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Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25-3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65-5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88-6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan - highlighting need for intervention efforts targeting the most marginalized groups.
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COVID-19 , Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Homosexualidad Masculina , Kazajstán , Pandemias , Infecciones por VIH/epidemiología , Estigma Social , COVID-19/epidemiologíaRESUMEN
Purpose: Rigorous adaptation methods are needed to revise existing evidence-based behavioral interventions for implementation for new target populations, revised/updated outcomes, new delivery modalities, recent advances, and new technologies. We describe an adaptation method designed to overcome the real-world challenges of having very limited existing expertise, resources, and time. Method: This adaptation method and accompanying visualization tool ("Deconstruction/Reconstruction Matrix") preserves theoretical mechanisms of behavior change, accounts for challenges in utilizing new technologies, and strengthens clinical processes, with an emphasis on safety. Results: The adaptation of an in-person HIV behavioral intervention for sexual and gender diverse men in Kazakhstan to one delivered remotely via telecommunication and social media technologies exemplifies the process and strengths of the method, concomitantly resulting in recommendations for adaptation and implementation of mobile health (mHealth) and digital health interventions. Discussion: This method allows researchers and clinicians to adapt interventions rapidly and rigorously and to benefit from new technologies.
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Although HIV incidence is rising among gay, bisexual, and other men (MSM) and transgender people who have sex with men (TSM) in Kazakhstan, whether stigmatizing attitudes and connectedness are associated with HIV testing in this region is not known. We analyzed data from one-time interviews with 304 adult MSM and TSM conducted 2018-2019 in three cities in Kazakhstan. Logistic regression determined whether HIV stigma, internalized homophobia, sexual and gender minority (SGM) connectedness predicted HIV testing (within the lifetime, past year, and past 6 months) before and after adjustment for sociodemographic characteristics. 80% of participants reported ever receiving an HIV test. Gay-identified participants reported less HIV stigma and internalized homophobia as well as greater connectedness relative to those with bisexual or other identities. In adjusted models, those who had ever tested reported lower HIV stigma (aOR 0.83, 95% CI 0.76-0.91, P < .001) and higher connectedness (aOR 1.17, 95% CI 1.06-1.29, P = .003) than those who had not; those who had ever tested reported lower internalized homophobia in the unadjusted model only (OR 0.95, 95% CI 0.91-0.99, P = .01). Similar differences and trends were found in models examining testing in the past year and past 6 months. Addressing stigmatizing attitudes and connectedness may improve uptake of HIV testing among MSM and TSM in Kazakhstan.
RESUMEN: Aunque la incidencia del VIH está aumentando entre homosexuales, bisexuales y otros hombres (HSH) y entre personas transgénero que tienen sexo con hombres (TSM) en Kazajistán, se desconoce si las actitudes estigmatizantes y la conexión están asociadas con las pruebas del VIH en esta región. Analizamos datos de entrevistas únicas con 304 HSH adultos y TSM realizadas en 2018-2019 en tres ciudades de Kazajistán. La regresión logística determinó si el estigma del VIH, la homofobia internalizada, la conexión de las minorías sexuales y de género (SGM) predijeron la prueba del VIH (durante la vida, el año pasado y los últimos 6 meses) antes y después del ajuste por características sociodemográficas. El 80% de los participantes informaron haber recibido alguna vez una prueba de VIH. Los participantes identificados como homosexuales informaron menos estigma del VIH y homofobia internalizada, así como una mayor conexión en relación con aquellos con identidades bisexuales u otras. En modelos ajustados, aquellos que alguna vez se habían hecho la prueba informaron un menor estigma del VIH (ORa 0,83, IC del 95% 0,76-0,91, P <0,001) y una mayor conectividad (OR 1,17, IC del 95% 1,06-1,29, P = 0,003) que aquellos quien no lo había hecho; aquellos que alguna vez habían realizado la prueba informaron una menor homofobia internalizada solo en el modelo no ajustado (OR 0,95; IC del 95%: 0,91-0,99; p = 0,01). Se encontraron diferencias y tendencias similares en modelos que examinaron las pruebas en el último año y los últimos 6 meses. Abordar las actitudes estigmatizantes y la conexión pueden mejorar la aceptación de las pruebas del VIH entre los HSH y TSM en Kazajistán.
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Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Adulto , Infecciones por VIH/diagnóstico , Prueba de VIH , Homofobia , Homosexualidad Masculina , Humanos , Kazajstán , Masculino , Conducta Sexual , Estigma SocialRESUMEN
Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016-2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny's approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Importance: HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. Objective: To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. Design: We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. Setting: We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Participants: Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. Intervention: The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Main outcome measures: Received an HIV test in the prior six months. Results: There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city ( AOR =1.08, 95% CI =1.05-1.12; p <.001). Conclusions: The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. Trial Registration: This trial is registered with clinicaltrials.gov ( NCT02786615 ). Funding: National Institute on Drug Abuse (NIDA), grant number R01DA040513. KEY POINTS: Question: Does the PRIDE in HIV Care intervention exert a community effect of increasing HIV testing among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM) in Kazakhstan? Findings: We employed a stepped-wedge, cluster-randomized controlled trial among three cities in Kazakhstan. There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city.Meaning: The intervention increased HIV testing among MSM and TSM in Kazakhstan who had not directly received the intervention, providing support for a community-wide impact.
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We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.
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Infecciones por VIH , Prueba de VIH , Hispánicos o Latinos , Parejas Sexuales , Minorías Sexuales y de Género , Femenino , Humanos , Masculino , Hispánicos o Latinos/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Prueba de VIH/estadística & datos numéricos , Homosexualidad Masculina/etnología , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Conducta Sexual , Estados Unidos/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Racismo/etnología , Racismo/estadística & datos numéricos , Homofobia/etnología , Homofobia/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Determinantes Sociales de la SaludRESUMEN
Limited research has examined prevalence rates and associations related to exchange sex behaviors among gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan. This study aimed to examine associations between earlier sexual debuts and lifetime exchange sex behaviors among Kazakhstani MSM. Using data from a National Institute on Drug Abuse-funded Human Immunodeficiency Virus (HIV) prevention trial, we conducted a secondary analysis of self-reported data from 766 adult cisgender MSM in Kazakhstan, who completed structured screening interviews. Earlier sexual debuts were measured as age of sexual onset prior to 16 years old with ages 16 and older as the reference group. Logistic regression models were used to estimate associations between earlier sexual debuts and lifetime reports of buying or selling sex for resources, with covariance adjustment for sociodemographic characteristics. The study findings indicated that, among our sample of MSM in Kazakhstan, 23% had sold sex, and 26% had bought sex in their lifetime. Kazakhstani MSM who reported an earlier sexual debut had significantly higher odds of ever selling or buying sex in their lifetime. Future research should examine how consensual and non-consensual sexual activities during childhood and adolescence relate to exchange sex behaviors and risk among MSM.
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Infecciones por VIH , Minorías Sexuales y de Género , Adulto , Humanos , Masculino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Kazajstán/epidemiología , Asunción de Riesgos , Conducta SexualRESUMEN
Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut-categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group-and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences.
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Víctimas de Crimen , Minorías Sexuales y de Género , Adulto , Masculino , Adolescente , Humanos , Niño , Homosexualidad Masculina , Kazajstán , Conducta SexualRESUMEN
A new I(-)/(SeCN)(2) redox mediator has favorable properties for dye-sensitized solar cells (DSCs) such as less visible light absorption, higher ionic conductivity, and downward shift of redox potential than I(-)/I(3)(-). It was then applied for DSCs towards increasing energy conversion efficiency, giving a new potential for improving performance.
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This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.
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Infecciones por VIH , Minorías Sexuales y de Género , Trastornos Relacionados con Sustancias , Personas Transgénero , Infecciones por VIH/prevención & control , Prueba de VIH , Homosexualidad Masculina , Humanos , Kazajstán/epidemiología , Masculino , Conducta Sexual , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18-26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission-particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.
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Negro o Afroamericano/psicología , Infecciones por VIH/prevención & control , Homosexualidad Masculina/etnología , Asunción de Riesgos , Trastornos Relacionados con Sustancias/psicología , Adolescente , Adulto , Homosexualidad Masculina/psicología , Humanos , Masculino , Ciudad de Nueva York , Conducta Sexual , Parejas Sexuales , Trastornos Relacionados con Sustancias/etnología , Sexo Inseguro , Adulto JovenRESUMEN
The complexation of Cu with phenol was investigated in aqueous solution to find the changes in toxicity toward Daphnia magna in mixtures of copper and phenol derivatives and determine an appropriate prediction model for the toxicity of these mixtures. In the titration experiment, the results showed that phenol played an important role in the remarkable reduction of the Cu(2+) concentration, due to its complexation with Cu, with the subsequent reduction in the toxicity of aqueous mixtures containing both Cu and phenol. As a result, it was clearly demonstrated that Cu-phenol formed a non-toxic complex toward D. magna as the mortality declined, despite the addition of phenol to a fixed Cu concentration. Meanwhile, prediction of the combined toxicity for binary mixtures of Cu and 11 phenol derivatives more accurately followed an independent action model (p = 0.143, df = 124, and t = -1.475 in t-test) than an effect summation model (p approximately 0, df = 134, and t = 7.528 in t-test) due to the dissimilar modes of action and the complexation reactions between Cu and each of the phenolic compounds. Consequently, this study supports the importance of considering complexation reactions in assessing the combined toxicity for the formulation of water quality in mixtures of heavy metals and organic compounds, and in these cases, an independent action model was found to be appropriate.
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Cobre/toxicidad , Daphnia/efectos de los fármacos , Fenoles/toxicidad , Contaminantes Químicos del Agua/toxicidad , Abastecimiento de Agua , Animales , Daphnia/metabolismo , Relación Dosis-Respuesta a Droga , Minería , Mortalidad , Aguas del Alcantarillado/químicaRESUMEN
Dye aggregation and electron recombination in TiO2 photoanodes are the two major phenomena lowering the energy conversion efficiency of dye-sensitized solar cells (DSCs). Herein, we introduce a novel surface modification strategy of TiO2 photoanodes by the fluorinated self-assembled monolayer (F-SAM) formation with 1H,1H,2H,2H-perfluorooctyltriethoxysilane (PFTS), blocking the vacant sites of the TiO2 surface after dye adsorption. The F-SAM helps to efficiently lower the surface tension, resulting in efficient repelling ions, e.g., I3(-), in the electrolyte to decrease the electron recombination rate, and the role of F-SAM is characterized in detail by impedance spectroscopy using a diffusion-recombination model. In addition, the dye aggregates on the TiO2 surface are relaxed by the F-SAM with large conformational perturbation (i.e., helix structure) seemingly because of steric hindrance developed during the SAM formation. Such multifunctional effects suppress the electron recombination as well as the intermolecular interactions of dye aggregates without the loss of adsorbed dyes, enhancing both the photocurrent density (11.9 â 13.5 mA cm(-2)) and open-circuit voltage (0.67 â 0.72 V). Moreover, the combined surface modification with the F-SAM and the classical coadsorbent further improves the photovoltaic performance in DSCs.
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3D TiO2 photoanodes in dye-sensitized solar cells (DSCs) are fabricated by the soft lithographic technique for efficient light trapping. An extended strategy to the construction of randomized pyramid structure is developed by the conventional wet-etching of a silicon wafer for low-cost fabrication. Moreover, the futher enhancement of light absorption resulting in photocurrent increase is achieved by combining the 3D photoanode with a conventional scattering layer.
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Colorantes/química , Suministros de Energía Eléctrica , Luz , Microtecnología/métodos , Semiconductores , Energía Solar , Electrodos , Titanio/químicaRESUMEN
A compact TiO2 layer (~1.1 µm) prepared by electrostatic spray deposition (ESD) and swift heavy ion beam (SHI) irradiation using oxygen ions onto a fluorinated tin oxide (FTO) conducting substrate showed enhancement of photovoltaic performance in dye-sensitized solar cells (DSSCs). The short circuit current density (Jsc = 12.2 mA cm(-2)) of DSSCs was found to increase significantly when an ESD technique was applied for fabrication of the TiO2 blocking layer, compared to a conventional spin-coated layer (Jsc = 8.9 mA cm(-2)). When SHI irradiation of oxygen ions of fluence 1 × 10(13) ions/cm(2) was carried out on the ESD TiO2, it was found that the energy conversion efficiency improved mainly due to the increase in open circuit voltage of DSSCs. This increased energy conversion efficiency seems to be associated with improved electronic energy transfer by increasing the densification of the blocking layer and improving the adhesion between the blocking layer and the FTO substrate. The adhesion results from instantaneous local melting of the TiO2 particles. An increase in the electron transport from the blocking layer may also retard the electron recombination process due to the oxidized species present in the electrolyte. These findings from novel treatments using ESD and SHI irradiation techniques may provide a new tool to improve the photovoltaic performance of DSSCs.
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Inorganic/organic nanocomposite counter electrodes comprised of sheetlike CoS nanoparticles dispersed in polystyrenesulfonate-doped poly(3,4-ethylenedioxythiophene (CoS/PEDOT:PSS) offer a synergistic effect on catalytic performance toward the reduction of triiodide for dye-sensitized solar cells (DSSCs), yielding 5.4% power conversion efficiency, which is comparable to that of the conventional platinum counter electrode (6.1%). The electrochemical impedance spectroscopy (EIS) and cyclic voltammetry measurements revealed that the composite counter electrodes exhibited better catalytic activity, fostering rate of triiodide reduction, than that of pristine PEDOT: PSS electrode. The simple preparation of composite (CoS/PEDOT:PSS) electrode at low temperature with improved electrocatalytic properties are feasible to apply in flexible substrates, which is at most urgency for developing novel counter electrodes for lightweight flexible solar cells.
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Electroquímica/métodos , Electrodos , Nanocompuestos/química , Nanopartículas/química , Catálisis , Nanotecnología , Tiofenos/químicaRESUMEN
Benign osteoblastoma is an uncommon primary bone tumor, extremely rare in calvarium. We present a case of a 25-year-old female with an osteoblastoma of parietal bone which was totally resected. The authors discussed the clinical presentation, radiographic finding, differential diagnosis and management of the benign calvarial osteoblastoma with a review of the literature.