HIV Information Avoidance, HIV Stigma, and Medical Mistrust among Black Sexual Minority Men in the Southern United States: Associations with HIV Testing.

Uptake of HIV testing is a critical step in the HIV prevention and treatment care cascade. Barriers to HIV testing, however, remain and innovative research in this area is warranted to improve uptake of testing. As such, we investigated the role of HIV information avoidance - a novel construct potentially related to HIV testing. We analyzed this construct in relation to other factors known to impact HIV testing, namely HIV stigma and medical mistrust. Multiple linear regression analyses indicated that HIV information avoidance was negatively associated with HIV testing, while medical mistrust was positively associated with HIV testing. HIV testing stigma was not associated with HIV testing. This work contributes to the developing literature on HIV information avoidance and its relationships with HIV stigma and HIV testing uptake. Further, these findings can inform HIV testing interventions which often do not focus on HIV information avoidance. Future research on the mechanisms of information avoidance that are amenable to intervention, and the temporal ordering of the relationship between information avoidance and HIV testing is warranted.

A Network Science Approach to Sex-Polydrug Use Among Black Sexually Minoritized Men and Transgender Women: The N2 Cohort Study.

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex (p < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02-2.14; p = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33-0.98; p = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21-0.64; p < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26-0.84; p = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers (p < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels.

Sexual Orientation, HIV Vulnerability-Enhancing Behaviors and HIV Status Neutral Care Among Black Cisgender Sexual Minority Men in the Deep South: The N2 Cohort Study.

Black sexual minority men (SMM) in the Deep South are heavily impacted by HIV; yet studies fail to consider discordance across aspects of sexual orientation (i.e., identity, attraction, behavior) or how a lack of concordance enhances vulnerability to HIV. We sought to explore the overlap across aspects of sexual orientation and examine associations between each aspect and the number of sexual partners who engaged in HIV vulnerability-enhancing behaviors, and HIV prevention and care outcomes. A total of 204 Black SMM completed surveys, reporting their sexual identity, attraction, and behavior (i.e., sex with men only vs. sex with men and women), number of condomless sex or transactional sex (e.g., buyers vs. sellers) partners in the past 6 months, and adherence to pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) among users. Less than one in four participants (22.5%) reported overlap in same-sex sexual orientations, while 17.1% of bisexual men reported overlap across aspects. In multivariable models, differences were found in how aspects of sexual orientation were associated with the number of partners who bought or sold sex; as well as how often participants tested for HIV in the past 12 months. Results suggest different aspects of sexual orientation have implications for addressing HIV among Black SMM in the Deep South.

RESUMEN: Los hombres negros de minorías sexuales (SMM) en el Sur Profundo de los Estados Unidos se ven gravemente afectados por el VIH; sin embargo, los estudios no suelen considerar la discrepancia entre los diferentes aspectos de la orientación sexual (es decir, identidad, atracción, comportamiento) o cómo la falta de concordancia aumenta la vulnerabilidad al VIH. Buscamos explorar el grado de concordancia entre los aspectos de la orientación sexual y examinar las asociaciones entre cada aspecto y la cantidad de parejas sexuales que se involucraron en comportamientos que incrementan la vulnerabilidad al VIH y los resultados de la prevención y atención del VIH. Un total de 204 hombres negros de SMM completaron encuestas sobre su identidad sexual, atracción y comportamiento (es decir, sexo solo con hombres frente a hombres y mujeres), número de parejas sexuales sin condón o sexo transaccional (p. ej., compradores frente a vendedores) en los últimos seis meses, y la adherencia a la profilaxis previa a la exposición (PrEP) o la terapia antirretroviral (TAR) entre los que utilizan estas tecnologías médicas. Menos de uno de cada cuatro participantes (22.5%) reportaron concordancia entre los distintos aspectos de la orientación sexual, mientras que el 17.1% de los hombres bisexuales reportaron concordancia en todos los aspectos. Utilizando modelos multivariables, se encontraron diferencias en el grado de asociación entre los diferentes aspectos de la orientación sexual y el número de parejas que compraron o vendieron sexo, así como entre los distintos aspectos de la orientación sexual y la frecuencia con la que los participantes se hicieron la prueba del VIH en los últimos 12 meses. Los resultados sugieren que diferentes aspectos de la orientación sexual tienen implicaciones para abordar el VIH entre los SMM negros en el Sur Profundo.

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

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.

Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen.

Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.

Rejection-identification and increased use of geosocial networking apps to meet male sexual partners among Black men who have sex with men.

Objective: The use of geosocial networking (GSN) apps to meet male sexual partners may contribute to HIV infection risk for Black men who have sex with men (MSM), but the psychosocial underpinnings of this behavior are not understood. In social psychology, the Rejection-Identification Model posits that identification with a socially stigmatized group emerges as a means of coping in response to perceived stigmatization-which can shape behavior. This study tested the Rejection-Identification process as a facilitator of increased use of GSN apps to meet male sexual partners among Black MSM who use these apps. Method: Black MSM (N = 103; Mage = 29.8) reporting a male sexual partner from a GSN app in the past year were recruited nationally from Grindr and Facebook. Participants completed an online survey in which they reported sociodemographic information, measures of racial stigma and Black identity, and characteristics of their past-year male sexual partners. Results: Participants in this sample reported that most of their past-year male partners came from GSN apps (Mpercent = 82.3), and results from hypothesis testing showed that greater perceived devaluation of Black people in society (i.e., public racial stigma) was associated with an increased percentage of GSN-met partners. In line with the Rejection-Identification Model, this relationship was mediated by greater Black identity centrality. Conclusions: Findings highlight psychosocial correlates of increased GSN app use to meet male sexual partners among Black MSM, which may place Black MSM at increased risk for HIV infection. Results also point to the possibility that these factors may be harnessed to develop HIV prevention strategies for Black MSM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Stigmatizing Beliefs about PrEP Use among Black Sexual Minority Men: A Test of Explanatory Mechanisms.

Stigma often is cited as a barrier to the uptake and use of pre-exposure prophylaxis (PrEP) to prevent HIV among Black sexual minority men (SMM). Socialized gender norms (i.e., restrictive emotionality) are associated with experiences and manifestations of stigma in men. However, the association between restrictive emotionality and the stigma surrounding PrEP use has received little attention in previous research. The present study examines the association between restrictive emotionality and holding stigmatizing beliefs about PrEP use with a theoretically informed serial mediation model testing internalized homophobia and LGBT community connectedness as mediators among a sample of 455 Black SMM in the Southeastern US. Results indicate that restrictive emotionality is associated with stigmatizing beliefs about PrEP use. Further, internalized homophobia and LGBT community connectedness were found to partially mediate the proposed relationship serially. Internalized homophobia, but not LGBT community connectedness, also independently mediated the association between restrictive emotionality and stigmatizing beliefs of PrEP use. This study provides important insights into how aspects of masculinity influence the manifestation of stigmatizing beliefs about PrEP use among Black SMM. The present findings have implications for reducing these beliefs, which are known to negatively impact uptake and use of the HIV prevention tool among Black SMM at elevated risk for HIV.

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

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.

A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious).

HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.

Black Sexual Minority Men's Stigma-Based Experiences Surrounding Pre-exposure Prophylaxis in the Southern United States.

Purpose: Intersecting experiences of stigma related to pre-exposure prophylaxis (PrEP) influence PrEP uptake among Black sexual minority men (BSMM) living in the southern United States; however, it is unclear what stigmatized identities and behaviors are impacted when accessing human immunodeficiency virus prevention options. To inform identity-specific PrEP interventions, this study examined stigma in BSMM's lives relating to intersecting experiences of PrEP stigma. Methods: We conducted 32 virtual, semistructured qualitative interviews with BSMM residing in the southeastern United States between February and April 2019. Results: We identified three themes (anticipated stigma, experiences of prejudice and stereotyping, and negative attitudes) and one subtheme within negative attitudes (othering social/sexual groups). Across all themes, PrEP stigma was often manifested through stigma against BSMM's sexual orientation or sexual behavior. BSMM in othering social/sexual groups displayed instances of cognitive dissonance by regularly expressing negative attitudes about and explicitly distancing themselves from social/sexual groups based on sexual orientation and sexual behavior. BSMM's race and gender were rarely mentioned as being stigmatized. Conclusions: Interventions focused on PrEP use could benefit from expanding their definition of PrEP stigma to include a stronger emphasis on intersecting identities and work to reduce cognitive dissonance in BSMM in the form of internalized homophobia.

"This Is To Help Me Move Forward": The Role of PrEp in Harnessing Sex Positivity and Empowerment Among Black Sexual Minority Men in the Southern United States.

In the United States (U.S.), Black sexual minority men (BSMM) are disproportionately burdened by HIV. Prevention advances, such as HIV pre-exposure prophylaxis (PrEP), play a key role in reducing HIV transmission and improving our understanding of sexual expression and health. Despite these advances, little is known regarding the potential link between PrEP use and positive sexuality, including the benefits that BSMM see in accessing PrEP. We conducted a thematic analysis of 32 interviews with BSMM in the Southern U.S. regarding their PrEP beliefs. We developed five themes: (1) Sexual freedom, (2) Agency and empowerment, (3) Making PrEP normative, (4) Behavioral health practices, and (5) Committed relationship tensions. Our findings suggest that BSMM are increasingly concerned about freedom of choice and invested in sexual empowerment as related to their PrEP use. Further, unanticipated benefits, community support, and relationship tensions are salient factors in considerations of PrEP use among BSMM. These findings have implications for how we might understand a broader movement toward sexual empowerment and positivity, and the pivotal role that PrEP serves in this movement.

PrEP-Related Interactive Toxicity Beliefs: Associations With Stigma, Substance Use, and PrEP Uptake.

Despite documented efficacy in reducing HIV transmission, pre-exposure prophylaxis (PrEP) uptake among Black sexual minority men (BSMM) is limited. One understudied factor which may impede PrEP uptake is PrEP-related interactive toxicity beliefs (i.e., believing it is hazardous to use alcohol/drugs while taking PrEP). Data from N = 169 HIV negative BSMM over 4 months showed high rates of agreement with at least one alcohol (78%) or drug (84%) interactive toxicity belief. Univariate analyses showed increased alcohol or drug interactive toxicity beliefs predicted lower PrEP uptake. Multivariable regression suggested those with PrEP-related alcohol or drug interactive toxicity beliefs were more likely to report high PrEP stigma, more negative PrEP beliefs (e.g., concern that taking PrEP disrupts life), and were more likely to use alcohol/drugs (respectively) prior to/during sex. Findings warrant intervention work targeting interactive toxicity beliefs with tailored messaging to mitigate PrEP stigma and correct concerns around substance use and PrEP.

Novel Latent Profile Analysis of a Test of Concept, Stigma Intervention to Increase PrEP Uptake Among Black Sexual Minority Men.

BACKGROUND: Pre-exposure prophylaxis (PrEP) has demonstrated efficacy for HIV prevention, yet uptake of PrEP among populations in urgent need of prevention tools (eg, Black sexual minority men) is limited, and stigma and medical mistrust remain strong barriers to accessing PrEP. PURPOSE: To evaluate a test of concept brief intervention to address stigma and medical mistrust as barriers to PrEP uptake using novel latent profile analysis. METHODS: Participants (N = 177) residing in the southeastern US were randomized to 1 of 4 arms to establish the potential impact of a brief, stigma focused counseling intervention (referred to as Jumpstart ) to increase PrEP uptake. We estimated intervention effect size (Cramer's V) for PrEP uptake and then explored differential intervention effects across latent profiles of psychosocial barriers to PrEP use. RESULTS: The intervention resulted in small, but meaningful effect size, with self-reported PrEP uptake increasing across Jumpstart conditions with the control condition reporting 24% uptake and Jumpstart plus text/phone calls (the most intensive intervention arm) reporting 37% uptake, and a similar pattern emerging for biologically confirmed PrEP use. Among participants 30 and older, Jumpstart participants were more likely to move to a postintervention profile with fewer barriers than control participants and reported the highest uptake of PrEP. CONCLUSIONS: Addressing social/emotional barriers to PrEP uptake is an essential component of bridging the gap between advances being made in biomedical forms of HIV prevention, and establishing and supporting access to those advances.

Precarious manhood and intentions to initiate preexposure prophylaxis among Black sexual minority men.

OBJECTIVE: The use of preexposure prophylaxis (PrEP) to prevent HIV infection is significantly low among Black sexual minority men (BSMM), although this group experiences the greatest HIV burden in the United States. One contextual factor suggested to impact BSMM's HIV prevention efforts is the concern about, and adherence to, cultural conceptions and expectations of masculinity. The present study sought to better understand the association between masculinity and PrEP uptake by examining associations between gender-relevant beliefs and perceptions, and intentions to initiate PrEP among a sample of BSMM residing in the U.S. South. METHOD: Participants (N = 114) completed assessments of precarious manhood beliefs, attitudes toward PrEP, concerns about PrEP use impacting support from social networks, projected perceptions of masculinity, and intentions to initiate PrEP. RESULTS: Precarious manhood beliefs were associated with greater intention to initiate PrEP; however, the indirect path of this association through attitudes toward PrEP was associated with lower intentions to initiate PrEP. In a hierarchical regression model, projected perceptions of masculinity were associated with intentions to initiate PrEP over and above other factors considered. Specifically, believing that one will be perceived as less masculine for seeking PrEP was associated with lower intentions to initiate PrEP. CONCLUSIONS: Findings suggest that BSMM's construal of masculinity in relation to HIV and PrEP is associated with intentions to initiate PrEP. Implications for increasing PrEP uptake among BSMM are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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

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.

Transgender women and HIV-related health disparities: falling off the HIV treatment cascade.

Background Transgender women living with HIV infection experience poorer health outcomes across the HIV continuum of care. While disparities are well established, their underlying mechanisms are not well understood. This study examined the HIV continuum of care (also known as the HIV treatment cascade), including linkage and engagement in care and health status among transgender women and cisgender women and cisgender men living with HIV. METHOD: Case-control matching was applied to a cohort of 1101 people living with HIV; 70 transgender women living with HIV were matched on years since testing HIV positive with cisgender women and cisgender men. Participants provided measures indicative of the HIV treatment cascade that included linkage and engagement in care, receiving and adhering to antiretroviral therapy (ART), and HIV viral suppression. Common correlates of HIV-related health status: depression symptoms, HIV-related stress, alcohol and drug use, healthcare conspiracy beliefs, medical mistrust, emotional social support and tangible social support, were also assessed. RESULTS: Transgender women were significantly less likely to receive ART, were less adherent to ART and had poorer HIV viral suppression than cisgender persons. Multivariable models demonstrated that health disparities were predicted by transgender women having poorer tangible social support over and above the other correlates of health outcomes. CONCLUSION: Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.

Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors.

The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.