Engagement in Care Among Newly Diagnosed HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From the Together 5,000 Study.

One-quarter of gay, bisexual, and other men who have sex with men (GBMSM) with diagnosed HIV are not engaged in HIV care. Between 2018 and 2019, 50 GBMSM completed qualitative interviews 3 months after receiving an HIV-positive result. Interviews explored barriers to and facilitators of engagement and retention in HIV testing and care. Thematic analysis revealed five major themes: (1) reason for HIV testing (e.g., self-testing), (2) linkage to care (e.g., appointment/logistic issues and social support as encouragement), (3) barriers to engagement in care (e.g., financial burden, competing priorities, and fear/stigma), (4) facilitators of engagement (e.g., financial assistance, patient-provider relationships, auxiliary support services, and health agency), and (5) PrEP as a missed prevention opportunity. Addressing individual-, social-, and policy-level barriers could improve GBMSM's engagement in HIV care. Further, capitalizing on GBMSM's health agency through partnerships with local agencies and fostering better patient-provider relationships could optimize HIV care continuity.

Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth.

Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.

Dimensions of Sexual Orientation as Predictors of STI-Related Outcomes Among Women: An Examination of 2011-2017 National Survey of Family Growth Data.

Background: To estimate sexual orientation associated disparities in sexually transmitted infection (STI)-related outcomes across multiple dimensions of sexual orientation. Methods: Using pooled 2011-2017 National Survey of Family Growth data (N = 16,854), we performed bivariate and multivariable logistic and multinomial regression analyses to estimate associations between sexual identity, behavior in the past 12 months, and attraction, and past-year STI treatment, receipt of the human papillomavirus (HPV) vaccine, and age at first HPV vaccination in cisgender women. Results: Bisexual-identified women (adjusted odds ratio [AOR] = 1.53, 95% confidence interval [CI] = 1.10-2.14) and who were sexually active with both men and women in the past 12 months (AOR = 1.64, 95% CI = 1.03-2.55) had significantly higher odds of past-year STI treatment, compared with their nonsexual minority counterparts. Lesbian-identified women (AOR = 0.44, 95% CI = 0.27-0.75) and women with female partners only (AOR = 0.32, 95% CI = 0.12-0.87) had significantly decreased odds of having initiated the HPV vaccine compared with their heterosexual counterparts. Women with both male and female partners who initiated the HPV vaccine had significantly higher odds of having received the vaccine during the latest age range, 18-25 years old (AOR = 2.32, 95% CI = 1.21-4.45) compared with women with male partners only. Conclusions: Sexual minority women continue to be at risk for poor sexual health outcomes, and these outcomes differ by specific components of sexual orientation.

Changing Trends in Substance Use and Sexual Risk Disparities among Sexual Minority Women as a Function of Sexual Identity, Behavior, and Attraction: Findings from the National Survey of Family Growth, 2002-2015.

Components of sexual minority (SM) status-including lesbian or bisexual identity, having same-sex partners, or same-sex attraction-individually predict substance use and sexual risk behavior disparities among women. Few studies have measured differing associations by sexual orientation components (identity, behavior, and attraction), particularly over time. Data were drawn from the 2002-2015 National Survey of Family Growth female sample (n = 31,222). Multivariable logistic regression (adjusted for age, race/ethnicity, education, marital/cohabitation status, survey cycle, and population-weighted) compared past-year sexual risk behavior, binge drinking, drug use, and sexually transmitted infection treatment among sexual minority women (SMW) versus sexual majority women (SMJW) by each sexual orientation component separately and by all components combined, and tested for effect modification by survey cycle. In multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. SM identity became nonsignificant in final adjusted models with all three orientation components; non-monosexual attraction and behavior continued to predict significantly elevated odds of risk behaviors, remaining associated with sexual risk behavior and drug use over time (attenuated in some cases). Trends in disparities over time between SMW versus SMJW varied by sexual orientation indicator. In a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW-especially those reporting non-monosexual behavior or attraction-and prioritize their health needs.

An Evaluation of the Effectiveness of School-Based Breastfeeding Education.

School-based interventions aimed at modifying the knowledge, attitudes, social norms, and intended future practice regarding breastfeeding may be an effective way of improving breastfeeding rates. A systematic review of relevant literature was conducted to identify scientifically rigorous studies on school-based interventions and promotion activities that focus on breastfeeding. Of the 1990 citations reviewed, only 6 empirical articles on school-based interventions to promote breastfeeding were found and these interventions vary greatly in terms of format, duration, outcome measures, and significance of the results. Overall, these studies demonstrated positive effects on perceptions and attitudes toward breastfeeding and increased behavioral intention of breastfeeding later in life. School-based breastfeeding promotion programs hold promise for increasing knowledge of breastfeeding and support for breastfeeding, promoting positive attitudes, creating a culture where breastfeeding is the norm, and increasing future intentions to breastfeed.

Use of the Internet and mobile-based "apps" for sex-seeking among men who have sex with men in New York City.

The Internet continues to be a popular venue for men who have sex with men (MSM) to seek sexual partners. Increased sexual risk behavior has been linked to MSM who use the Internet to seek partners. However, there has been little research on how new mobile-based social networking applications ("apps") may affect sex-seeking and sexual risk behaviors of MSM. One hundred twenty-six MSM in New York City were recruited to complete an online survey on the use of the Internet and other technology for sex-seeking. The authors collected data on variables of interest including sexual sensation seeking, gay identity affirmation, internalized homophobia, Internet/app use, and sexual behavior with men met via the Internet and mobile apps. Results indicated that men who use both the Internet and mobile apps to seek partners were younger and reported higher incomes (p<.05) than men who used the Internet only. There were no significant differences between the groups with regard to race, sexual sensation seeking, gay identity affirmation, or internalized homophobia, indicating that the use of mobile-based apps for sex-seeking may be simply an example of evolving technologies. These findings may provide insight for the feasibility and planning of effective mobile app-based HIV/STI programs for MSM.

Intersecting identities and the association between bullying and suicide attempt among New York city youths: results from the 2009 New York city youth risk behavior survey.

OBJECTIVES: We examined the intersections of sexual minority, gender, and Hispanic ethnic identities and their interaction with experiences of bullying in predicting suicide attempt among New York City youths. METHODS: We performed secondary data analysis of the 2009 New York City Youth Risk Behavior Survey, using logistic regression to examine the association of sexual identity, gender, ethnicity, and bullying with suicide attempt. We stratified results on these measures and reported adjusted odds ratios. RESULTS: Compared with non-sexual minority youths, sexual minority youths had 4.39 and 1.96 times higher odds, respectively, of attempting suicide and reporting bullying. Identity variables did not interact with bullying in predicting suicide attempt individually; however, a four-way interaction term was significant. The effect of bullying on suicide attempt was strongest among non-Hispanic sexual minority male youths (odds ratio = 21.39 vs 1.65-3.38 for other groups). CONCLUSIONS: Sexual minority, gender, and ethnic identities interact with bullying in predicting suicide attempt among New York City youths. Interventions to limit both the prevalence and the effect of bullying among minority youths should consider an intersectional approach that considers ethnic, gender, and sexual identities.

Online sex-seeking behaviors of men who have sex with men in New York City.

The ongoing HIV epidemic among men who have sex with men (MSM) in New York City and the increased use of Internet sexual social networking websites by MSM fosters a need to understand the characteristics and sex-related behaviors of this group. The authors conducted an online survey of 195 MSM who use sexual social networking websites in New York City. Demographic characteristics, sexual sensation seeking, and HIV optimism-skepticism were compared among participants reporting sex with and without condom use (safe sex and high-risk sex, respectively) with partners met online. There was no difference in income, education, race, or employment status between the groups. The groups differed significantly in age, sexual sensation seeking, and HIV optimism-skepticism. In a multivariate logistic regression both HIV optimism-skepticism (p < .05) and sexual sensation seeking (p < .05) were significant predictors of high-risk sexual behavior (pseudo-R(2) = .24). This information should be considered when developing interventions for this group. For example, to reach those with high sexual sensation seeking, public health professionals should design sex-positive prevention messages for online distribution that highlight safer sex without condemning risky sexual practices.

The NYC Condom: use and acceptability of New York City's branded condom.

We assessed awareness and experience with the NYC Condom via surveys at 7 public events targeting priority condom distribution populations during 2007. Most respondents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alternative condoms offered for free: 22% wanted ultra-thin, 18% extra-strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives.