Acceptability and Feasibility of a Tai Chi/Qigong Intervention for Older People Living With HIV.

Tai chi/qigong (TCQ) is a low impact, meditative movement with breathwork that may benefit people with HIV (PWH) over 50 years old. This study is a feasibility clinical trial of a remote TCQ intervention for older PWH. Participants (n = 48) were recruited via clinic sites and social media and randomized to a TCQ, sham qigong, or wait-list control group. The 12-week intervention included fourteen 45-60-minute sessions. Acceptability (satisfaction, attitudes, practice, attendance) and feasibility (retention rate, adverse events, remote delivery) data were surveyed. Overall retention rate was 72.9%, but 81.2% for the TCQ group. Most TCQ participants attended at least 10 sessions (62.5%) and were practicing TCQ after 2 weeks (72.7%). Over 92% of TCQ participants reported satisfaction and positive attitudes and preferred remote versus in person delivery (63.6%). Two mild intervention related adverse events occurred. Findings suggest that a remote TCQ intervention is acceptable, feasible, and safe among older PWH.

RESUMEN: Tai chi/qigong (TCQ) es un movimiento meditativo de bajo impacto con ejercicios de respiración que puede beneficiar personas que viven con VIH (PVV) mayores de 50 años. Este estudio es un ensayo clínico de viabilidad que evalúa una intervención de TCQ administrada remotamente para personas mayores que viven con VIH. Participaron personas (n = 48) reclutadas en clínicas y redes sociales, asignadas aleatoriamente a un grupo de TCQ, qigong falso, o control en lista de espera. La intervención duró 12 semanas con catorce sesiones de 45 a 60 minutos. Se encuestaron datos sobre aceptabilidad (satisfacción, actitudes, práctica, asistencia) y viabilidad (retención, eventos adversos, entrega remota). La tasa de retención general fue del 72,9%, pero del 81,2% para el grupo de TCQ. La mayoría de los participantes de TCQ asistieron a al menos 10 sesiones (62,5%) y continuaron practicando después de 2 semanas (72,7%). La satisfacción y las actitudes positivas hacia la intervención fueron reportadas por más del 92% de los participantes de TCQ quienes prefirieron la participación remota contra clases en persona (63,6%). Dos eventos adversos leves relacionados con la intervención ocurrieron. Los resultados sugieren que una intervención de TCQ administrada de forma remota es aceptable, viable y seguro para personas mayores que viven con VIH.

Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression.

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.

RESUMEN: Evaluamos el rol de la atención centrada en el paciente en la supresión viral duradera (es decir, todos los resultados de las pruebas de carga viral < 200 copias por ml durante 2019) mediante la realización de un estudio de cohorte retrospectivo de clientes manejados médicamente por el Programa Ryan White del condado de Miami-Dade (RWP). Se obtuvieron medidas resumidas de las prácticas de atención centradas en el paciente de los proveedores afiliados a RWP usando una encuesta de 1352 clientes. Los modelos de redes bayesianos analizaron la relación compleja entre los factores psicosociales y de atención centrada en el paciente. De 5037 clientes, 4135 (82,1%) tenían una supresión viral duradera. Los ingresos del hogar fueron el factor asociado con la supresión viral duradera más fuerte. Además, la puntuación promedia de la relación con proveedores de atención médica y la puntuación promedia de "el proveedor conoce al paciente como persona" fueron asociados con una supresión viral duradera. La puntuación de la relación con proveedores de atención médica moderó la asociación entre los ingresos bajos del hogar y la falta de supresión viral duradera. Aunque la atención centrada en el paciente apoya el éxito de la atención médica del VIH, también se necesita un apoyo integral para las personas con necesidades psicosociales insatisfechas.

Comorbidities among persons living with HIV (PLWH) in Florida: a network analysis.

People living with HIV (PLWH) experience a higher rate of age-related comorbidities at younger ages. Understanding common comorbidities among PLWH and their relationship to one another could be significant in improving aging for PLWH. The goal of the present study is to identify the most common comorbidities among PLWH and the relationship between them using network analysis. We used abstracted electronic medical record (EMR) data of PLWH from the Florida Cohort study, a prospective cohort study conducted in eight cities in Florida, USA. We used International Classification of Diseases (10th revision, ICD-10) code to classify comorbidities and organ systems. Network analysis was conducted to determine the degree and betweenness centrality among comorbidities. We included 756 PLWH with an average age of 46.4 years (SD 11.3) in the analysis. Infectious diseases (A00-B99, 50.8%), mental and behavioural (F01-F99, 47.0%), endocrine, nutritional and metabolic (E00-E88, 45.2%), and circulatory (I00-I99, 39%) disorders were the most prevalent system comorbidities among PLWH. Hypertensive disorder (I10-I1635.8%), dyslipidaemia (E78, 25.7%) and major depressive disorder (F32-F33, 23.9%) were the most common non-infectious conditions affecting PLWH. Viral hepatitis (B15-B19, 17.1%) and syphilis (A15-A53, 12%) were the most common coinfections among PLWH. Hypertension, dyslipidaemia and major depressive disorder were the most central of the comorbidities among PLWH. Comorbidities among PLWH were most prevalent for chronic disease and mental illness. Targeting shared disease risk factors in addition to monitoring known pathological pathways may prevent comorbidities among PLWH.

A Content Analysis of HIV-Related Stigmatizing Language in the Scientific Literature, From 2010-2020: Findings and Recommendations for Editorial Policy.

Despite negative effects of HIV-related stigma on people with HIV, some scientific literature continues to use stigmatizing terms. Our study aimed to explore the use of HIV-related stigmatizing language in the scientific literature between 2010 and 2020 based on 2015 UNAIDS terminology guidelines. We searched for articles with the stigmatizing term "HIV/AIDS-infected" or any variations that were peer-reviewed, published between 2010 and 2020, and in English or with an English translation. Our search yielded 26,476 articles that used the stigmatizing term of interest. Frequencies on the variables of interest (journal, year, and country) were run. The use of these terms increased from 2010 to 2017 and decreased from 2018 to 2020. Most journals using the terms were HIV/AIDS specific or on infectious diseases, but the journal with the greatest frequency of use was on general science and medicine. Thirty-six percent of the articles emanated from the United States. To reduce the use of stigmatizing language in the HIV literature, action should be taken by authors, reviewers, editors,educators, and publishers should create formal policies promoting use of non-stigmatizing language.

Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change.

Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.

Examining the Psychometrics of the National HIV Behavioral Surveillance Measure for Community HIV-Related Stigma.

The research tested the psychometrics of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS) community HIV-related stigma scale. Data was from men who have sex with men (MSM) NHBS cycles conducted 2011-2017 in Miami-Dade, Florida among n = 1455 participants. MSM were cis-gender male, 18+ years old, reported lifetime oral/anal sex with a male, and lived in Miami-Dade County. We assessed reliability using Cronbach's alpha and McDonald's omega, determined factors using principal factor analysis, and assessed construct validity using five a priori hypotheses. The scale was unidimensional, had questionable internal reliability (α = 0.68, ω = 0.69), and met four of five a priori hypotheses in the expected direction. Correlations were medium-weak in strength and only one was consistently met. Future iterations of the NHBS survey should consider replacing the 4-item community HIV-related stigma scale with an instrument that has superior internal reliability, measures multiple HIV-related stigma dimensions, and demonstrates stronger evidence of validity.

RESUMEN: La investigación evaluó la psicometrías de la escala comunitaria de estigma relacionada con el VIH de La Vigilancia del Comportamiento Nacional del VIH de los Centros de Control y la Prevención de Enfermedades (National HIV Behavioral Surveillance, NHBS por sus siglas en Ingles). Los datos fueron de hombres que tienen sexo con hombres (HSH) ciclos NHBS realizados 2011­2027 en Miami-Dade, Florida entre n = 1455 participantes. Los HSH eran hombres cisgénero, mayores de 18 años, reportando haber tenido sexo oral/anal de toda la vida con un hombre y vivían en el condado de Miami-Dale. Evaluamos la confiabilidad usando el alfa de Cronbach y el omega de McDonald, determinamos los factores usando el análisis de factores principales y evaluamos la validez de constructo usando cinco hipótesis a priori. La escala era unidimensional, tenía una fiabilidad interna cuestionable (α = 0.68, ω = 0.69), y cumplía cuatro de cinco hipótesis a priori en la dirección esperada. Las correlaciones fueron de intensidad media-débil y solo una se cumplió de manera consistente. Las iteraciones futuras de la encuesta NHBS debería considerar reemplazar la escala comunitaria de estigma relacionada con el VIH de 4 ítems por un instrumento que tenga una confiabilidad interna superior, mida múltiples dimensiones del estigma relacionado con el VIH y demuestre una evidencia mas solida de validez.

Changes in Mental Health Among People with HIV During the COVID-19 Pandemic: Qualitative and Quantitative Perspectives.

People with HIV (PWH) are at risk for adverse mental health outcomes, which could be elevated during the COVID-19 pandemic. This study describes reasons for changes in mental health among PWH during the pandemic. Data come from closed- and open-ended questions about mental health changes from a follow-up to a cohort study on PWH in Florida during part of the COVID-19 pandemic (May 2020-March 2021). Qualitative data were analyzed using thematic analysis. Among the total sample of 227 PWH (mean age 50.0, 49.7% men, 69.2% Black/African American, 14.1% Hispanic/Latino), 30.4% reported worsened mental health, 8.4% reported improved mental health, and 61.2% reported no change. The primary reasons for worsened mental health were concerns about COVID-19, social isolation, and anxiety/stress; reasons for improved mental health included increased focus on individual wellness. Nearly one-third of the sample experienced worsened mental health. These results provide support for increased mental health assessments in HIV treatment settings.

Condom use likelihood within the context of PrEP and TasP among men who have sex with men in Florida: a short report.

Despite the development of targeted interventions for men who have sex with men, this population continues to comprise the majority of new HIV diagnoses. Though condoms are highly efficacious, some sexually active MSM use sero-sorting as a method of HIV prevention. This study aimed to characterize: (1) differences between partner sero-status and condom use likelihood, and (2) demographic, behavioral, and knowledge-related factors influencing condom use likelihood with varying sero-status partners. Using convenience sampling, 150 sexual and gender minority men completed a survey on PrEP and sexual behaviors. The majority of participants identified as racial/ethnic minorities (51.7%), having 4 years of college or more (52.0%), and being HIV-negative (not on PrEP) (68.8%). Our sample reported the lowest average condom use likelihood with a partner on PrEP (2.93 ± 1.39) and the highest average likelihood with an HIV-positive partner (unknown VL) (4.57 ± 0.98). Age, race/ethnicity, education, HIV-status, and HIV and PrEP knowledge were significantly associated with differences in condom use likelihood. Our findings elucidate the complexity of sero-sorting scenarios and decision-making processes in the context of biomedical HIV prevention. These results may provide insight for future condom use and sero-sorting interventions in the context of biomedical HIV prevention.

Gay Neighborhoods: Can They Be Identified in a Systematic Way Using Latent Class Analysis?

Identifying gay neighborhoods could help in targeting HIV prevention efforts for men who have sex with men. This study's purpose was to identify gay neighborhoods using latent class analysis (LCA). Data at the ZIP code level were drawn from the American Community Survey, website lists of gay bars and neighborhoods, and the Florida Department of Health HIV surveillance system. A two-class model was selected based on fit. About 9% of the ZIP code data was in class two, which was designated as gay neighborhoods. Cohen's kappa coefficient was used to examine agreement between the classification of ZIP codes from LCA and websites. Fair agreement was found (0.2501). Gay neighborhoods could serve as a place to disseminate information about pre-exposure prophylaxis and other methods for HIV prevention. Improved measures, such as the planned question about same-sex spouses for the 2020 US Census, are needed to identify gay neighborhoods in population-level surveys.

Acting with awareness moderates the association between lifetime exposure to interpersonal traumatic events and craving via trauma symptoms: a moderated indirect effects model.

BACKGROUND: History of exposure to traumatic events (ETE) is common among women in substance use disorder (SUD) treatment and is related to craving. We examined whether ETE (i.e., emotional, physical, sexual abuse) in childhood, adulthood, or both is related to craving via trauma symptoms and how trait mindfulness might attenuate this association. METHODS: Baseline data from a larger randomized clinical trial of a mindfulness-based intervention for women (N = 245) in SUD treatment were used. Inclusion criteria were: 18-65 years of age, SUD diagnosis, English fluency, no cognitive impairment, and willingness to be audio recorded and provide consent. Demographics and validated measures of ETE, posttraumatic stress symptoms, trait mindfulness, and substance use craving were collected via in-person interviews. Descriptive statistics, correlational analysis, and relative direct, indirect, and conditional indirect effects models were run. RESULTS: Most participants identified as Hispanic (58.5%), had at least a high school education (52.2%), with a mean age of 32.2. Women reported ETE in childhood only (20.4%), adulthood only (17.5%), both childhood and adulthood (50.0%), and never (11.4%). Compared to women with ETE in both childhood and adulthood, those with exposure in adulthood only (ß = -.10, 95% CI = -.20, -.02) or no exposure (ß = -.11, 95% CI = -.23, -.03; [∆R2= .347, F(8, 245) = 15.7, p < .001) had lower craving via lower trauma symptomatology but no difference when compared to those with ETE only in childhood. Acting with awareness moderated this indirect effect (∆R2 = .04, F(3, 245) = 4.66, p = .004. At low levels of awareness, women with ETE during both childhood and adulthood reported higher craving via trauma symptomatology than women with no exposure or only adulthood exposure. CONCLUSIONS: Low levels of acting with awareness may worsen trauma symptoms after ETE, which in turn may lead to more craving for women in substance use treatment. Despite a small moderating effect size, acting with awareness may have clinical significance due to the prevalence of trauma symptoms among women in SUD treatment.

Incarceration History and HIV Care Among Individuals Living with HIV in Florida, 2014-2018.

The present study examines the HIV continuum of care outcomes among people living with HIV (PLWH) who have either recent (< 12-months) or distal (> 12-months) incarceration history compared to those without an incarceration history. A self-administered survey (as part of the Florida Cohort Study (n = 932)) was used to collect data on demographic information, linkage to care, retention in care, HIV medication adherence, viral suppression, and incarceration history. Those with recent incarceration history were least likely to report HIV medication adherence greater than or equal to 95% of the time (χ2 = 8.79; p = 0.0124), always take their medications as directed (χ2 = 15.29; p = 0.0005), and to have durable viral suppression (χ2 = 16.65; p = 0.0002) compared to those distally or never incarcerated. In multivariable analyses, those never and distally incarcerated had greater odds of care linkage ([vs recently incarcerated] AOR = 2.58; CI: 1.31, 5.07; p = 0.0063, AOR = 2.09; CI: 1.11, 3.95; p = 0.0228, respectively). Those never incarcerated had greater odds of taking ART as directed ([vs recently incarcerated] AOR = 2.53; CI: 1.23 - 5.19; p = 0.0116). PLWH with an incarceration history may need more on-going monitoring and follow-up HIV care than those without previous incarceration regardless of when incarceration occurred.

RESUMEN: El presente estudio examina el cuidado continuo entre las personas que viven con VIH (PVVS) con antecedentes penales recientes (en los últimos 12 meses) o más (> 12 meses) en comparación con aquellos sin antecedentes penales. Se utilizaron datos del Estudio de Cohorte de la Florida (n = 932). Se utilizó una encuesta auto administrada para recopilar datos sobre variables demográficas, vínculo al cuidado, retención al cuidado, adherencia a medicamentos contra el VIH, supresión viral e historial de encarcelamiento. Aquellos con antecedentes penales recientes fueron menos probable de reportar adherencia a medicamentos contra el VIH, mayor o igual a, el 95% de las ocasiones (χ2 = 8.79; p = 0.0124), tomando siempre sus medicamentos según las instrucciones (χ2 = 15.29; p = 0.0005), y tener una supresión viral duradera (χ2 = 16.65; p = 0.0002) en comparación con los encarcelados en el pasado o nunca encarcelados. En los análisis multivariables, aquellos que nunca fueron encarcelados y aquellos que estuvieron encarcelados hace mucho tiempo atrás tuvieron mayor probabilidad de estar vinculados con el cuidado médico ([en contraste con aquellos recientemente encarcelados]AOR = 2.58; CI: 1.31, 5.07; p = 0.0063, AOR = 2.09; CI: 1.11, 3.95; p = 0.0228, respectivamente). Aquellos que nunca fueron encarcelados tuvieron mayor probabilidad de tomar la TAR según indicado ([en contraste con aquellos recientemente encarcelados] AOR = 2.53; CI: 1.23 ­ 5.19; p = 0.0116). PVVS con historial de encarcelamiento necesitan más monitoreo y cuidado de seguimiento continuo en comparación con aquellos sin encarcelaciones previas, independientemente de cuando ocurrió el encarcelamiento.

Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida.

Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI] 3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.

RESUMEN: Investigaciones previas han documentado que el estigma relacionado con el VIH contribuye al alto riesgo de trastornos de salud mental entre las personas que viven con VIH. Nuestro estudio examina la asociación entre el estigma declarado y síntomas de ansiedad y depresión entre las personas que viven con VIH. Utilizamos datos de referencia recopilados por el "Florida Cohort Study" de 932 personas que viven con VIH. La mayoría de la muestra sobrepasaba 45 años (63.5%), era masculina (66.0%), y racialmente negra (58.1%). La mayoría había experimentado estigma declarado (53.1%). Además, 56.5% y 65.2% mostro niveles de síntomas leves a moderados/severos de ansiedad y depresión, respectivamente. Aquellos que experimentaron cualquier nivel de estigma declarado (vs ninguno) tenían mayores probabilidades de niveles de síntomas leves y moderados/severos de ansiedad (vs ninguno) (ORa[IC] 1.54[1.13, 2.10], p = 0.006; ORa[IC] 3.36[2.14, 5.26], p < 0.001, respectivamente) y depresión (ORa[IC] 1.61[1.19, 2.18], p = 0.002; ORa[IC] 3.66[2.32, 5.77], p < 0.001, respectivamente). Los resultados sugieren la necesidad de evaluar las intervenciones para las personas que viven con VIH para reducir los efectos nocivos del estigma declarado en la salud mental.

HIV testing intentions and cognitive reappraisal among Latino emerging adults.

Negative emotions related to HIV testing may influence an individual's intentions to test for HIV. However, emotion regulation strategies such as cognitive reappraisal which involves reframing the meaning of an event to modify one's emotional response to it may potentially help to regulate these emotions and facilitate decisions to get tested for HIV. In this exploratory study, we examined the association between cognitive reappraisal and HIV testing intentions and whether this association differs by gender. Cross-sectional data were collected from a convenience sample of 157 Latino emerging adults aged 18-25 years living in Arizona and Florida through an online survey. Hierarchical logistic regression models were used to analyze the data. Results indicated that cognitive reappraisal was significantly associated with HIV testing intentions (aOR: 1.44, 95% CI:1.04-1.99) and that this association was specific to females (aOR: 2.48, 95% CI: 1.39-4.43). Our results demonstrate the potential of cognitive reappraisal to facilitate HIV testing intentions among females. HIV prevention interventions should incorporate cognitive reappraisal training to regulate and adapt to the negative emotions associated with HIV testing in efforts to increase HIV testing.

PrEP awareness among people living with HIV in Florida: Florida Cohort study.

In 2017, Florida ranked 2nd nationally in prevalence and incidence rates of HIV infections in the United States. Due to the high burden of HIV and low viral suppression in Florida, it is of increased importance to study methods of HIV prevention such as preexposure prophylaxis(PrEP) in this state. Our study aimed to examine correlates of PrEP awareness among PLWH in Florida and describe patterns of PrEP awareness/information sources. Using data collected from the Florida Cohort study between 2014 and 2018, 530 PLWH answered items that were hypothesized to be correlated with PrEP awareness. Of our sample, 53.8% were aware of PrEP. Urban location of recruitment, sexual partner's use of PrEP, use of viral suppression as an HIV prevention strategy, and engagement in transactional sex were all significantly associated with higher odds of PrEP awareness. Care providers and HIV/AIDS support groups were the most frequently listed sources of PrEP awareness, sources of future PrEP information, and most trusted sources for PrEP information. Findings from this study could inform future interventions that aim to increase PrEP awareness among PLWH to increase PrEP awareness and uptake among their HIV-negative social and sexual networks.

The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.

HIV-related stigma and life goals among people living with HIV (PLWH) in Florida.

PURPOSE: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida. METHODS: We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal's difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models. RESULTS: The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (ß = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (ß = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (ß = 0.001[- 0.002, 0.004]; p = 0.562). CONCLUSION: The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.

Self-efficacy and HIV testing among Latino emerging adults: examining the moderating effects of distress tolerance and sexual risk behaviors.

Latino emerging adults in the United States are at a high risk of HIV and have a low prevalence of HIV testing. This study examined the association between self-efficacy for HIV testing, distress tolerance and lifetime history of HIV testing, and tested the moderating effect of distress tolerance and sexual risk behaviors on the association between self-efficacy and lifetime history of HIV testing. Data were collected from a cross-sectional sample of 157 Latino emerging adults aged 18-25 using an online survey and were analyzed using hierarchical logistic regression and moderation analyses. We found that 62.8% of those engaging in sexual risk behaviors had ever been tested for HIV. Participants that reported higher levels of self-efficacy (aOR=3.49, 95%CI: 1.78-6.83) were more likely to have ever been tested for HIV in their lifetime. There was a statistically significant three-way interaction among self-efficacy for HIV testing, distress tolerance and sexual risk behaviors (b=2.76, 95%CI: .52, 5.00, p=.016). This interaction suggests that among those that reported any sexual risk behaviors, higher levels of self-efficacy were associated with lifetime history of HIV testing only at higher levels of distress tolerance. Further research is warranted to determine how self-efficacy and distress tolerance work together among high-risk groups to promote HIV testing.

Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida.

HIV-related stigma is associated with many negative health outcomes among people living with HIV (PLHIV). The theory of intersectionality suggests that the interactions of social identities affect PLHIV's experiences of stigma. This study aims to identify individual and interactive marginalized-group identities correlated with enacted HIV-related stigma among PLHIV in Florida. The sample (n = 932) was majority male (66.6%), Black (58.5%), and non-Latino (80.2%) with 53% reporting experiences of HIV-related stigma. In multinomial regression models, the interaction between race and ethnicity was significant where non-White Latinos had higher odds of experiencing high levels of enacted stigma [AOR (CI) 7.71 (2.41, 24.73), p < 0.001] compared to white non-Latinos. Additionally, racial minorities were less likely to have experienced moderate or high levels of enacted stigma [AOR (CI) 0.47 (0.31, 0.72), p < 0.001; AOR (CI) 0.39 (0.22, 0.70), p = 0.002, respectively]. Moreover, women had higher odds of experiencing high levels of enacted stigma [AOR (CI) 2.04 (1.13, 3.67), p = 0.018]. The results suggest that intersectionality is important to consider in HIV-related stigma research and future interventions.

The Pre-exposure Prophylaxis (PrEP) Continuum of Care and Correlates to Initiation Among HIV-Negative Men Recruited at Miami Gay Pride 2018.

While the national HIV infection rate is decreasing, the highest rates of infections continue among men who have sex with men (MSM), particularly minority MSM. It is important to understand attitudes, knowledge, and behaviors surrounding HIV prevention methods, such as pre-exposure prophylaxis (PrEP). In the present study, we created a snapshot of the PrEP continuum of care and identified participant demographic and sources of PrEP awareness factors that were associated with PrEP initiation. Data were collected using anonymous paper-based surveys employing a venue intercept procedure. A total of 188 HIV-negative men completed the survey at Miami Gay Pride 2018. Participants answered questions regarding demographics, PrEP use, and sources of PrEP awareness. The sample was majority Hispanic (55.4%), gay (83.0%), and single (57.7%). The constructed PrEP continuum revealed that a low proportion of those identified as PrEP naïve (n = 143) for HIV infection had PrEP interest (49/143). Moreover, among those who initiated PrEP (n = 45), a high proportion were retained in a PrEP program (37/45), with approximately half achieving medication adherence (25/45). Age group, PrEP knowledge, and source of PrEP awareness were all significantly associated with PrEP initiation. In areas with high HIV infection rates, studies like these offer crucial insight on how public health practitioners should proceed in the goal of decreasing HIV transmission rates. More research is needed to increase PrEP uptake and adherence.

Population-based methods for estimating the number of men who have sex with men: a systematic review.

The objective of this systematic review was to summarise population-based methods (i.e. methods that used representative data from populations) for estimating the population size of men who have sex with men (MSM), a high-risk group for HIV and other sexually transmissible infections (STIs). Studies using population-based methods to estimate the number or percentage of MSM or gay men were included. Twenty-eight studies met the inclusion criteria. Seven studies used surveillance data, 18 studies used survey data, and six studies used census data. Sixteen studies were conducted in the US, five were conducted in European countries, two were conducted in Canada, three were conducted in Australia, one was conducted in Israel, and one was conducted in Kenya. MSM accounted for 0.03-6.5% of men among all studies, and ranged from 3.8% to 6.4% in the US, from 7000 to 39100 in Canada, from 0.03% to 6.5% in European countries, and from 127947 to 182624 in Australia. Studies using surveillance data obtained the highest estimates of the MSM population size, whereas those using survey data obtained the lowest estimates. Studies also estimated the MSM population size by dimensions of sexual orientation. In studies examining these dimensions, fewer people identified as MSM than reported experience with or attraction to other men. Selection bias, differences in recall periods and sampling, or stigma could affect the estimate. It is important to have an estimate of the number of MSM to calculate disease rates, plan HIV and STI prevention efforts, and to allocate resources for this group.