Trends in HIV Risk, Testing, and Treatment among MSM in Chicago 2004-2014: Implications for HIV Elimination Planning.

Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasingly, in addition to behavioral factors, biomedical interventions have been found to play important roles in HIV prevention. In this analysis, we used four waves of cross-sectional data (2004, 2008, 2011, and 2014) from the National HIV Behavioral Surveillance System (NHBS) to examine trends in key behaviors and biomedical interventions among MSM in Chicago (N = 3298). Logistic regression was used to determine changes in behaviors and use of biomedical interventions. Condomless sex increased significantly in waves 3 and 4, compared to wave 1: wave 3 (AOR = 2.07; 95% CI 1.53, 2.78) and wave 4 (AOR = 2.19; 95% CI 1.62, 2.96). Compared to those aged 18-24, older participants were significantly less likely to be routinely tested for HIV: 30-39 (AOR = 0.63; 95% CI 0.48, 0.83), 40-49 (AOR = 0.40; 95% CI 0.29, 0.55), and >50 (AOR = 0.28; 95% CI 0.18, 0.43). Awareness of both post-exposure prophylaxis (PEP)(​AOR = 3.13; 95% CI 1.22, 8.03) and pre-exposure prophylaxis (PrEP)(​AOR = 10.02; 95% CI 2.95, 34.01) increased significantly in wave 4, compared to wave 3. These results suggest a potential increase in HIV rates among men with main and casual partners and should be monitored closely as PrEP becomes more widespread among MSM of all races and ethnicities in Chicago. This study also suggests that further analyses of the barriers to PEP and PreP uptake among high-risk populations are necessary.

Burnout in HIV/AIDS Volunteers: A Socio-Cultural Analysis among Latino Gay, Bisexual Men, and Transgender People.

Understanding factors associated with burnout among HIV/AIDS volunteers has long-ranging implications for community organizations and prevention. Using a cross-sectional sample of Latino gay/bisexual men and transgender people (N=309), we assess potential correlates of burnout identified by multiple theories, including factors associated with volunteering (experiences, motives) and contextual factors (stigma, sense of community). Reporting negative volunteering experiences was positively associated with burnout, while being motivated by personal HIV/AIDS experiences and having a greater sense of GLBT community was negatively related to burnout. The study highlights central challenges and opportunities to retain volunteers from marginalized communities.

Sexual identity development: relationship with lifetime suicidal ideation in sexual minority women.

AIMS AND OBJECTIVES: This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support. BACKGROUND: Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk. DESIGN: This is a cross-sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent-driven sampling methods. METHODS: Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large (N = 820), ethnically diverse sample of sexual minority women. RESULTS: Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation. CONCLUSIONS: Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide.

HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia.

OBJECTIVES: We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus. METHODS: In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test. RESULTS: The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive-unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive-aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants. CONCLUSIONS: There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive-unaware group characteristics suggest an important role for structural, social, and individual interventions.

Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS.

In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals.

GayBy Boomers' social support: exploring the connection between health and emotional and instrumental support in older gay men.

We evaluate the association between emotional and instrumental support and perceived health and depression symptoms in a sample of 182 gay/bisexual men age ≥ 55. Perceived health was positively correlated with number of sources of emotional support and depression was negatively associated with instrumental support and health care providers' knowledge of patients' sexual orientation. Depression mediates the connection between providers' knowledge of patients' sexual orientation and perceived health. Number of sources of emotional support varied negatively with age and ethnic minority status, and positively with living with a partner. Instrumental support seemed to be dependent on living with a partner.

Corrigendum: Beyond identity and generations: bringing life course theory to studies of older gay men.

[This corrects the article DOI: 10.3389/fsoc.2024.1393607.].

Beyond identity and generations: bringing life course theory to studies of older gay men.

The last century's numerous, rapid social changes affecting gay men make studies of gay male aging a ripe topic for life course theory, which views later life as the product of historical grounded interchanges between individual lives, social change, and structural contexts. That identifying as gay can occur at any point in the life course widens some life course theorists' primary focus on early-life events to include those occurring throughout the life course. Yet most historically-attentive research on older gay men focuses on generations and identity development rather than on cohorts - groups who entered a system or context at the same time - or on the cumulative, concrete outcomes of encountering social change at a particular point in the life course. This article argues for gay male aging studies' use of life course theory, specifically, its focus on cohort membership's implications for later life, including cumulative disadvantage, in addition to more generationally-focused investigations. After briefly reviewing scholarship on older gay men, we introduce the life course approach and its critique by queer gerontologists for adopting a heteronormative view of the LGBT life course and eliding its distinctive contours. With particular attention to later-life concrete outcomes rather than identity formation, we explore key historical events in gay men's lives that have produced (in the case of the AIDS epidemic) or could produce (for example, the Marriage Equality Act, the Don't Ask, Don't Tell policy) distinctive gay male cohorts. We then consider intra-cohort variation within gay male cohorts before exploring some the barriers to investigating cohorts and cohort effects among older gay men.

Aging With HIV: Health Policy and Advocacy Priorities.

The aging of people with HIV (PWH) is a major public health accomplishment and a social and cultural phenomenon. It highlights the human capacity to overcome adversity, the effectiveness of public health strategies (e.g., prevention and treatment), and the new challenges as well. Our societies are not well prepared to address the needs of older PWH and the changes they are creating. Stigma toward HIV, older age, and homosexuality, along with racism, have kept PWH largely invisible, resulting in limited investment in prevention and medical and social services. It is imperative that we develop an effective policy response to address the unique needs of PWH. The purpose of this article is to highlight current knowledge and emerging issues in HIV and aging to serve as a foundation on which to develop policy and program recommendations that will meet the new challenge.

Social integration and health: community involvement, stigmatized identities, and sexual risk in Latino sexual minorities.

The purpose of this study is to contribute to the conceptual understanding and practical application of social integration theory to health behaviors. We test whether community involvement in AIDS and GLBT organizations moderates the relationship of racial and homosexual stigmata to sexual risk behavior among gay and bisexual men and transgender persons of Latin American origin or descent. We use structural equation modeling to analyze data from a sample of 643 individuals recruited via respondent-driven sampling. Among those not involved in community organizations, homosexual and racial stigmata are related to sexual activity under the influence of alcohol and drugs, which is linked to sexual risk behavior. Among the involved group, the stigmata are not linked to sexual activity under the influence of alcohol and drugs, or to sexual risk behavior. The moderating role of community involvement seems to be more salient in those currently involved than those ever involved.

Navigating partnerships and addressing tough issues in promoting health among GLBTQ youth: an interview with Jesus Ramirez-Valles. Interview by Carmen J. Head .

Gay, lesbian, bisexual, transgendered, and questioning (GLBTQ) youth have a number of challenges to face as they develop socially and sexually. Acceptance, discrimination, violence, and a sense of belonging are just a number of issues that complicate the life of GLBTQs as they seek to establish their identity. Many of the challenges that GLBTQ youth are faced with make them more susceptible to practicing risky behaviors that can lead to HIV/AIDS and STDS. When GLBTQ youth of color are living in poor neighborhoods or suffer from some form of racial discrimination, they face even greater challenges.

Public Health Has an Equity Problem: A Latinx's Voice.

Public health has an equity problem. One of the main pillars of our public health system, schools and academic programs of public health, are under the control of white (heterosexual) faculty. They continue to exclude brown, black, and indigenous people from their faculty and leadership ranks. This racism pervades institutional policies and culture and is a major fault in the quest for health equity. In this essay, I center on the experience of Latinx faculty to examine the roots of this inequity and the arguments for diversity and inclusion. I also propose avenues for change and argue for institutional transformation that goes beyond adding people of color to faculty and leadership roles.

Fostering health equity research: Development and implementation of the Center for Health Equity Research (CHER) Chicago.

INTRODUCTION: The purpose of this article is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality. METHODS: Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early-stage investigators (ESIs) and to establish community partnership mechanisms. RESULTS: CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence. CONCLUSION: There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.

HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons.

OBJECTIVES: We examined HIV prevalence and the socioeconomic correlates of HIV infection, sexual risk behaviors, and substance use among Latino gay and bisexual men and transgender persons in Chicago and San Francisco. METHODS: Data were collected from a sample of 643 individuals (Chicago: n=320; San Francisco: n=323) through respondent-driven sampling and computer-assisted self-administered interviews. RESULTS: HIV prevalence in San Francisco (0.325; 95% confidence interval [CI]=0.260, 0.393) was higher than in Chicago (0.112; 95% CI=0.079, 0.163). In San Francisco, HIV prevalence was higher among US-born residents than among those born outside the country; in Chicago, the opposite was true. Heavy use of alcohol was prevalent, especially in Chicago (0.368; 95% CI=0.309, 0.432; San Francisco: 0.154; 95% CI=0.116, 0.192). Drug use and more education were positively correlated and greater age was negatively correlated with unprotected anal intercourse. CONCLUSIONS: Heavy alcohol drinking and use of drugs remain a significant public health problem in this population. Drug use was more closely linked to HIV sexual risk behaviors than was heavy drinking.

Global Citizen, Immigrant, Survivor, Activist, Gayby Boomer, Academic, and Editor: Dr. Sy and the History of AIDS Education and Prevention.

In this 30th anniversary of AIDS Education and Prevention, we turn our attention to its founder and editor, Dr. Francisco Sy. I trace Dr. Sy's trajectory, from growing up in a Filipino-Chinese family in Manila to Harvard, Johns Hopkins, South Carolina, and then to the journal. The loss of friends and colleagues to the AIDS epidemic stands out as Sy's driving force behind the journal. AIDS Education and Prevention was also created to fill a tremendous gap in the field: a scientific platform to circulate and discuss research on HIV and AIDS prevention. Over its life course, the content of the journal has mirrored the life of epidemic. Initially, the articles focused on knowledge, attitudes, and behaviors, mostly in the United States. Now, the articles deal with health interventions and pre-exposure prophylaxis, with authors coming from all over the globe. In Sy's opinion, HIV will become endemic, as other infectious diseases have over our history of epidemics, so the role of journals such as AIDS Education and Prevention will remain vital.