The Intersection of Age and HIV Status for Black Sexual Minority Men (BSMM): A Social Network Analysis.

Advancements in treatment have resulted in increased life expectancy for individuals living with HIV. However, there is a dearth of literature focused on the intersection of age and HIV status, particularly for older Black sexual minority men (SMM) who are disproportionately impacted by HIV. This study aimed to examine the intersecting effect of age and HIV status on Black SMM social networks in a sample from the Social Network and Prevention Study. Participants were 18 years of age or older, identified as cis-gender Black or African American, self-identified as SMM, reported unprotected sex within the past six months, and resided in Baltimore city or a surrounding county. The sample was divided into four categories by age (e.g., young, mature) and HIV status (e.g., positive, negative). Of the sample, 167 men were (a) Young & HIV negative, 116 men were (b) Young & HIV positive, 44 men were (c) Mature & HIV negative, and 42 men were (d) Mature & HIV positive. Among the four groups, mature men who were HIV positive had the fewest average number of alters who knew they were SMM. There was also overlap in the range of age of sexual partners across the four groups, ranging from 17 to 53.5 (Group 1), 20-60 (Group 2), 29.5-60 (Group 3), and 23-63 (Group 4) years of age. Although a cross-sectional analysis, our findings suggest value in life course-informed research and practice for providing HIV and sexual health programming. Focus on services provided by community organizations may help mitigate existing disparities.

A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse-managed care.

AIM: To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. DESIGN: We engaged a qualitative descriptive study design. METHODS: Semi-structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. RESULTS: Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow-up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse-managed office-based opioid treatment, and (2) Novel methods to engage patients. CONCLUSIONS: Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in-person visits. Nurse-managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call-in' lines to engage patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office-based opioid treatment by conducting assessments and expanding capacity for other wrap-around services. IMPACT: We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse-managed care. REPORTING METHOD: The consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION: Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.

Intervention Approaches to Address Intimate Partner Violence and HIV: a Scoping Review of Recent Research.

PURPOSE OF REVIEW: Intimate partner violence (IPV) remains a critical challenge to HIV prevention and treatment efforts across the globe. We examined recently published (January 9, 2017-January 9, 2023) integrated behavioral interventions designed to address IPV and HIV across the care continuum. RECENT FINDINGS: Fifteen studies (involving n = 10,947 participants) met the inclusion criteria for this review. Majority (n = 13) of studies focused on IPV and HIV prevention whereas two studies addressed IPV and HIV care engagement among women living with HIV. Ten studies were conducted on the African continent representing 5 countries. Most interventions (n = 11) focused on individual-level outcomes among cisgender women although two involved male partners. About half of the interventions reviewed (n = 8) showed effectiveness on both IPV and HIV outcomes compared to control groups. Integrated HIV/IPV interventions are needed to address the synergistic nature of these epidemics among marginalized populations. Future studies should focus on developing and implementing strength-based interventions among people living with HIV, men, transgender people, and Black women in the USA. Additionally, researchers and program managers should consider addressing structural and internalized stigma as potential behavioral mechanisms for improving health among people simultaneously experiencing or at-risk for HIV and IPV.

HIV stigma and disclosure of alcohol use to physicians: examining the mediating role of depression among persons living with HIV.

Alcohol use among persons living with HIV (PWH) can lead to poor disease outcomes. Disclosure of alcohol consumption to physicians is critical to inform HIV care. HIV stigma is associated with poor care engagement, and this relationship is partially mediated by depression. However, less is known about how HIV stigma and depression affect reporting of alcohol use to care providers. We used baseline data from an HIV intervention trial of 330 adult PWH in Baltimore, MD. We fit a path model to examine whether HIV stigma was associated with increased depression symptoms and whether higher levels of depression were, in turn, associated with underreporting of alcohol use to physicians. Among PWH reporting past 6-month alcohol use (n = 182, 55%), 64% met symptom criteria for probable depression, 58% met criteria for hazardous drinking, and 10% reported not disclosing alcohol use to their physician. HIV stigma was associated with higher levels of depression (ß = 0.99, p < .0001); depression was associated with a lower likelihood of alcohol disclosure (ß = -0.04, p < .0001); and depression mediated the indirect pathway from stigma to alcohol disclosure (ß = -0.04, p < .01). Methods to augment or strengthen alcohol self-report may be useful in HIV care, particularly among PWH experiencing HIV stigma and depression.

Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review.

INTRODUCTION: People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. DESIGN AND METHODS: Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition-related outcomes, and reported patient-provider relationship. RESULTS: Twenty-three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co-located services and a positive patient-provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. CONCLUSIONS: To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated 'Good', this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. CLINICAL RELEVANCE: Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID.

Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder.

Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers' perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.

Peer Approaches to Improve HIV Care Cascade Outcomes: a Scoping Review Focused on Peer Behavioral Mechanisms.

PURPOSE OF REVIEW: There are three main components of peer-based approaches regardless of type: education, social support, and social norms. The purpose of this scoping review was to examine evidence in the literature among peer-based interventions and programs of components and behavioral mechanisms utilized to improve HIV care cascade outcomes. RECENT FINDINGS: Of 522 articles found, 40 studies were included for data abstraction. The study outcomes represented the entire HIV care cascade from HIV testing to viral suppression. Most were patient navigator models and 8 of the studies included all three components. Social support was the most prevalent component. Role modeling of behaviors was less commonly described. This review highlighted the peer behavioral mechanisms that operate in various types of peer approaches to improve HIV care and outcomes in numerous settings and among diverse populations. The peer-based approach is flexible and commonly used, particularly in resource-poor settings.

The role of overdose reversal training in knowing where to get naloxone: Implications for improving naloxone access among people who use drugs.

Background: Naloxone distribution and training programs have been implemented to combat the opioid overdose crisis. While many individuals are trained, ongoing naloxone access is not ensured by these programs. We explored whether people who use drugs (PWUD) in Baltimore City, Maryland could identify a location where they would go to obtain naloxone and how training changed where they would be willing to access naloxone. Methods: We surveyed 574 PWUD as to whether they had heard of, been trained to use, and knew where to get naloxone. Among participants who had heard of naloxone, we tested for differences in knowing where to get naloxone by training. Results: The majority (95.3%) had heard of naloxone. Of these, 84.0% could name a location where they would access naloxone, but only 11.7% named multiple. Pharmacies (32.3%) and medical providers (excluding drug treatment providers) (22.9%) were the most commonly identified sources. Participants who had been trained to use naloxone were more likely to report that they would obtain naloxone from the needle exchange and were less likely to report they did not know where they would go to get it or that they would go to a medical provider (excluding drug treatment providers) for naloxone. Conclusions: Naloxone training was associated with participants' ability to name a location where they would obtain naloxone. Medicalized sources of naloxone remained the most commonly reported. These sources, however, may be associated with significant barriers to access, such as cost. Trainings should provide comprehensive education about low-cost/free sources to ensure ongoing naloxone access among people who use drugs.

Co-Occurring Opioid Use and Depressive Disorders: Patient Characteristics and Co-Occurring Health Conditions.

OBJECTIVE: Among persons with opioid use disorder (OUD), co-occurring depression is linked to a greater risk of opioid misuse, overdose and suicide. Less is known about characteristics and other comorbid health conditions of persons with co-occurring opioid use and depressive disorders. METHODS: This study used electronic health record (EHR) encounters from the Geisinger Health System prior to the fall of 2019. Adult patients were recruited from a medication-based treatment clinic and had an OUD diagnosis (N = 692). Co-occurring depression was defined by a depression diagnosis in the EHR. Multivariable logistic regression was performed to assess differences in characteristics, behavioral health and medical diagnoses, as well as opioid overdose and suicide attempt or ideation between individuals with and without comorbid depression. RESULTS: Forty-seven percent of patients with OUD had a lifetime depression diagnosis. Individuals with co-occurring depression were more likely to be female and have comorbid chronic pain or other medical conditions. Co-occurring depression was associated with an increased likelihood of other mental health and substance use disorders, as well as opioid overdose and/or suicide attempt or ideation. CONCLUSIONS: While it is established that co-occurring depression is associated with increased risk of overdose and suicide, this study adds that other health conditions, including chronic pain and common medical conditions, are more prevalent among persons with co-occurring depressive disorders. Results highlight the need to consider these complex health needs when developing treatment plans and services.

Community engagement and linkage to care efforts by peer community-health workers to increase PrEP uptake among sexual minority men.

PURPOSE: Pre-exposure prophylaxis (PrEP) prevents HIV yet uptake remains suboptimal across the United States. This paper evaluates the impact of outreach activities led by nurse supervised community healthcare workers (CHWs) on the PrEP care cascade. METHODS: This is an observational programmatic evaluation of LGBTQ + community outreach between March 1, 2016, to March 31, 2020, as part of a public health initiative. Descriptive statistics are used to characterize the data by outreach type. RESULTS: 2,465 participants were reached. Overall, a PrEP appointment was scheduled for 94 (3.8%) with 70 (2.8%) confirmed to have completed a PrEP visit. Success for each type of community outreach activity was evaluated with virtual models outperforming face-to-face. Face-to-face outreach identified nine persons among 2,188 contacts (0.41%) completing an initial PrEP visit. The website prepmaryland.org identified 4 among 24 contacts (16.7%) and the PrEP telephone/text warm-line identified 18 among 60 contacts (30%). The PrEPme smartphone application identified 39 among 168 contacts (23.2%). CONCLUSIONS: Face-to-face community outreach efforts reached a large number of participants, yet had a lower yield in follow-up and confirmed PrEP visits. All virtual platforms reached lower total numbers, but had greater success in attendance at PrEP visits, suggesting enhanced linkage to care.

Individual and Social Network Factors Associated with High Self-efficacy of Communicating about Men's Health Issues with Peers among Black MSM in an Urban Setting.

Black men who have sex with men (BMSM) bear a disproportionate burden of HIV in the USA. BMSM face stigma, discrimination and barriers to health care access, and utilization. Peers (male or female) may assist BMSM in navigating their health issues by engaging in communication to support in their health care needs. Individuals with high self-efficacy of communicating about men's health issues with peers can be trained as community popular opinion leaders (CPOLs) to change peer behaviors by promoting risk reduction communication. We examined the characteristics associated with high self-efficacy of communicating with peers about men's health issues among 256 BMSM from a behavioral HIV intervention conducted in Baltimore, Maryland. In the multivariate logistic model, gay identity (AOR: 2.10, 95% CI: 1.15,3.83), involvement in the house and ballroom community (AOR: 2.50, 95% CI: 1.14,5.49), larger number of network members who are living with HIV (AOR: 6.34, 95% CI: 1.48,27.11), and larger number of network members who would loan them money (AOR: 1.46, 95% CI: 1.05,2.03) were statistically significantly associated with high self-efficacy of communicating with peers about men's health issues. We also found that having depressive symptoms (AOR: 0.43, 95% CI: 0.24, 0.77) was negatively associated with high self-efficacy of communicating with peers about men's health issues. Findings from the current study can inform future studies to identify better CPOLs who are able to communicate effectively with peers about men's health issues for BMSM.

"When You're Getting High You Just Don't Want to Be Around Anybody." A Qualitative Exploration of Reasons for Injecting Alone: Perspectives from Young People Who Inject Drugs.

BACKGROUND: Rates of death from opioid overdose continue to rise in the United States. One harm reduction strategy designed to reduce fatal overdose risk among people who inject drugs (PWID) is an advisory to not use drugs alone. However, the feasibility and acceptability of this message have not been evaluated. Objectives: This paper explores the drug use practices of young PWID related to injecting alone and reasons for doing so. Methods: From 2015 to 2016, 23 in-depth interviews were completed in Baltimore, Maryland with young PWID. Participants were recruited through street/venue-based outreach and word of mouth. Inclusion criteria were 1) age 18-30 and 2) self-report injection drug use in past 6 months. Participants were asked about drug use history, overdose knowledge/experiences, and injection-related practices including when, where, and with whom drugs were injected. Results: Injecting drugs alone was common among members of this sample. Reasons for injecting alone included 1) the desire to alleviate withdrawal symptoms, 2) feelings of shame regarding one's drug use, 3) lack of knowledge about Good Samaritan Laws, 4) financial circumstances, and 5) a lack of trusted peers with whom to inject, often due to disrupted social networks. Conclusions: Young PWID inject alone for a variety of reasons, putting them at increased risk of fatal overdose. These findings demonstrate that "don't use alone" messages may not be sufficient given the complex realities of PWID's injection practices. Harm reduction programs employing such messaging should also offer alternative options for overdose prevention/risk reduction for those who do inject alone.

Sources of Stress among Adults with Co-occurring Drug Use and Depressive Symptoms.

Stress, drug use, and depression are interconnected, but less is understood about sources of stress among adults with co-occurring drug use and depressive symptoms. The current study aimed to identify sources of stress and correlates among these adults. Data come from a cross-sectional baseline survey, including participants (n = 336) 18 to 55 years old, who reported past 6-month heroin or cocaine use and depressive symptoms. Exploratory factor analysis was conducted to identify sources of stress. Chi-square and multivariable Poisson regression with robust error variance were used to explore correlates of each factor. Three sources of stress were identified: financial stress related to drugs, stress due to community features, and stress involving a person's network. Past 6-month injection drug use (aPR = 1.34, 95% CI 1.07-1.67), perceived lack of control over drug use (aPR = 1.80, 95% CI 1.41-2.30), and difficulty abstaining from drug use (aPR = 1.55, 95% CI 1.22-1.97) were associated with an increased risk of high drug-related financial stress. Neighborhood disorder (aPR = 2.42, 95% CI 1.80-3.24) and sleeping on the street (aPR = 1.37, 95% CI 1.04-1.80) were associated with an increased risk of high community-level stress. Past 6-month injection drug use (aPR = 1.28, 95% CI 1.04-1.58), perceived lack of control over drug use (aPR = 1.37, 95% CI 1.10-1.70), and drug use stigma was associated with an increased prevalence of high drug network stress (aPR = 1.32, 95% CI 1.05-1.65). Stress is a complex construct, including distinct sources and correlates. Further understanding of sources of stress is beneficial in recognizing potentially modifiable challenges faced by individuals who use drugs and experience depressive symptoms.

Fentanyl and Drug Overdose: Perceptions of Fentanyl Risk, Overdose Risk Behaviors, and Opportunities for Intervention among People who use Opioids in Baltimore, USA.

BACKGROUND: Fentanyl-related mortality has skyrocketed among people who use opioids (PWUO) in North America. The current study of PWUO aims to examine the perceived fentanyl risk and training needs; fatal overdose prevention behaviors; and, feasibility of a peer education approach to reducing fentanyl-related fatal overdoses in Baltimore, Maryland, USA. METHODS: 316 street-recruited PWUO were interviewed about fentanyl in Baltimore, MD. RESULTS: Most participants (56%) reported that "all" or "almost all" heroin in Baltimore was adulterated with fentanyl and were worried (75%) about their drug buddies overdosing on fentanyl. Half (54%) the participants felt that they needed more training to respond to an overdose. Many participants (66%) reported receiving naloxone or a prescription for it, yet only 17% carried naloxone with them "often" or "always." Among people who inject drugs (PWID) only 13% had naloxone available "often" or "always" when they injected with others, and 51% "often" or "always" injected alone. Almost half of participants (47%) were "very willing" to talk with people in their neighborhood about fentanyl. CONCLUSIONS: The majority of PWUO perceived that most heroin in Baltimore was adulterated with fentanyl, yet most did not carry naloxone and PWID often did so alone. Given the high perceived risk of fentanyl and relatively low uptake of fatal overdose prevention behaviors, there is an urgency for safe injection facilities, access to medically assisted treatment, and programs that work with the drug-using community to deliver overdose prevention training as well as promote behaviors to carry naloxone and not use drugs alone.

An examination of grit in black men who have sex with men and associations with health and social outcomes.

AIMS: This study sought to examine the prevalence and correlates of grit in a sample of Black men who have sex with men (BMSM) in Baltimore, Maryland. METHODS: A trained research assistant administered the Short-Grit and Center for Epidemiological Studies Depression (CES-D) scales and surveyed participants of a community-based behavioral health intervention for demographic, health, and sexual behaviors. RESULTS: Of 239 participants, two-thirds scored in the high grit category. A greater proportion of men with high grit demonstrated higher educational attainment, were employed in the prior 6 months, reported very good/excellent health, were human immunodeficiency virus-positive, scored < 16 on the CES-D, and had more friends who were gay. After controlling for other variables, high grit was associated with higher odds of having more friends who are gay and lower odds of alcohol use, unemployment, and a high CES-D score. CONCLUSIONS: These findings demonstrate that grit could be an important mechanism upon which to focus health and behavioral interventions for BMSM.

The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland.

BACKGROUND: There has been a dramatic increase in drug overdose deaths in the United States. In the current study, the authors examined factors associated with witnessing a drug overdose. METHODS: A sample of 450 substance users in Baltimore, Maryland, were recruited for a behavioral intervention and were administered a survey. Multinomial logistic regression models were used to compare participants who never witnessed a drug overdose with those who witnessed one in the prior 6 months and those who witnessed an overdose over 6 months ago. RESULTS: Most (58%) participants were male, 40% experienced homelessness in the prior 6 months, 63% reported a history of heroin injecting, 84% had snorted heroin, 75% reported witnessing a drug overdose, and 38% experienced an overdose. In multinomial logistic regression models, witnessing an overdose in the past 6 months was associated with number of different types of places where drugs were used (adjusted odds ratio [aOR] = 1.34), history of experiencing an overdose (aOR = 1.80), injecting heroin and/or speedball (aOR = 1.78), and snorting heroin (aOR = 1.54). Witnessing an overdose more than 6 months ago was associated with number of different places where drugs were used (aOR = 1.25), history of experiencing an overdose (aOR = 1.61), snorting heroin (aOR = 1.42), and injecting heroin or speedball (aOR = 1.47). CONCLUSIONS: These data suggest that people who engage in more public and frequent drug use, and hence are more likely to witness an overdose, should be targeted for interventions to prevent and treat drug overdose.

People Who Inject Drugs and Have Mood Disorders-A Brief Assessment of Health Risk Behaviors.

BACKGROUND: People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. OBJECTIVES: Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. METHODS: With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. RESULTS: While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.

Associations Between Drug and Alcohol Use Patterns and Sexual Risk in a Sample of African American Men Who Have Sex with Men.

Men who have sex with men (MSM) are the largest risk group in the US HIV epidemic and African American MSM (AA MSM) are disproportionately affected. Substance-abusing sexual minorities warrant attention as they are at elevated risk for HIV, yet are not a homogeneous risk group. The purpose of this study was to use latent class analysis to identify patterns of drug and alcohol use in a sample of 359 AA MSM and examine associations with sexual risk. Three classes were identified: Individuals who used multiple substances (poly-users) (18 %), alcohol/marijuana users (33 %) and individuals who had low probability of reporting drug or problematic alcohol use (50 %). Results from multivariate analysis indicate that poly-users were older and more likely to report sex exchange and recent sexually transmitted infection compared to the other classes. Alcohol and poly-users were more likely to report sex under the influence. Identifying and defining substance use patterns can improve specification of risk groups and allocation of prevention resources.

No one runs alone: Combining community-based program evaluation with photo elicitation interviewing among people experiencing homelessness.

BACKGROUND: Homelessness is associated with poor physical and mental health, but social support may reduce negative health outcomes. A community-academic partnership with Back on My Feet (BoMF), an organization in Baltimore, MD serving people experiencing homelessness, used photo elicitation interviews (PEI) to explore how social interactions within program activities improved mental health among participants. METHODS: Between October 2018 and June 2019, 29 BoMF participants were recruited. Participants were provided digital cameras and photographed what BoMF meant to them. Participants presented photographs in meetings that were audio recorded and transcribed. Thirty-three themes and 44 photographs were generated. Findings were presented at a public photo exhibit. The partnership used content analysis of transcripts to build upon participant-generated themes for peer-review publication. RESULTS: Social interaction among BoMF participants and volunteers helped participants form new positive social networks, often for the first time, which made participants feel valued by their peers. This led to increased self-worth, a greater sense of social support and social connectedness, and confidence that participants could overcome future challenges. CONCLUSIONS: Combining community-based research with PEI provided a nuanced understanding of the mechanisms through with BoMF's activities facilitated positive mental health among participants and was a feasible approach to program evaluation.

"Through the Things That Have Happened to Me, They've Made Me Stronger": Individual and Interpersonal Sources of Violence and Resilience Among a Diverse Sample of Transgender Women in Los Angeles.

Within the United States, transgender women face a disproportionate burden of violence, experiencing increased rates of multiple forms of violence compared with cisgender women and other sexual/gender minority groups. Among transgender women, further racial/ethnic disparities in experiences of violence exist. Resilience has been shown to be protective against the adverse impacts of violence on mental and physical health outcomes, yet little is known about unique sources of resilience, coping, and strength among transgender women. Sixteen in-depth interviews were conducted with a racially diverse sample of transgender women between May and July, 2020 in Los Angeles. Participants were between the ages of 23 and 67 years. Four participants identified as African American/Black, four as Latina, four as White, two as Asian, and two as Native American. Participants were recruited from a local social service organization. Interview questions assessed social network characteristics, experiences of violence, coping mechanisms, and sources of resilience in response to violence. Deductive and inductive coding schemes were used to identify common themes, and data analysis focused upon experiences of violence and sources of resilience/coping. Violence was common among members of the sample, with every participant reporting a history of multiple forms of violence. Violence perpetration came from many sources, including cisgender male strangers, family members, intimate partners, and other transgender women. Women also reported multiple sources of strength and coping, including engaging in self-care and leisure activities, behavioral adaptations, mentorship/support from other transgender women, and striving to "pass" as cisgender. Despite having faced extensive violence, the participants in this sample were resilient, demonstrating many internal and external coping mechanisms and sources of strength. These findings can inform programs and services that target transgender women, providing participants with opportunities to build resilience and other coping mechanisms to buffer the harmful mental and physical health impacts of exposure to violence.