Neighborhood Safety and Neighborhood Police Violence Are Associated with Psychological Distress among English- and Spanish-Speaking Transgender Women of Color in New York City: Finding from the TURNNT Cohort Study.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

Sexually Explicit Media Use by Sexual Identity: A Comparative Analysis of Gay, Bisexual, and Heterosexual Men in the United States.

Advances in production and distribution of sexually explicit media (SEM) online have resulted in widespread use among men. Limited research has compared contexts of use and behaviors viewed in Internet SEM by sexual identity. The current study examined differences in recent SEM use (past 6 months) by sexual identity among an ethnically diverse sample of 821 men who completed an online survey in 2015. Both gay and bisexual men reported significantly more frequent use of Internet SEM compared to heterosexual men. Although most participants reported viewing SEM at home (on a computer, tablet, or smartphone), significantly more gay men reported SEM use at a sex party or commercial sex venue than either heterosexual or bisexual men. Sexual identity predicted viewing of high-risk and protective behaviors in separate logistic regression models. Specifically, compared to heterosexual men, gay and bisexual men had increased odds of viewing condomless anal sex (gay OR 5.20, 95 % CI 3.35-8.09; bisexual OR 3.99, 95 % CI 2.24-7.10) and anal sex with a condom (gay OR 3.93, 95 % CI 2.64-5.83; bisexual OR 4.59, 95 % CI 2.78-7.57). Compared to gay men, heterosexual and bisexual men had increased odds of viewing condomless vaginal sex (heterosexual OR 27.08, 95 % CI 15.25-48.07; bisexual OR 5.59, 95 % CI 3.81-8.21) and vaginal sex with a condom (heterosexual OR 7.90, 95 % CI 5.19-12.03; bisexual OR 4.97, 95 % CI 3.32-7.44). There was also evidence of identity discrepant SEM viewing as 20.7 % of heterosexual-identified men reported viewing male same-sex behavior and 55.0 % of gay-identified men reported viewing heterosexual behavior. Findings suggest the importance of assessing SEM use across media types and contexts and have implications for research to address the potential influence of SEM on sexual behavior (e.g., investigate associations between viewing condomless vaginal sex and engaging in high-risk encounters with female partners).

Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices.

OBJECTIVE: To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families. STUDY DESIGN: The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall. RESULTS: A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004). CONCLUSIONS: Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01541761.

Adapting the Get Yourself Tested Campaign to Reach Black and Latino Sexual-Minority Youth.

BACKGROUND: Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population. METHOD: This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design. RESULTS: During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth.

Sociodemographic Differences in Perspectives on Postpartum Symptom Reporting.

OBJECTIVE: The overall goal of this work is to create a patient-reported outcome (PRO) and decision support system to help postpartum patients determine when to seek care for concerning symptoms. In this case study, we assessed differences in perspectives for application design needs based on race, ethnicity, and preferred language. METHODS: A sample of 446 participants who reported giving birth in the past 12 months was recruited from an existing survey panel. We sampled participants from four self-reported demographic groups: (1) English-speaking panel, Black/African American race, non-Hispanic ethnicity; (2) Spanish-speaking panel, Hispanic-ethnicity; (3) English-speaking panel, Hispanic ethnicity; (4) English-speaking panel, non-Black race, non-Hispanic ethnicity. Participants provided survey-based feedback regarding interest in using the application, comfort reporting symptoms, desired frequency of reporting, reporting tool features, and preferred outreach pathway for concerning symptoms. RESULTS: Fewer Black participants, compared with all other groups, stated that they had used an app for reporting symptoms (p = 0.02), were least interested in downloading the described application (p < 0.05), and found a feature for sharing warning sign information with friends and family least important (p < 0.01). Black and non-Hispanic Black participants also preferred reporting symptoms less frequently as compared with Hispanic participants (English and Spanish-speaking; all p < 0.05). Spanish-speaking Hispanic participants tended to prefer calling their professional regarding urgent warning signs, while Black and English-speaking Hispanic groups tended to express interest in using an online chat or patient portal (all p < 0.05) CONCLUSION: Different participant groups described distinct preferences for postpartum symptom reporting based on race, ethnicity, and preferred languages. Tools used to elicit PROs should consider how to be flexible for different preferences or tailored toward different groups.

Results from two online surveys comparing sexual risk behaviors in Hispanic, black, and white men who have sex with men.

Many men who have sex with men (MSM) are among those who increasingly use the internet to find sexual partners. Few studies have compared behavior by race/ethnicity in internet-based samples of MSM. We examined the association of race/ethnicity with HIV risk-related behavior among 10,979 Hispanic, black, and white MSM recruited online. Significant variations by race/ethnicity were found in: age, income level, sexual orientation, number of lifetime male and female sexual partners, and rates of unprotected anal intercourse (UAI). Black and Hispanic men were more likely to report anal intercourse during the last sexual encounter, but white men were more likely to report UAI. In multivariate analysis, UAI was associated with HIV infection and sex with a main partner. Significant risk behavior variations by race/ethnicity were found. Research is needed to better target online interventions to MSM who engage in UAI or have other risk factors for transmitting or acquiring HIV.

Sexual dysfunction in an Internet sample of U.S. men who have sex with men.

INTRODUCTION: Relatively little is known about sexual dysfunction (SD) in men who have sex with men (MSM). AIM: In order to better understand SD symptoms in MSM, we assessed self-reported SD symptoms, individually and by latent class analysis (LCA). METHODS: In 2004-2005 an Internet sample of U.S. MSM was recruited from gay-oriented sexual networking, chat and news websites. The analytic sample comprised 7,001 men aged 18 or older who reported lifetime male sex partners and oral or anal sex with a male partner in their most recent encounter within the past year. MAIN OUTCOME MEASURES: Seven questions on SD symptoms that occurred during the past 12 months inquired about low sexual desire, erection problems, inability to achieve an orgasm, performance anxiety, premature ejaculation, pain during sex, and sex not being pleasurable. RESULTS: Self-reported symptoms of SD were high. Overall, 79% of men reported one or more SD symptoms in the past year, with low sexual desire, erection problems, and performance anxiety being the most prevalent. Four distinct underlying patterns of sexual functioning were identified by LCA: no/low SD, erection problems/performance anxiety, low desire/pleasure, and high SD/sexual pain. High SD/sexual pain was distinguished from the other patterns by club drug use and use of prescription and non-prescription erectile dysfunction medication before sex in the past year. Additionally, men associated with the high SD/sexual pain group were younger, single, more likely to have poor mental and physical health, and more likely to have been diagnosed with a sexually transmitted infection in the past year compared to men in the no/low SD group. CONCLUSIONS: LCA enabled us to identify underlying patterns of sexual functioning among this sample of MSM recruited online. Future research should investigate these distinct subgroups with SD symptoms in order to develop tailored treatments and counseling for SD.

Evaluating a bilingual video to improve infant feeding knowledge and behavior among immigrant Latina mothers.

Childhood obesity is recognized as a major health problem in the United States and is occurring at ever younger ages. While most prevention efforts are aimed at school-age children, this project focuses on the caregivers of children from 0 to 24 months of age. This study is an evaluation of an educational English/Spanish infant feeding video, distributed for home viewing at one New York City Special Supplemental Food Program for Women, Infants and Children (WIC) center (video group) but not at three others (comparison group). Baseline, 3 and 6 month infant feeding knowledge and behavior surveys were conducted. For this report, analyses are restricted to Latina immigrant mothers. The video and comparison group mothers were similar in age, education, and parity. The video group was more likely to speak Spanish at home, and had lower knowledge scores at baseline. At the 6 month follow-up, knowledge increased for both groups, but the video group showed a greater increase in knowledge between baseline and 6 months: in ordered logistic regression analyses the video group had a 1.7 times greater score increase at each outcome level. The video group also showed positive changes in behavior-later age at first solid feeding was observed in the video group. We found that an inexpensive, low-intensity video intervention can positively impact maternal knowledge and behavior related to infant feeding among immigrant Latinas. Attention should be given to intervening early with high-risk populations.

Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study.

INTRODUCTION: In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. METHODS AND ANALYSES: TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. ETHICS AND DISSEMINATION: The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups.

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.

The HCV Synthesis Project: scope, methodology, and preliminary results.

BACKGROUND: The hepatitis C virus (HCV) is hyper-endemic in injecting drug users. There is also excess HCV among non-injection drug users who smoke, snort, or sniff heroin, cocaine, crack, or methamphetamine. METHODS: To summarize the research literature on HCV in drug users and identify gaps in knowledge, we conducted a synthesis of the relevant research carried out between 1989 and 2006. Using rigorous search methods, we identified and extracted data from published and unpublished reports of HCV among drug users. We designed a quality assurance system to ensure accuracy and consistency in all phases of the project. We also created a set of items to assess study design quality in each of the reports we included. RESULTS: We identified 629 reports containing HCV prevalence rates, incidence rates and/or genotype distribution among injecting or non-injecting drug user populations published between January 1989 and December 2006. The majority of reports were from Western Europe (41%), North America (26%), Asia (11%) and Australia/New Zealand (10%). We also identified reports from Eastern Europe, South America, the Middle East, and the Caribbean. The number of publications reporting HCV rates in drug users increased dramatically between 1989 and 2006 to 27-52 reports per year after 1998. CONCLUSION: The data collection and quality assurance phases of the HCV Synthesis Project have been completed. Recommendations for future research on HCV in drug users have come out of our data collection phase. Future research reports can enhance their contributions to our understanding of HCV etiology by clearly defining their drug user participants with respect to type of drug and route of administration. Further, the use of standard reporting methods for risk factors would enable data to be combined across a larger set of studies; this is especially important for HCV seroconversion studies which suffer from small sample sizes and low power to examine risk factors.

Non-injection drug use and Hepatitis C Virus: a systematic review.

This systematic review examined the evidence on the prevalence of the Hepatitis C Virus (HCV) in non-injecting drug users (NIDUs) who sniff, smoke or snort drugs such as heroin, cocaine, crack or methamphetamine. The search included studies published from January 1989 to January 2006. Twenty-eight eligible studies were identified and the prevalence of HCV in these NIDU populations ranged from 2.3 to 35.3%. There was substantial variation in study focus and in the quality of the NIDU data presented in the studies. The results of our systematic review suggested that there are important gaps in the research of HCV in NIDUs. We identified a problem of study focus; much of the research did not aim to study HCV in users of non-injection drugs. Instead, NIDUs were typically included as a secondary research concern, with a principal focus on the problem of transmission of HCV in IDU populations. Despite methodological issues, HCV prevalence in this population is much higher than in a non-drug using population, even though some IDUs might have inadvertently been included in the NIDU samples. These studies point to a real problem of HCV in NIDU populations, but the causal pathway to infection remains unclear.

Males' Ability to Report Their Partner's Contraceptive Use at Last Sex in a Nationally Representative Sample: Implications for Unintended Pregnancy Prevention Evaluations.

Addressing and enabling the role of males in contraceptive choices may facilitate efforts to reduce unintended pregnancy rates and disparities in the United States, but little is known about males' ability to report their partners' contraceptive use. Data from the 2011-2013 National Survey of Family Growth from 2,238 males aged 15 to 44 years who had vaginal sex with a noncohabiting or nonmarital partner and were not seeking pregnancy were examined to tabulate the proportion of males able to report whether their partner used a specific contraceptive method use at last sex (PCM) by sociodemographic and sexual history characteristics. Logistic regression was used to assess odds of being unable to report PCM, adjusting for age and sexual history factors. Most (95.0%) were able to report PCM, with no difference by age group (chi-square = 7.27, p = .281) in unadjusted analyses. Males with a new sex partner (14.8% of the sample), compared with those with an established sex partner, had significantly higher odds of being unable to report PCM in bivariate (11.7% vs. 3.7%, chi-square = 39.39, p < .001) and multivariable (adjusted odds ratio [AOR]: 3.17, 95% confidence interval [CI: 1.74, 5.65]) analyses. Those whose last sexual encounter was more than 3 months ago also had higher odds of being unable to report in bivariate ( OR: 1.74, 95% CI [1.05, 2.87]) and multivariable analyses (AOR: 2.04, 95% CI [1.04, 4.03]). Most men were able report PCM, but reporting was significantly lower among men with new sex partners. To inform future research and evaluation relying on male report, validation studies comparing male report with partner report, specifically among new couples, are needed.

Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time.

OBJECTIVE: To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families. METHODS: This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign. RESULTS: Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found. CONCLUSIONS: Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.

Aging without Medicare? Evidence from New York City.

Medicare and Social Security often are assumed to provide universal coverage for the population age 65 and older. Evidence from New York City raises doubts. Data from the Statewide Planning and Research Cooperative System, the Centers for Medicare and Medicaid Services, the Social Security Administration, and the U.S. Bureau of the Census provide evidence that 16% to 20% of New York City residents age 65 and older lack such coverage. Noncoverage is not unique to this city, but it may be particularly common there. Noncoverage is pronounced in, but not limited to, certain immigrant groups. Because the population share covered by Medicare increases with age and most hospitalizations not covered by Medicare are paid by Medicaid, Medicaid gradually may be replacing Medicare as the payer for hospitalizations for a substantial share of the 65+ population in New York City.

Engagement in Care, Psychological Distress, and Resilience are Associated with Sleep Quality among HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men.

OBJECTIVES: We investigated risk and protective factors associated with sleep quality among a national sample of HIV-positive gay, bisexual, and other men who have sex with men (GBMSM). DESIGN: This study reports on findings from both an eligibility survey and baseline assessment for an online HIV risk reduction intervention. PARTICIPANTS: There were 16,466 completed eligibility surveys. A total of 1,205 eligible men completed a baseline assessment after consenting to participate in the intervention. MEASUREMENTS AND RESULTS: Among participants with a completed eligibility survey, men with an HIV-positive status had significantly worse sleep quality and more frequent use of sleep medications during the past month than HIV-negative men. Within the intervention sample (n = 1,205 HIV-positive participants), men with symptoms of anxiety (Adjusted odds ratio [AOR]=2.80; 95% confidence interval [CI]: 1.93-4.06) and depression (AOR=1.66; CI: 1.14-2.43), and who reported a detectable viral load in the past six months (AOR=1.57; CI: 1.06-2.33) had increased odds of poor sleep quality after controlling for demographic characteristics, socioeconomic status, ART use and adherence, substance use, and CD4 count. However, men with greater perceived resilience had decreased odds of reporting poor sleep quality during the past month (AOR=0.68; CI: 0.51-0.89). CONCLUSIONS: Findings from this online study call for more attention to the role of sleep in immune system functioning and engagement in HIV care. Results further suggest a need to design and test culturally-appropriate sleep health interventions for GBMSM living with HIV that promote protective factors and target particular behavioral changes (i.e., stress reduction, substance use).

Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women.

OBJECTIVE: To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women. METHODS: We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether 4 domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered individually and also cumulatively, were associated with having a low internal locus of control over the prevention of child obesity. RESULTS: The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least 1 hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (adjusted odds ratio, 2.38; 95% confidence interval, 1.50-3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship with an increased odds of having a low internal locus of control. CONCLUSIONS: Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately affect infant feeding practices and child weight trajectories.

Developing a Video-Based eHealth Intervention for HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) accounted for 67% of new US human immunodeficiency virus (HIV) infections in 2012; however, less than 40% of HIV-positive GBMSM are virally suppressed. Preventing transmission from virally unsuppressed men who have condomless anal sex (CAS) with serodiscordant partners is a public health imperative. New HIV infections in GBMSM are attributed in part to online access to sex partners; therefore, low-cost eHealth interventions are a unique opportunity to reach men where they meet partners. OBJECTIVE: To describe the protocol of a randomized controlled trial evaluating whether video-based messaging delivered online may lead to reductions in serodiscordant CAS and increased HIV disclosure. METHODS: Sex Positive!([+]) is a two-arm, phase III, video-based randomized controlled trial delivered online to GBMSM living with HIV. Participants in the intervention arm receive 10 video vignettes grounded in social learning and social cognitive theories that are designed to elicit critical thinking around issues of HIV transmission and disclosure. Participants in the attention control arm receive 10 video vignettes that focus on healthy living. All videos are optimized for mobile viewing. The study protocol includes five online assessments conducted over a 1-year period among 1500 US white, black, or Hispanic/Latino GBMSM living with HIV who report suboptimal antiretroviral therapy (ART) adherence or a detectable viral load in the past 12 months and recent CAS (past 6 months) with HIV-negative or unknown status male partners. Compared to the control arm, we hypothesize that men who watch the intervention videos will report at 12-month follow-up significantly fewer serodiscordant CAS partners, increased HIV disclosure, and improved social cognition (eg, condom use self-efficacy, perceived responsibility). RESULTS: Participant recruitment began in June 2015 and ended in December 2015. CONCLUSIONS: This protocol describes the underlying theoretical framework and measures, study design, recruitment challenges, and antifraud measures for an online, video-based randomized controlled trial that has the potential to decrease HIV transmission risk behaviors among HIV-positive GBMSM who struggle with ART adherence. The Sex Positive!([+]) intervention allows for participation through multiple Internet-based mediums and has the potential to reach and engage a broader population of HIV-positive GBMSM who are virally unsuppressed. CLINICALTRIAL: ClinicalTrials.gov NCT02023580; https://clinicaltrials.gov/ct2/show/NCT02023580 (Archived by WebCite at http://www.webcitation.org/6iHzA8wRG).

Exploring pharmacy and home-based sexually transmissible infection testing.

UNLABELLED: Background This study assessed the feasibility and acceptability of pharmacy and home-based sexually transmissible infection (STI) screening as alternate testing venues among emergency contraception (EC) users. METHODS: The study included two phases in February 2011-July 2012. In Phase I, customers purchasing EC from eight pharmacies in Manhattan received vouchers for free STI testing at onsite medical clinics. In Phase II, three Facebook ads targeted EC users to connect them with free home-based STI test kits ordered online. Participants completed a self-administered survey. RESULTS: Only 38 participants enrolled in Phase I: 90% female, ≤29 years (74%), 45% White non-Hispanic and 75% college graduates; 71% were not tested for STIs in the past year and 68% reported a new partner in the past 3 months. None tested positive for STIs. In Phase II, ads led to >45000 click-throughs, 382 completed the survey and 290 requested kits; 28% were returned. Phase II participants were younger and less educated than Phase I participants; six tested positive for STIs. Challenges included recruitment, pharmacy staff participation, advertising with discretion and cost. CONCLUSIONS: This study found low uptake of pharmacy and home-based testing among EC users; however, STI testing in these settings is feasible and the acceptability findings indicate an appeal among younger women for testing in non-traditional settings. Collaborating with and training pharmacy and medical staff are key elements of service provision. Future research should explore how different permutations of expanding screening in non-traditional settings could improve testing uptake and detect additional STI cases.

Care for the uninsured in general internists' private offices.

This paper examines the care of uninsured patients in general internists' private practices. More than two-thirds of internists provide at least some charity care, usually to their existing patients who have become uninsured. They appear to be filling a need for people who are moving between coverage, by helping bridge coverage intervals. Approximately two-thirds of all internists accommodate uninsured patients by reducing the charge or creating a payment plan, with internists who are practice owners much more likely to do so. This care to the uninsured is important, especially with growing unemployment rates, because the safety net would not be able to absorb these patients.