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In response to the increased recognition of racism as a public health crisis, we assessed links between racial discrimination and HIV-related risk behavior for Black men. Specifically, using survey data from 530 Black heterosexual men (18-44 years old, M = 31.0, SD = 7.8), we tested two moderated-mediation models: (1) a protective model, in which resilience and social capital protected against the indirect effect of racial discrimination on alcohol-related sexual behavior via binge drinking, and (2) a bounded model, in which racial discrimination limited the indirect effects of resilience and social capital on alcohol-related sexual behavior via binge drinking. We found support for the bounded model only. Specifically, resilience was indirectly associated with decreased alcohol-related sexual behavior via lower binge drinking when racial discrimination was low to moderately high, but not when racial discrimination was at its highest levels. Resilience was not directly associated with alcohol-related sexual behavior. Social capital was directly related to lower odds of alcohol-related sexual behavior. At high levels of racial discrimination, however, social capital was indirectly related to increased alcohol-related sexual behavior via binge drinking. High levels of racial discrimination limit beneficial effects of resilience on alcohol-related sexual behavior. Social capital maintains a beneficial effect if social bonds are not associated with binge-drinking norms or behaviors. Results highlight the limitations of individual-level resilience and the need to conceptualize and support resilience as a social-structural resource.
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Consumo Excesivo de Bebidas Alcohólicas , Racismo , Conducta Sexual , Capital Social , Adolescente , Adulto , Humanos , Masculino , Adulto Joven , Consumo de Bebidas Alcohólicas , Negro o Afroamericano , Heterosexualidad , Infecciones por VIHRESUMEN
Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.
RESUMEN: Los sesgos sociales pueden influir sobre los juicios de proveedores de salud con respecto a la profilaxis pre-exposición (PrEP) y el consecuente acceso de los pacientes a PrEP. Proveedores de cuidados primarios y de VIH en los Estados Unidos (n = 370) respondieron una encuesta experimental. Cada proveedor leyó una historia médica de un paciente ficticio interesado en obtener PrEP. Las historias médicas variaron la raza (Negro o Blanco) y conducta de riesgo (hombre que tiene sexo con hombres [HSH], hombre que tiene sexo con mujeres [HSM], u hombre usuario de drogas inyectables [HDI]) del paciente. Los proveedores reportaron juicios clínicos y completaron medidas sobre prejuicio. La evidencia sobre sesgos raciales en los juicios clínicos fue mínima. Los proveedores que expresaron prejuicio sexual bajo a moderado, juzgaron que el paciente HSH tendría mayor adherencia a PrEP que el paciente HSM, lo cual se asoció con mayor intención de prescribir PrEP; el prejuicio sexual se asoció negativamente con la adherencia anticipada en HSH. El paciente HDI fue percibido como en mayor riesgo, con menor adherencia, menos preocupado por la seguridad, y menos responsable que los HSH y HSM; los juicios sobre baja adherencia y responsabilidad estuvieron asociados con menor intención de prescribir PrEP.
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Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Juicio , Masculino , Conducta SexualRESUMEN
In a body of research typically focused on risk reduction and disease prevention, other factors motivating the sexual behaviours of Latino sexual minority men, such as resource-based power and sexual pleasure, are less well understood. To this end, Latino immigrant sexual minority men living in New York City were surveyed about their sexual behaviours, perceived power differentials, and pleasure from insertive and receptive anal intercourse. Power and pleasure were examined as associations with behavioural profiles identified through latent class analysis, adjusting for age and partner type. Four latent classes of Latino sexual minority men were identified based on behaviours reported during the most recent sexual event: behaviourally insertive (14.2%), behaviourally versatile (25.9%), behaviourally receptive (29.2%), and limited penetrative behaviour (30.7%). Participants who derived pleasure from insertive and receptive anal intercourse had higher odds of belonging in the behaviourally insertive and behaviourally receptive class, respectively. Perceptions of resource-based power were not associated with class membership. Findings highlight the importance of sexual pleasure as a driver of sexual behaviour, irrespective of power dynamics. Sexual health curricula and interventions for sexual minority men should consider sexual pleasure and sex-affirmative frameworks when providing sexuality education and promoting sexual wellbeing.
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Infecciones por VIH , Minorías Sexuales y de Género , Hispánicos o Latinos , Homosexualidad Masculina , Humanos , Masculino , Percepción , Placer , Conducta Sexual , Parejas SexualesRESUMEN
Incarceration fractures relationship ties and has been associated with unprotected sex. Relationships where both individuals have a history of incarceration (dual incarceration) may face even greater disruption and involve more unprotected sex than relationships where only one individual has been incarcerated. We sought to determine whether dual incarceration is associated with condom use, and whether this association varies by relationship type. Data come from 499 sexual partnerships reported by 210 individuals with a history of incarceration. We used generalized estimating equations to examine whether dual incarceration was associated with condom use after controlling for individual and relationship characteristics. Interaction terms between dual incarceration and relationship commitment were also examined. Among currently committed relationships, dual incarceration was associated with inconsistent condom use (AOR: 4.33; 95% CI 1.02, 18.45). Dual incarceration did not affect condom use in never committed relationships. Reducing incarcerations may positively impact committed relationships and subsequently decrease HIV-related risk.
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Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Conducta Sexual , Parejas Sexuales/psicología , Sexo Inseguro/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prisiones , Asunción de Riesgos , Sexo Seguro/estadística & datos numéricos , Sexo Inseguro/psicologíaRESUMEN
OBJECTIVES: Although social science research has examined police and law enforcement-perpetrated discrimination against Black men using policing statistics and implicit bias studies, there is little quantitative evidence detailing this phenomenon from the perspective of Black men. Consequently, there is a dearth of research detailing how Black men's perspectives on police and law enforcement-related stress predict negative physiological and psychological health outcomes. This study addresses these gaps with the qualitative development and quantitative test of the Police and Law Enforcement (PLE) Scale. METHOD: In Study 1, we used thematic analysis on transcripts of individual qualitative interviews with 90 Black men to assess key themes and concepts and develop quantitative items. In Study 2, we used 2 focus groups comprised of 5 Black men each (n = 10), intensive cognitive interviewing with a separate sample of Black men (n = 15), and piloting with another sample of Black men (n = 13) to assess the ecological validity of the quantitative items. For Study 3, we analyzed data from a sample of 633 Black men between the ages of 18 and 65 to test the factor structure of the PLE, as we all as its concurrent validity and convergent/discriminant validity. RESULTS: Qualitative analyses and confirmatory factor analyses suggested that a 5-item, 1-factor measure appropriately represented respondents' experiences of police/law enforcement discrimination. As hypothesized, the PLE was positively associated with measures of racial discrimination and depressive symptoms. CONCLUSIONS: Preliminary evidence suggests that the PLE is a reliable and valid measure of Black men's experiences of discrimination with police/law enforcement. (PsycINFO Database Record
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Negro o Afroamericano/estadística & datos numéricos , Racismo/estadística & datos numéricos , Adulto , Negro o Afroamericano/psicología , Análisis Factorial , Humanos , Aplicación de la Ley , Masculino , Persona de Mediana Edad , Psicología Social , Racismo/psicología , Estereotipo , Adulto JovenRESUMEN
Although extensive research documents that Black people in the U.S. frequently experience social discrimination, most of this research aggregates these experiences primarily or exclusively by race. Consequently, empirical gaps exist about the psychosocial costs and benefits of Black men's experiences at the intersection of race and gender. Informed by intersectionality, a theoretical framework that highlights how multiple social identities intersect to reflect interlocking social-structural inequality, this study addresses these gaps with the qualitative development and quantitative test of the Black Men's Experiences Scale (BMES). The BMES assesses Black men's negative experiences with overt discrimination and microaggressions, as well their positive evaluations of what it means to be Black men. First, we conducted focus groups and individual interviews with Black men to develop the BMES. Next, we tested the BMES with 578 predominantly low-income urban Black men between the ages of 18 and 44. Exploratory factor analysis suggested a 12-item, 3-factor solution that explained 63.7% of the variance. We labeled the subscales: Overt Discrimination, Microaggressions, and Positives: Black Men. Confirmatory factor analysis supported the three-factor solution. As hypothesized, the BMES's subscales correlated with measures of racial discrimination, depression, resilience, and social class at the neighborhood-level. Preliminary evidence suggests that the BMES is a reliable and valid measure of Black men's experiences at the intersection of race and gender.
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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.
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Infecciones por VIH/epidemiología , Seropositividad para VIH/psicología , Homosexualidad/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Adolescente , Adulto , Colombia/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/psicología , Seropositividad para VIH/epidemiología , Homosexualidad/psicología , Humanos , Masculino , Persona de Mediana Edad , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Personas Transgénero/psicología , Adulto JovenRESUMEN
Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.
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HIV-related comorbidities in underrepresented minority populations are reframed to include the co-occurring problems of systemic and structural barriers, within the mentoring context as a buffer and as action-oriented. This framework is discussed to improve racial and ethnic minority diversity in the research workforce from the perspectives of HIV comorbidities and mentoring. An integrated and coordinated approach to HIV-related comorbidities and inequities may be helpful when combined with research on the social-structural contributions as drivers to diversify the research workforce. We emphasize how these key research issues (a) provide a platform for training and retraining a highly motivated, diverse workforce and (b) facilitate the empowerment of these trained individuals to conduct rigorous scientific research on social-structural factors to mitigate the effects of these comorbidities. We conclude that a diverse research workforce is necessary but insufficient for improving training-related outcomes or reducing comorbidity effects. Additional considerations are warranted that include systemic approaches and changes at the structural and institutional levels.
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Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.
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Anti-Black police brutality in the United States is not a new problem, but at least a 400-year old one. Mainstream psychology has responded to this critical racial and social justice issue by conceptualizing it primarily as an outcome of police officers' social cognition (e.g., threat perceptions) or implicit racial biases. Such individualistic and cognitive perspectives, however, ignore the fundamental role of anti-Black structural racism in facilitating the ability of law enforcement to terrorize, brutalize, and kill Black people with impunity. As with the media and public attention, mainstream psychology has also tended to frame acts of anti-Black police brutality as outliers, or occasional lethal and spectacular events, rather than as a broad spectrum of routine acts that structure policing and police brutality as a world for Black people in the United States. Informed by critical psychology, and the critical theoretical frameworks of critical race theory, intersectionality, and Afro-Pessimism, the goal of this article is to critically engage with the topic of anti-Black police brutality. By critically engage, we mean expose and challenge the economic, social, and material power relations that disproportionately expose Black people to police brutality; and conceptualize police brutality not as a series of aberrant incidents, but as a structure that in essence constructs and reifies Blackness and Whiteness. We also introduce the Anti-Black Police Brutality Continuum, a conceptual framework of police brutality as a broad spectrum of routine manifestations of anti-Black structural racism, and criticize mainstream psychology's deferral of a critical and transformative response to anti-Black police brutality. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Policia , Racismo , Negro o Afroamericano , Población Negra , Humanos , Aplicación de la Ley , Policia/psicología , Estados UnidosRESUMEN
We examined the association between social-structural stressors-racial discrimination, incarceration, and unemployment-and depressive symptoms among 578 predominantly low-income urban Black men, ages 18-45. We also examined the extent to which two protective factors-social support and problem-solving coping-moderated the relationship between social-structural stressors and depressive symptoms. Results showed that more everyday racial discrimination and incarceration, but not unemployment, significantly predicted more depressive symptoms. The links between discrimination, incarceration, and depressive symptoms were stronger for men who reported lower levels of problem-solving coping and social support than those with higher levels. Our study suggests that interventions emphasizing protective factors may help Black men cope with some of the deleterious effects of racial discrimination and incarceration. It also underscores a need for structural interventions that reduce racial discrimination and incarceration. Depression among Black men is not simply a biomedical or psychological condition, but also a critical health equity issue. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Depresión , Racismo , Adaptación Psicológica , Adolescente , Adulto , Negro o Afroamericano/psicología , Población Negra , Depresión/psicología , Humanos , Masculino , Persona de Mediana Edad , Racismo/psicología , Adulto JovenRESUMEN
This study aimed to identify Top, Bottom, and Versatile sexual role identities and anal sex behavior profiles using latent class analysis in a sample of 942 sexual minority men living in Bogotá. A Versatile-insertive and receptive class (52.2%) was the most prevalent of the four resulting classes, whereas the least common was a class (1.7%) that did not use labels and had a low probability of anal sex. We examined whether identity and relational factors (i.e., sexual orientation, LGBT collective identity, and partner type) were associated with profiles. Gay identity was associated with versatile and receptive classes and bisexual identity was associated with insertive and versatile classes. LGBT collective identity was associated with the class characterized by Bottom identity and receptive positioning. Partner type was not associated with class membership, but versatile behaviors were more common among encounters with a main partner. Models using data at different timescales offered consistent patterns of behavior between the last encounter and the past three months, though the versatile class in the three-month model split into two classes based on frequency of versatile positioning. Findings highlight the relationship between sexual identity and positioning and can inform interventions for sexual health education and identity development.
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Infecciones por VIH , Minorías Sexuales y de Género , Bisexualidad , Colombia , Femenino , Homosexualidad Masculina , Humanos , Masculino , Conducta Sexual , Parejas SexualesRESUMEN
We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and patient-centered care for Latinxs living with HIV. Quantitative and qualitative data were simultaneously collected to capture the complex interactions among care providers, staff, and patients as well as to monitor practice changes that occurred as a result of the project implementation. The practice transformation intervention consisted of core competency workforce training, workflow redesign, and data-driven quality improvement strategies utilized to guide the intervention and to gather data from providers and patients. The mixed-methods approach facilitated meaningful change within the clinic that resulted in improved patient outcomes, patient experiences of care, and increases in staff's perceived level of knowledge of patient-centered care and improved efficiencies in HIV health care service delivery.
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Infecciones por VIH , Atención a la Salud , Infecciones por VIH/prevención & control , Humanos , Atención Dirigida al Paciente/métodos , Mejoramiento de la Calidad , Recursos HumanosRESUMEN
It is exciting to watch intersectionality travel from its roots in Black feminist activism and critical legal studies to increasingly more mainstream research domains such as psychology and psychopathology. We commend Mennies et al. (Journal of Abnormal Child Psychology, 2020) for their application of the intersectionality framework to the study of psychopathology and treatment utilization in youth in the ABCD study. We argue, however, that this application falls short of its intersectional promise. We discuss some conceptual and methodological/analytical issues that evidence the focal article's lack of alignment with intersectionality's core tenets, particularly regarding the central role of power and social-structural factors as drivers of inequities across intersectional positions. Specifically, we discuss our concerns with the testing and flattening of intersectionality, the selection and operationalization of intersectional positions, and the use of conventional regression models as quantitative analytical approach. We end by suggesting ways that intersectionality can help reduce the inequities in psychopathology and treatment utilization identified by Mennies et al. (Journal of Abnormal Child Psychology, 2020).
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Feminismo , Trastornos Mentales , Adolescente , Negro o Afroamericano , Niño , Demografía , Humanos , Trastornos Mentales/terapia , PsicopatologíaRESUMEN
Gentrification-the process by which middle-class individuals (often White) move into lower-income neighborhoods (often Black), consequently displacing existing residents and changing the neighborhood's social character-is a relatively new and rapid phenomenon in Washington, DC. From 2000 to 2010, DC had the second fastest rate of gentrification in the USA. Gentrification is a major and disproportionate source of disadvantage for low-income Black DC residents. In light of the relative dearth of psychological research focused on gentrification, this study sought to answer the following research questions: What are Black men's experiences with gentrification in DC and how are Black men psychosocially affected by the gentrification of their neighborhoods? Data used in this study were obtained in Fall 2013 via nine semi-structured focus groups from nine DC neighborhood clusters. Participants were 83 self-identified Black men between the ages of 18 and 48 (M = 29.96, SD = 6.90) who reported predominantly low socioeconomic status. Black men's experiences with gentrification in DC included experiencing changing demographics and spaces, being discriminated against by police, blaming the Black community for gentrification and displacement and recognizing the positives of gentrification. Gentrification had negative psychosocial effects on participants, including race-based social exclusion, restricted mobility, reduced social cohesion and sense of community belonging, loss of control, and internalized blame. It is imperative that psychologists and other health professionals recognize and further explore the psychosocial and health consequences of gentrification on longtime Black residents and promote solutions to reduce the stress associated with this understudied driver of racial/ethnic health inequities.
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Negro o Afroamericano/psicología , Pobreza/etnología , Características de la Residencia/estadística & datos numéricos , Cambio Social , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , District of Columbia , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Using a community-based participatory approach, we developed a film to promote HIV testing among young men who have sex with men (MSM) in Bogotá. Using a 5-step process to develop the intervention, we conducted 11 focus groups with MSM (n = 141) to receive community feedback at each step. To evaluate the intervention we recruited 300 young MSM to complete a baseline survey in December 2017. Between February-June 2018, 63 participants watched the film and completed a post-viewing survey, which showed the intervention was acceptable for the target population. Between August-December 2018, 48 MSM who watched the film and 47 who did not (control group) completed a follow-up survey. To obtain preliminary evidence of the efficacy of the intervention, we assessed the main effect of time (baseline vs. follow-up) and the interaction between time and group (intervention vs. control) on HIV testing uptake and intentions, and knowledge of HIV transmission dynamics and HIV-related rights. Knowledge of HIV rights increased from baseline to follow-up in the intervention group only. HIV Knowledge increased for both groups. HIV testing intentions increased significantly more for non-gay-identified men in the intervention group, but the overall effect of the intervention was not significant. Testing uptake did not change.
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Educación a Distancia , Infecciones por VIH , Minorías Sexuales y de Género , Colombia , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Prueba de VIH , Homosexualidad Masculina , Humanos , MasculinoRESUMEN
INTRODUCTION: Globally, transgender populations are disproportionally impacted by HIV and effective HIV prevention interventions targeting these populations are critically needed. Such interventions require research focused on the specific needs and experiences of transgender people. This methodological review aims to determine the extent to which HIV prevention research has included transgender participants by subsuming them into non-transgender populations, or by centring them either in comparison with other groups or as the sole focus of research. METHODS: We searched five electronic databases (e.g. SCOPUS) for empirical studies that focused on HIV prevention and included transgender participants, published through 31 December 2020. For each study, we extracted information on: (a) types of inclusion of transgender participants; (b) total sample size and number/percentage of transgender participants; (c) country(ies) where study was conducted; (d) HIV research topics; (e) methods (i.e. quantitative, qualitative or mixed-methods research) and (f) gender identity of transgender participants. RESULTS AND DISCUSSION: Of 667 HIV prevention studies included in the review, 38.5% subsumed transgender participants into cisgender populations (most frequently combining transgender women with cisgender men who have sex with men), 20.4% compared transgender and cisgender participants and 41.1% focused exclusively on transgender populations. Our global scoping review also revealed that these three types of transgender inclusion in HIV prevention research vary greatly over time, place and thematic areas. Transgender women are the focus of the majority of reviewed studies, whereas transgender men and gender expansive people are rarely included as participants. CONCLUSIONS: Inclusion of transgender persons as participants in HIV prevention research has significantly increased, particularly in the last decade. Further research centred on transgender participants and their experiences are needed to develop effective HIV prevention interventions for transgender populations. We advocate for HIV prevention research to move from subsuming transgender people, to trans-centred research that asks questions that focus on their specific needs and experiences. We provide recommendations to move from trans-subsumed to trans-centred HIV prevention research.
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Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Femenino , Identidad de Género , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , MasculinoRESUMEN
Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation. Approach: We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18-34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access. Findings: For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007). Originality: We described how fear of deportation limits healthcare access for immigrant Latinx MSM. Research implications: Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.