ethnic identity development. Researchers and interventionists need to be creative and innovative in their HIV prevention approaches and ensure that programs are grounded in the lives and realities of gay and bisexual adolescents and young adults.

Introduction to meta-analysis

Book

Jan 2009

The Unexpected Movement of the HIV Epidemic in the Southeastern United States

Article

Apr 2005
JAIDS-J ACQ IMM DEF

Background: Approximately 16 million people are enrolled in institutions of higher learning in the United States. However, college students have not been perceived as at high risk for HIV infection. In early 2003, acute HIV infection was diagnosed in 2 men attending college in North Carolina. We describe an epidemiologic investigation of newly diagnosed HIV infection in men attending college in North Carolina. Methods: We reviewed state surveillance records examining new HIV diagnoses in men 18-30 years old between January 1, 2000 and December 31, 2003, living in 69 North Carolina counties. Risk behavior and demographic information for HIV-infected men enrolled in college were compared with HIV-infected male nonenrollees. Results: Of the 735 records available for review, 84 (11%) were college men. Eighty-seven percent of college men were African American and 92% were men who have sex with men (MSM) or men who have sex with men and women (MSM/W). Compared with noncollege men, college men were more likely to be African American (odds ratio 3.70, 95% CI = 1.86-7.54), to report meeting sex partners at bars or dance clubs (odds ratio 3.01, 95% CI = 1.77-5.10) or on the Internet/chat lines (odds ratio 4.95, 95% CI = 2.53-9.64), or to report use of “ecstasy” or club drugs (odds ratio 4.51, 95% CI = 1.15-15.40). Newly diagnosed HIV infection was found in men in 37 colleges located in North Carolina or surrounding states and a sexual partner network investigation linked 21 colleges, 61 students, and 8 partners of students. Conclusion: We describe an epidemic of HIV infection occurring in North Carolina college students, primarily involving African American MSM and MSM/W. College students represent an at-risk, accessible population, which deserves further HIV prevention interventions.

Estimating HIV Protective Effects of Method Adherence With Combinations of Preexposure Prophylaxis and Condom Use Among African American Men Who Have Sex With Men

Article

Feb 2015

Prevention of sexually acquired HIV infection now includes both consistent condom use and daily use of oral antiretroviral preexposure prophylaxis (PrEP). Persons at substantial HIV risk can now use one or both prevention methods, but a combined HIV protective effect has not been assessed. We use deterministic models to examine the impact of method adherence and rates of PrEP and male condom use on number of anticipated HIV infections. Analyses were based on hypothetical cohorts of 10,000 African American men who have sex with men (AAMSM), a population with the highest HIV incidence in the United States. Parameters used in the model (condom effectiveness, PrEP effectiveness, HIV incidence) were based on published findings. Among AAMSM who never use PrEP, an estimated 323 annual HIV infections would occur among those who always use condoms, 1007 among sometimes condom users, and 1094 among never condoms users. Among AAMSM who never (or inconsistently) use condoms, 295 (272) infections would occur among those who report at least 90% PrEP adherence and 744 (684) infection occur with less than 50% adherence. Among AAMSM who are consistently (or sometimes) taking PrEP, the highest protection is seen with consistent condom use, 87 (220) HIV infections and 92.0% (79.9%) prevention effectiveness. Among AAMSM with inconsistent or never condom use, the addition of PrEP at either modest or high adherence can increase HIV protection. For consistent condom users, any PrEP use can increase HIV protection. These analyses provide an approach for rethinking HIV risk management by calculating combined HIV protective effects of using one or more effective prevention methods.

Understanding the HIV disparities between Black and White men who have sex with men in the USA using the HIV care continuum: A modelling study

Article

Dec 2014

Black/white disparities in HIV incidence and prevalence among men who have sex with men (MSM) in the United States remain largely unexplained. We examined the impact on HIV prevalence and incidence of interventions that decrease disparities in HIV care. Deciding which interventions have most impact on reducing disparities is critical. Using available US Centers for Disease Control and Prevention (CDC) estimates, we constructed HIV care continua for black and white MSM for 2009-2010. These estimates were used as parameters in a deterministic model to yield estimated race-specific transmissions, transmission rates, incidence rates, and rate-ratios (RR). We examined the impact of changes in the care continuum for black MSM on transmission and incidence rates. Marked disparities were found throughout the care continuum: ultimately, 16% of black and 34% of white MSM achieved viral suppression. Based on these care continua, 9,833 and 9,710 new HIV transmissions were estimated annually respectively from HIV-positive black and white MSM (transmission RR=1·36 and incidence RR=7·92). In a model where black and white MSM have identical care outcomes, transmission RR=1·00 and incidence RR=5·80. Scenarios of 95% diagnosis, 95% retention, and concurrent 95% diagnosis and 95% retention respectively yield transmission RR=1·00, 1·02, 0·56, and incidence RR=5·81, 5·93, 3·28. Disparities in HIV transmission rates may be reduced by improving the HIV care continuum outcomes, but existing racial disparities in HIV prevalence will likely continue to drive higher incidence among black MSM for decades to come.

The Role of Stigma and Medical Mistrust in the Routine Health Care Engagement of Black Men Who Have Sex With Men

Article

Dec 2014

Unlabelled: Objectives: We assessed how health care-related stigma, global medical mistrust, and personal trust in one's health care provider relate to engaging in medical care among Black men who have sex with men (MSM). Methods: In 2012, we surveyed 544 Black MSM attending a community event. We completed generalized linear modeling and mediation analyses in 2013. Results: Twenty-nine percent of participants reported experiencing racial and sexual orientation stigma from heath care providers and 48% reported mistrust of medical establishments. We found that, among HIV-negative Black MSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since their last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV-positive Black MSM, experiencing stigma from health care providers was associated with longer gaps in time since last HIV care appointment. Conclusions: Interventions focusing on health care settings that support the development of greater awareness of stigma and mistrust are urgently needed. Failure to address psychosocial deterrents will stymie progress in biomedical prevention and cripple the ability to implement effective prevention and treatment strategies.

An Introduction to Meta-Analysis

Article

Mar 2009

IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points

HIV Incidence Among Men With and Those Without Sexually Transmitted Rectal Infections: Estimates From Matching Against an HIV Case Registry

Article

Jun 2013
CLIN INFECT DIS

Background. Sexually transmitted bacterial rectal infections are objective markers of HIV risk behavior. Quantifying HIV risk among men who have sex with men (MSM) who have had these infections can inform prevention efforts. We measured HIV risk among MSM who have and those who have not been diagnosed with rectal Chlamydia trachomatis (CT) and/or rectal Neisseria gonorrhoeae (GC).Methods. HIV incidence among a cohort of 276 HIV-negative MSM diagnosed with rectal CT and/or GC in New York City sexually transmitted disease (STD) clinics was compared to HIV incidence among HIV-negative MSM without these infections. Matches against the citywide HIV/AIDS registry identified HIV diagnoses from STD clinics, and by other providers. Cox proportional hazards models were used to explore factors associated with HIV acquisition among MSM with rectal infections.Results. HIV-negative MSM with rectal infections (>70% of which were asymptomatic) contributed 464.7 person-years of follow-up. Among them, 31 (11.2%) were diagnosed with HIV, of whom 14 (45%) were diagnosed by non-STD clinic providers. The annual HIV incidence was significantly higher among MSM with rectal infections (6.67%; 95% confidence interval [CI], 4.61%-9.35%) than among MSM without rectal infections (2.53%; 95% CI, 1.31%-4.42%). Black race (hazard ratio, 4.98; 95% CI, 1.75-14.17) was associated with incident HIV among MSM with rectal CT/GC.Conclusions. One in 15 MSM with rectal infections was diagnosed with HIV within a year, a higher risk than for MSM without rectal infections. Such data have implications for screening for rectal STD, and may be useful for targeting populations for risk-reduction counseling and other HIV prevention strategies, such as preexposure prophylaxis. © 2013 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected] /* */

HIV Transmission in the United States: Considerations of Viral Load, Risk Behavior, and Health Disparities

Article

Mar 2013
AIDS BEHAV

Ongoing HIV transmission is related to prevalence, risk behavior and viral load among persons with HIV. We assessed the contribution of these factors to HIV transmission with transmission rate models and data reported to National HIV Surveillance and published rates of risk behavior. We also estimated numbers of persons with risk behaviors and unsuppressed viral load among sexual risk groups. The transmission rate is higher considering risk behavior (18.5 infections per 100 people with HIV) than that attributed to unsuppressed viral load (4.6). Since persons without risk behavior or suppressed viral load presumably transmit HIV at very low rates, transmission can be attributed to a combination of these factors (28.9). Service needs are greatest for MSM; their number with unsuppressed viral load engaging in unprotected discordant sex was 8 times the number of male heterosexuals and more than twice the number of female heterosexuals with high-risk transmission potential. While all persons with HIV need optimal care, treatment as prevention is most relevant when risk behavior is present among persons with unsuppressed HIV viral load.

High HIV incidence and prevalence and associated factors among young MSM in 21 USA cities, 2008.

Article

Oct 2012
AIDS

Objective: To estimate HIV prevalence, annual HIV incidence density, and factors associated with HIV infection among young MSM in the United States. Design: The 2008 National HIV Behavioral Surveillance System (NHBS), a cross-sectional survey conducted in 21 US cities. Methods: NHBS respondents included in the analysis were MSM aged 18-24 with a valid HIV test who reported at least one male sex partner in the past year. We calculated HIV prevalence and estimated annual incidence density (number of HIV infections/total number of person-years at risk). Generalized estimating equations were used to determine factors associated with testing positive for HIV. Results: Of 1889 young MSM, 198 (10%) had a positive HIV test; of these, 136 (69%) did not report previously testing HIV positive when interviewed. Estimated annual HIV incidence density was 2.9%; incidence was highest for blacks. Among young MSM who did not report being HIV infected, factors associated with testing HIV positive included black race; less than high school education; using both alcohol and drugs before or during last sex; having an HIV test more than 12 months ago; and reporting a visit to a medical provider in the past year. Conclusion: HIV prevalence and estimated incidence density for young MSM were high. Individual risk behaviors did not fully explain HIV risk, emphasizing the need to address sociodemographic and structural-level factors in public health interventions targeted toward young MSM.

Characteristics Associated With Retention Among African American and Latino Adolescent HIV-Positive Men: Results From the Outreach, Care, and Prevention to Engage HIV-Seropositive Young MSM of Color Special Project of National Significance Initiative

Article

Apr 2010
JAIDS-J ACQ IMM DEF

Background: Surveillance points to an urgent public health need for HIV prevention, access, and retention among young men of color who have sex with men (YMSM). The purpose of this multisite study was to evaluate the association between organizational- and individual-level characteristics and retention in HIV care among HIV-positive YMSM of color. Methods: Data were collected quarterly via face-to-face interviews and chart abstraction between June 2006 and September 2008. Participants were aged 16-24 years, enrolled at 1 of 8 participating youth-specific demonstration sites, and engaged or reengaged in HIV care within the last 30 days. Generalized estimating equations were used to examine factors associated with missing research and care visits. Stata v.9.0se was used for analysis. Results: Of 224 participants, the majority were African American (72.7%), 19-22 years old (66.5%), had graduated high school or equivalent (71.8%), identified as gay or homosexual (80.8%), and disclosed having had sex with a man before HIV diagnosis (98.2%). Over the first 2¼ years of the study, only 11.4% of visits were missed without explanation or patient contact. Characteristics associated with retention included being <21 years old, a history of depression, receipt of program services, and feeling respected at clinic; those associated with poorer retention included having a CD4 count <200 at baseline and being Latino. Conclusions: Special Projects of National Significance programs were able to achieve a high level of retention over time, and individual and program characteristics were associated with retention. Latino YMSM, those not receiving services, and those not perceiving respect at the clinic were at increased risk of falling out of care. Retention is essential to providing HIV+ adolescents with treatment, including reducing antiretroviral resistance development. Innovative programs that address the needs of the YMSM of color population may result in improved retention.

Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis

Article

Jul 2012
LANCET

We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA. We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM. We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38-0·75, for Canada and 0·67, 0·50-0·92, for the USA). Black MSM in the UK (1·86, 1·58-2·18) and the USA (3·00, 2·06-4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23-1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes. Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes. None.

Sampling Considerations in Research on HIV Risk and Illness

Chapter

Jan 2002

Graham Kalton

This chapter deals with sampling issues for surveys related to HIV risk and illness. Surveys are used to study a wide variety of issues related to the AIDS epidemic, for example: 1. General population surveys provide information about the public’s knowledge of AIDS and its modes of transmission, about attitudes toward persons with AIDS, about behaviors that put persons at risk of contracting AIDS, and about the effectiveness of public media campaigns relating to AIDS. 2. Client surveys of users of AIDS counseling and testing services provide information about the characteristics and behaviors of these persons and about the types and effectiveness of the services provided. 3. Surveys of members of high-risk groups, such as gay men, bisexuals, i.v. drug users, and prostitutes, provide information on the members’ risk behaviors, knowledge about AIDS, attitudes to changing risk behaviors, and contacts, if any, with counseling and testing services. The sampling methods that may be employed for general population surveys are well established. Depending on whether a general population survey is to be conducted by face-to-face or telephone interviewing, standard area or random digit dialing (RDD) sampling methods may be used. Area sampling

Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men - 21 cities, United States, 2008Department of Health and Human Services Centers for Disease Control and PreventionMMWR Morb Mortal Wkly Rep201059371201120720864920

Article

Jan 2010

Centers for Disease Control and Prevention

Men who have sex with men (MSM) are at increased risk for infection with human immunodeficiency virus (HIV). In 2006, 57% of new HIV infections in the United States occurred among MSM. To estimate and monitor risk behaviors, CDC's National HIV Behavioral Surveillance system (NHBS) collects data from metropolitan statistical areas (MSAs) using an anonymous cross-sectional interview of men at venues where MSM congregate, such as bars, clubs, and social organizations. This report summarizes NHBS data from 2008, which indicated that, of 8,153 MSM interviewed and tested in the 21 MSAs participating in NHBS that year, HIV prevalence was 19%, with non-Hispanic blacks having the highest prevalence (28%), followed by Hispanics (18%), non-Hispanic whites (16%), and persons who were multiracial or of other race (17%). Of those who were infected, 44% were unaware of their infection. Men who know their current HIV infection status can be linked to appropriate medical care and prevention services. Once linked to prevention services, men can learn ways to avoid transmitting the virus to others. Young MSM (aged 18--29 years) (63%) and minority MSM (other than non-Hispanic white) (54%) were more likely to be unaware of their HIV infection. Efforts to ensure at least annual HIV testing for MSM should be strengthened, and HIV testing and prevention programs should increase their efforts to reach young and minority MSM.

Early Linkage and Retention in Care: Findings from the Outreach, Linkage, and Retention in Care Initiative Among Young Men of Color Who Have Sex with Men

Article

Jun 2011
AIDS PATIENT CARE ST

Early linkage and retention in HIV clinical care is essential for optimal disease management, promotion of health, and receipt of secondary prevention messages to decrease onward transmission of HIV. Youth, specifically racial/ethnic minority young men who have sex with men (YMSM), continue to acquire new HIV infections and have been shown to be less likely to engage in regular HIV care and adhere to scheduled medical visits. The goal of the current study was to evaluate the characteristics of participants and program delivery that were associated with early linkage and retention in HIV care among HIV-infected YMSM of color enrolled in an outreach, linkage, and retention study. Of the 334 patients included in the linkage analysis, 72% were linked to care within 30 days of diagnosis, 81% within 60 days, and 87% within 90 days. While no patient-level characteristics were associated with early linkage, having the person who provided the positive HIV test result refer the patient to HIV care (p=0.048), specifically calling to make the appointment (p=0.009), was associated with earlier linkage. Retention of Latino participants (96.2%) was significantly higher than for the African-American (79.9%) youth (p=0.006). Overall, 221 participants had at least 1 year of possible follow-up and 82.8% of these participants were retained at 1 year. While unique challenges exist in the care of adolescents infected with HIV from identification to engagement and retention in clinical care, programs that are responsive and dedicated to the needs of these youth can be successful in retaining them in care.

Prevalence and Protective Value of Serosorting and Strategic Positioning Among Black and Latino Men Who Have Sex With Men

Article

May 2010
SEX TRANSM DIS

Self-reported HIV-negative black and Latino MSM who engaged in serosorting or strategic positioning were less likely to have unrecognized HIV infection than men who engaged in unprotected anal intercourse without using these risk-reduction strategies.

Sexual Risk, Nitrite Inhalant Use, and Lack of Circumcision Associated With HIV Seroconversion in Men Who Have Sex With Men in the United States

Article

Jun 2005
JAIDS-J ACQ IMM DEF

Men who have sex with men (MSM) continue to account for the largest number of new HIV infections in the United States, but limited data exist on independent risk factors for infection beyond the early 1990s. The HIV Network for Prevention Trials Vaccine Preparedness Study enrolled 3257 MSM in 6 US cities from 1995 to 1997. HIV seroincidence was 1.55 per 100 person-years (95% confidence interval: 1.23-1.95) over 18 months of follow-up. On multi-variable analysis using time-dependent covariates, independent risk factors for HIV seroconversion were increased number of reported HIV-negative male sex partners (adjusted odds ratio (AOR) = 1.14 per partner, population attributable risk (PAR) = 28%), nitrite inhalant use (AOR = 2.2, PAR = 28%), unprotected receptive anal sex with an HIV unknown serostatus partner (AOR = 2.7, PAR = 15%) or HIV-positive partner (AOR = 3.4, PAR = 12%), protected receptive anal sex with an HIV-positive partner (AOR = 2.2, PAR = 11%), lack of circumcision (AOR = 2.0, PAR = 10%), and receptive oral sex to ejaculation with an HIV-positive partner (AOR = 3.8, PAR = 7%). Having a large number of male sex partners, nitrite inhalant use, and engaging in receptive anal sex explained the majority of infections in this cohort and should be targeted in prevention strategies for MSM.

Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They are Infected With HIV in the United States

Article

Sep 2005
JAIDS-J ACQ IMM DEF

To compare the prevalence of high-risk sexual behaviors in HIV persons aware of their serostatus with that in HIV persons unaware of their status in the United States and to discuss implications for HIV prevention programs. A meta-analysis was conducted on 11 independent findings. Six findings compared HIV(+) aware persons with independent groups of HIV(+) unaware persons (between-group comparisons), and 5 findings compared seroconverting individuals before and after being notified of their HIV status (within-subject comparisons). Outcomes were self-reported unprotected anal or vaginal intercourse (UAV) during specified recall periods. The analysis integrating all 11 findings indicated that the prevalence of UAV with any partner was an average of 53% (95% confidence interval [CI]: 45%-60%) lower in HIV persons aware of their status relative to HIV(+) persons unaware of their status. There was a 68% reduction (95% CI: 59%-76%) after adjusting the data of the primary studies to focus on UAV with partners who were not already HIV(+). The reductions were larger in between-group comparisons than in within-subject comparisons. Findings for men and women were highly similar. The prevalence of high-risk sexual behavior is reduced substantially after people become aware they are HIV(+). Increased emphasis on HIV testing and counseling is needed to reduce exposure to HIV(+) from persons unaware they are infected. Ongoing prevention services are needed for persons who know they are HIV(+) and continue to engage in high-risk behavior.

HIV among African American gay and bisexual men

Jan 2014

Disease Centers
Control
Prevention

Centers for Disease Control and Prevention. HIV among African American gay and bisexual men. 2014. http://www.cdc.gov/hiv/ risk/racialethnic/bmsm/facts/.

More HIV prevention funding should be shifted to gay men, Fenway says

Jan 2013

Fenway The
Institute

The Fenway Institute. More HIV prevention funding should be shifted to gay men, Fenway says. 2013. http://www.fenway health.org/site/News2?page=NewsArticle&id=8675.

PEPFAR Blueprint: Creating an AIDS-free Generation

Department Of State

Department of State. PEPFAR Blueprint: Creating an AIDS-free Generation. Washington, D.C.: 2012.

HIV Transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study

A Rodger
T Bruun
V Cambiano
P Vernazza
V Estrada
J V Lunzen

Rodger, A.; Bruun, T.; Cambiano, V.; Vernazza, P.; Estrada, V.; Lunzen, JV., et al. HIV Transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study.. Conference on Retroviruses and Opportunistic Infections; Boston. 2014;

Best practices guide to reform hiv-specific criminal laws to align with scientifically-supported factors

Department Of Justice

Department of Justice. Best practices guide to reform hiv-specific criminal laws to align with scientifically-supported factors. Washington, D.C.: 2014.

uninsured rate lowest since 2008: uninsured rate declines most among blacks and lower-income Americans

Gallup

Gallup. U.S., uninsured rate lowest since 2008: uninsured rate declines most among blacks and lower-income Americans. 2014. http://www.gallup.com/poll/168248/uninsured-ratelowest-2008.aspx

Implementation of PrEPin STD and community health clinics in the US: high uptake and drug concentrations among MSM in the demo project

S Cohen
E Vittinghoff
P Anderson
S Doblecki-Lewis
O Bacon
W Chege

Cohen, S.; Vittinghoff, E.; Anderson, P.; Doblecki-Lewis, S.; Bacon, O.; Chege, W., et al., editors. Implementation of PrEPin STD and community health clinics in the US: high uptake and drug concentrations among MSM in the demo project.. 9th international conference on HIV treatment and prevention; Miami. 2014;

Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States

Jan 2014
AIDS BEHAV
972-996

M E Levy
L Wilton
G Phillips
Ii
S N Glick
I Kuo
R A Brewer

Levy ME, Wilton L, Phillips G II, Glick SN, Kuo I, Brewer RA, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18(5):972-96.

Prevalence and awareness of HIV infection among men who have sex with men-21 cities

Jan 2008
1201-1207

Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men-21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010; 59(37):1201-7. [PubMed: 20864920]

HIV risk, prevention, and testing behaviors among men who have sex with men-National HIV Behavioral Surveillance System, 21 U.S. Cities, United States

Jan 2011
1

T J Finlayson
B Le
A Smith
K Bowles
M Cribbin
I Miles
TJ Finlayson

The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men

Jan 2015
e75

L A Eaton
D D Driffin
C Kegler
H Smith
C Conway-Washington
D White
LA Eaton

The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students

Jan 2005
531

L B Hightow
P D Macdonald
C D Pilcher
A H Kaplan
E Foust
T Q Nguyen
LB Hightow

HIV incidence among young men who have sex with men-seven US cities

Jan 2001
440

Centers for Disease Control and Prevention

Centers for Disease Control and Prevention. HIV incidence among young men who have sex with men-seven US cities, 1994-2000. MMWR Morb Mortal Wkly Rep. 2001; 50(21):440-4. [PubMed: 11475380]

Prevalence and awareness of HIV infection among men who have sex with men-21 cities, United States

Jan 2010
1201

Centers for Disease Control and Prevention

Running Backwards: Consequences of HIV Incidence Rates for the Next Generation of Black MSM in the United States

Abstract

No full-text available

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