A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men.

Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.

Power and Inequality: Intimate Partner Violence Against Bisexual and Non-Monosexual Women in the United States.

While just over one in three heterosexual women will experience intimate partner violence (IPV) in her lifetime, 61% of bisexual women and 78% of non-monosexual women will. Combining previous research and theories on power, social resources, binegativity, and gender-based violence, this article analyzes the role of power and inequality in non-monosexual women's IPV victimization. Using data from the National Intimate Partner and Sexual Violence Survey, this article first examines rates of IPV victimization for statistically significant differences between monosexual (e.g., only have dating, romantic, and sexual partners of one sex/gender) and non-monosexual (e.g., have dating, romantic, and sexual partners of multiple sexes/genders) women in the United States and, second, introduces theoretically important variables to logistic regression analyses to determine the correlates of IPV victimization among non-monosexual women (age, race ethnicity, income, education, immigration status, and indigeneity; partner gender; sexual identity). Findings indicate that non-monosexual women are more likely to experience sexual, emotional, and psychological/control violence, and intimate stalking, but have an equivalent risk of experiencing physical violence. Moreover, having an abusive partner who is a man, having a lot of relative social power, and self-identifying as "bisexual" are all significant factors in violence victimization. Importantly, this is the first study using nationally representative data that confirms non-monosexual women are particularly at risk for sexual identity-based violence at the hands of their male/man partners, suggesting binegativity and biphobia may indeed be linked to hegemonic masculinity. Suggestions for moving research forward include improving data collection efforts such that we can disentangle gender from sex and individual aggregate power from relationship inequalities, as well as more adequately account for the timing of sexual identity disclosures within relationships, relative to the timing of violent episodes.

Intimate Partner Violence and Mental Health Among Transgender/Gender Nonconforming Adults.

There is significant evidence to suggest that intimate partner violence (IPV) is associated with mental health problems including anxiety and depression. However, this research has almost exclusively been conducted through heteronormative and cisgender lenses. The current study is an exploratory, quantitative analysis of the relationship between experiences of IPV and mental health among transgender/gender nonconforming (TGNC) adults. A national sample of 78 TGNC individuals completed a survey online measuring participants' experiences with IPV and depression, anxiety, and satisfaction with life. Of the sample, 72% reported at least one form of IPV victimization in their lifetime: 32% reported experiencing sexual IPV, 71% psychological IPV, 42% physical IPV, and 29% IPV assault with injury. All four types of IPV were positively associated with anxiety, and all but physical abuse was significantly associated with depression. None of the four types of IPV was associated with satisfaction with life. In a canonical correlation, IPV victimization and mental health had 31% overlapping variance, a large-sized effect. Sexual IPV and anxiety were the highest loading variables, suggesting that TGNC individuals who have experienced sexual IPV specifically tended to have higher levels of anxiety. These findings support previous qualitative, small-sample studies suggesting that IPV is a pervasive problem in the TGNC community. TGNC individuals who have experienced IPV may be at increased risk for mental health problems, and therefore, IPV history may trigger appropriate mental health screenings and referrals for this population in health care settings.

Transgender and gender non-conforming adult preparedness for aging: Concerns for aging, and familiarity with and engagement in planning behaviors.

Background: Research on transgender and gender-nonconforming (TGNC) aging is limited. To date, most of the literature about TGNC aging has focused on discrimination (particularly in healthcare), violence and abuse, caregiving and family relations, and religiosity. Aims: The purposes of this study were to: (a) document concerns about aging among TGNC adults, including concerns that are identity-specific; (b) examine preparation for aging and end of life (i.e., familiarity and planning) among TGNC adults; and (c) examine potential differences in familiarity and planning based on gender identity. Methods: One hundred fifty-four individuals who currently or have ever identified as TGNC completed a national online survey assessing these constructs. Results: TGNC individuals reported many concerns about aging, both gender identity-specific and not. The most common aging concern was losing the ability to care for themselves followed by having to go into a nursing home or assisted living facility. The age preparatory behaviors individuals were most commonly aware of included: life insurance, wills, organ donation, regular medical checkups, living wills, durable power of attorney for healthcare, and trusts. Gender-nonconforming individuals had significantly more familiarity with age preparatory behaviors than trans feminine individuals, but had lower levels of planning to engage in age preparatory behaviors than both trans masculine and trans feminine individuals. Conclusion: The current findings highlight the need for providers to address age preparatory behaviors with TGNC individuals or provide referrals to support individuals in this planning.

The role of syringe exchange programs and sexual identity in awareness of pre-exposure prophylaxis (PrEP) for male persons who inject drugs.

BACKGROUND: Male persons who inject drugs (male PWID) are at heightened risk for HIV, particularly if they also have sex with men. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for this population, but PrEP awareness within different sexual identities among male PWID is not well-understood. We report factors associated with greater awareness among male PWID to identify efficient means of awareness dissemination. METHODS: Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Log-linked Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios and determine differences in awareness of PrEP. RESULTS: Among a sample of 332 male PWID (i.e., PWID who identified as male, not transgender) we find awareness of PrEP to be low (23%) among male PWID despite 68% reporting condomless vaginal/anal sex and 32% reporting injection equipment sharing in the last twelve months. Multivariable analysis found greater PrEP awareness associated with gay or bisexual identity (aPR: 2.77, 95% CI: 1.81-4.24) and having a conversation about HIV prevention at a syringe exchange program (SEP) (aPR: 2.71, 95% CI: 1.87-3.94) to be associated with increased PrEP awareness. CONCLUSION: We found low rates of PrEP awareness among male PWID. However, our findings provide insight into information diffusion that can be utilized to increase PrEP awareness among male PWID and among all PWID. We suggest that gay and bisexual social networks and syringe exchange programs are diffusing PrEP awareness among male PWID and can be harnessed to increase PrEP awareness among male PWID.

Disability, sexual orientation, and the mental health outcomes of intimate partner violence: A comparative study of women in the U.S.

BACKGROUND: Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes-such as anxiety, depression, suicidal ideation, and alcohol use-is lacking. OBJECTIVE: To examine the impact of the intersection of disability and sexual orientation on women's post-intimate partner violence mental health outcomes: including difficulty sleeping, missing school or work, or reporting some post-traumatic stress disorder symptomology and a self-reported subjective measure of overall wellbeing. METHODS: Data come from the National Intimate Partner and Sexual Violence Survey (2010). A series of chi-square analyses were conducted (applying standardized sample weights and adjusting standard errors for both clustering and stratification for survey data). RESULTS: Bisexual women are significantly more likely than straight women to report being disabled prior to victimization, but all disabled women-regardless of sexual orientation-are equivalently likely to rate their mental health as poor and/or actively experience difficulty sleeping, difficulty going to work or school, and/or PTSD. CONCLUSIONS: Aligned with previous work, this study finds that bisexual women are significantly more likely than straight women to be disabled prior to experiencing all forms of intimate partner violence; and that disabled women, generally, are significantly more likely than not-disabled women to experience the negative mental health consequences of that violence. However, contrary to previous work, there are no sexual orientation disparities in said mental health outcomes among disabled women. Clinically, it is important for health care providers to be aware of the significant impact of intimate partner violence on the disabled women they regularly provide care to.

Invisibility Is Not Invincibility: The Impact of Intimate Partner Violence on Gay, Bisexual, and Straight Men's Mental Health.

Intimate partner violence (IPV) is a critical public health problem. However, there is limited research conducted on and about men who are survivors. This project extends previous research by examining the post-traumatic impact of diverse forms of IPV (sexual, physical, emotional, control, and stalking) on the internalized and externalized mental health of gay, bisexual, and straight men. Using data from the National Intimate Partner and Sexual Violence Survey (2011; N = 18,957), we find that all men are equally likely to report emotional victimization and controlling tactics (with between 50% and 70% doing so), while bisexual men are significantly more likely to report physical and sexual violence and gay men are significantly more likely to report intimate stalking. Due to these experiences, gay men are significantly more likely to report missing school or work, but bisexual men are significantly more likely to rate their current overall mental health as poor. Around 10% of all men, regardless of sexual orientation, report post-traumatic stress disorder symptomology and 30% of all men report difficulty sleeping. This research suggests that sexual orientation is a critical area of focus in the study of violence and mental health for men and that we can no longer ignore the voices and needs of men survivors: Invisibility is not invincibility.

Patterns of Intimate Partner Violence Victimization and Perpetration Among Sexual Minority Women: A Latent Class Analysis.

This study explored patterns of intimate partner violence (IPV) victimization and perpetration in 150 sexual minority women (SMW): 25.3% had been sexually victimized, 34% physically victimized, 76% psychologically victimized, and 29.3% suffered an IPV-related injury. A latent class analysis found four behavioral patterns: (1) minor-only psychological perpetration and victimization; (2) no IPV; (3) minor-severe psychological, physical assault, and injury victimization, and minor-only psychological, physical, and injury perpetration; and (4) severe psychological, sexual, physical assault, and injury victimization and perpetration. Individuals who experienced and/or perpetrated all types experienced the greatest heterosexism at work, school, and in other contexts.