Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California.

Young men who have sex with men (YMSM) are at alarming risk for HIV acquisition, demonstrating the highest rates of incident infection of any age-risk group. GRINDR is a global positioning service-based social networking application popular with YMSM for sexual partnering. To assess the characteristics of YMSM who use GRINDR, we conducted a computer-assisted self-interview-based survey of 375 YMSM using GRINDR in metropolitan Los Angeles, recruited using the GRINDR platform. The median age was 25 (interquartile range, 22-27) years old, 42.4 % caucasian, 6.4 % African American, 33.6 % Latino, and 14.1 % Asian/Pacific Islander. Participants reported high rates of sexual partnering and unprotected anal intercourse (UAI). The majority (70 %) of those reporting unprotected anal intercourse reported low perception of HIV-acquisition risk. Of the participants, 83.1 % reported HIV testing within the past 12 months; 4.3 % had never been HIV tested. Of the participants, 4.5 % reported HIV-positive serostatus; 51.7 % indicated that they would be interested in participating in a future HIV prevention trial. Latinos were more likely than either caucasians or African Americans to endorse trial participation interest (odds ratio, 1.9; 95 % confidence interval [1.1-3.3]). HIV-positive test results were associated with increased number of anal sex partners in the past 3 months (adjusted odds ratio (AOR), 1.53 [0.97-2.40]), inconsistent inquiry about partners' serostatus (AOR, 3.63 [1.37-9.64]), reporting the purpose for GRINDR use including "friendship" (AOR, 0.17 [0.03-1.06), and meeting a sexual partner in a bookstore in the past 3 months (AOR, 33.84 [0.99-1152]). Men recruited via GRINDR were high risk for HIV acquisition or transmission and interested in clinical trial participation, suggesting potential for this method to be used for recruitment of YMSM to HIV prevention trials.

HIV prevention technology transfer: challenges and strategies in the real world.

OBJECTIVES: We examined implementation of evidence-based interventions for HIV prevention at community-based organizations in Los Angeles County, CA. METHODS: We conducted 2 waves of interviews with 34 organization staff members. We analyzed activities reported by staff in the phases (preimplementation, implementation, and maintenance and evolution) and activities defined by the technology transfer model for evidence-based HIV prevention interventions. RESULTS: Staff members were able to select, adapt, and implement evidence-based HIV prevention interventions despite challenges in each phase of technology transfer. Preimplementation challenges included lack of information and poor fit between the interventions and organizations' clients. Implementation challenges included retention of participants across intervention sessions and staff turnover. A challenge in the maintenance and evolution phase was enhancing staff skills in outcome monitoring and cost analyses. CONCLUSIONS: Technical assistance must be matched to the specific challenges found in each phase of technology transfer. Successful transfer of evidence-based HIV prevention interventions will depend on their continued uptake and use by organization staff. This study highlights directions for improving communications regarding appropriate modifications to these interventions and for organizational planning to continue adapted interventions.

Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men.

BACKGROUND: Methamphetamine-dependent gay and bisexual men (GBM) are at high risk for HIV transmission, largely due to drug-associated sexual risk behaviors. This project evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors among this population. METHODS: In this randomized controlled trial, 162 methamphetamine-dependent (SCID-verified) GBM in Los Angeles County were randomly assigned to one of four treatment conditions for 16 weeks: standard cognitive behavioral therapy (CBT, n=40), contingency management (CM, n=42), combined cognitive behavioral therapy and contingency management (CBT+CM, n=40), and a culturally tailored cognitive behavioral therapy (GCBT, n=40). Stimulant use was assessed thrice-weekly during treatment using urine drug screens (48 measures). Sexual risk behaviors were monitored monthly (four measures). Follow-up assessments were conducted at 6 (80.0%) and 12 months (79.9%). RESULTS: Statistically significant differences in retention (F(3,158)=3.78, p<.02), in longest period of consecutive urine samples negative for methamphetamine metabolites (F(3,158)=11.80, p<.001), and in the Treatment Effectiveness Score were observed by condition during treatment (F(3,158)=7.35, p<.001) with post hoc analyses showing the CM and CBT+CM conditions to perform better than standard CBT. GEE modeling results showed GCBT significantly reduced unprotected receptive anal intercourse (URAI) during the first 4 weeks of treatment (X2=6.75, p<.01). During treatment between-group differences disappeared at follow-up with overall reductions in outcomes sustained to 1-year. CONCLUSIONS: Among high-risk methamphetamine-dependent GBM, drug abuse treatments produced significant reductions in methamphetamine use and sexual risk behaviors. Drug abuse treatments merit consideration as a primary HIV prevention strategy for this population.

Perceived employment barriers and their relation to workforce-entry intent among people with HIV/AIDS.

As treatments have improved health and quality of life for people with HIV/AIDS, many have contemplated workforce reentry. Workforce reentry rarely occurs among people with illness-related disability. The authors mailed a survey that included workforce-entry-related concerns to 1,991 HIV/AIDS clients. Factor analysis extracted 6 areas of concern (benefits loss, work-related health, job skills, discrimination, personal health care, workplace accommodation). Levels of concern generally increased with HIV acuity level and time since last worked. Work-related health concerns predicted consideration of workforce entry, and work-related health concerns and benefits-loss concerns predicted estimated time to return to work. Findings provide quantitative validation of intuitive categories of workforce-entry concerns among people with HIV/AIDS and suggest that concerns may shift with progress toward workforce entry.

Getting Off: development of a model program for gay and bisexual male methamphetamine users.

An evidence-based gay-specific cognitive behavioral therapy (GCBT) intervention for methamphetamine-using gay and bisexual men was adapted for use in a community-based setting, thereby moving research into practice. The 48-session, 16-week GCBT intervention was revised to 24 sessions requiring 8 weeks and renamed Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users. GCBT was modified for implementation within the limited resources and capacity of community-based organizations while also retaining drug use and HIV risk reduction outcomes. Since 2007, Getting Off has been sustained with public health funding at the community site and has been adopted by multiple community-based sites.

Opportunities for HIV combination prevention to reduce racial and ethnic health disparities.

Despite advances in HIV prevention and care, African Americans and Latino Americans remain at much higher risk of acquiring HIV, are more likely to be unaware of their HIV-positive status, are less likely to be linked to and retained in care, and are less likely to have suppressed viral load than are Whites. The first National HIV/AIDS Strategy (NHAS) has reducing these disparities as one of its three goals by encouraging the implementation of combination high-impact HIV intervention strategies. Federal agencies have expanded their collaborations in order to decrease HIV-related disparities through better implementation of data-driven decision making; integration and consolidation of the continuum of HIV care; and the reorganization of relationships among public health agencies, researchers, community-based organizations, and HIV advocates. Combination prevention, the integration of evidence-based and impactful behavioral, biomedical, and structural intervention strategies to reduce HIV incidence, provides the tools to address the HIV epidemic. Unfortunately, health disparities exist at every step along the HIV testing-to-care continuum. This provides an opportunity and a challenge to everyone involved in HIV prevention and care to understand and address health disparities as an integral part of ending the HIV epidemic in the United States. To further reduce health disparities, successful implementation of NHAS and combination prevention strategies will require multidisciplinary teams, including psychologists with diverse cultural backgrounds and experiences, to successfully engage groups at highest risk for HIV and those already infected with HIV. In order to utilize the comprehensive care continuum, psychologists and behavioral scientists have a role to play in reconceptualizing the continuum of care, conducting research to address health disparities, and creating community mobilization strategies.

Adapting HIV prevention evidence-based interventions in practice settings: an interview study.

BACKGROUND: Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements. METHODS: Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention. RESULTS: Participants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings. CONCLUSION: Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the aims of the original interventions. Providing strategic technical assistance and written guidance can facilitate effective HIV prevention technology transfer of evidence-based interventions.

Perceived discrimination in the context of multiple group memberships.

This study examined the joint impact of gender and ethnicity on expectations of general discrimination against oneself and one's group. According to the double-jeopardy hypothesis, women of color will expect to experience more general discrimination than men of color, White women, and White men because they belong to both a low-status ethnic group and a low-status gender group. Alternatively, the ethnic-prominence hypothesis predicts that ethnic-minority women will not differ from ethnic-minority men in their expectations of general discrimination because these expectations will be influenced more by perceptions of ethnic discrimination, which they share with men of color, than by perceptions of gender discrimination. All results were consistent with the ethnic-prominence hypothesis rather than the double-jeopardy hypothesis.