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INTRODUCTION: The objective of this study is to characterize the associations between demographic, attitudinal, and leadership factors with COVID-19 vaccination rates, vaccination intentions among those not vaccinated, and attitudes about vaccination safety, effectiveness, and importance. METHODS: A serial cross-sectional anonymous online survey was administered to soldiers at two large U.S. Army Divisions located in the Southwestern region of the U.S. at two different time points (April-May 2021 [Time 1; T1] N = 24,629; July-August 2021 [Time 2; T2] N = 21,116). Binary logistic regressions were used to assess demographic and attitudinal predictors of vaccination receipt and vaccination intent. Multinomial logistic regressions were used to assess demographic and leadership predictors of endorsement of three vaccination attitudes concerning effectiveness, safety, and importance. RESULTS: Approximately 43% of soldiers reported that they received a COVID-19 vaccine at T1, increasing to 67% at T2. Soldiers who agreed with three separate statements on vaccination effectiveness, safety, or importance were more likely to indicate that they intended to get the vaccination at both time points. Soldiers who reported that their immediate supervisor encouraged soldiers to get a COVID-19 vaccine were more likely to indicate that the vaccination was effective, safe, or important at both time points. DISCUSSION: Negative attitudes about COVID-19 vaccines were prevalent and correlated with less intention to get a vaccination. However, prioritizing leadership engagement around the importance of vaccinations may be a simple but widely effective intervention point to increase future vaccine uptake following the development of novel vaccines to future COVID-19 variants.
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COVID-19 , Personal Militar , Humanos , Intención , Vacunas contra la COVID-19/uso terapéutico , Estudios Transversales , COVID-19/prevención & control , SARS-CoV-2 , VacunaciónRESUMEN
In Spring 2020, the New York Army and Air National Guard (NYNG) rapidly deployed to New York City (NYC) to assist in the recovery, processing, and transport of COVID-19 decedents. This study reports on a survey conducted by NYNG service members three to six months post-mission (n = 177). Data showed that there was a dose-response relationship between mission stress exposure and decremented mental health, but certain activities were associated with better mental health outcomes. The paper also reviews resources provided by behavioral health personnel to support service members during the mission and lessons learned to inform future decedent recovery missions.
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COVID-19 , Personal Militar , Humanos , COVID-19/epidemiología , Ciudad de Nueva York/epidemiología , Pandemias , Salud Mental , Personal Militar/psicologíaRESUMEN
The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted employment and finances, childcare, and behavioral health across the United States. The Behavioral Health Advisory Team assessed the pandemic's impact on the behavioral health of U.S. Army soldiers and their families. Over 20,000 soldiers at three large installation groups headquartered in the northwestern continental U.S., Republic of Korea, and Germany participated in the cross-sectional survey. Multivariable logistic regression models indicated that key demographics (gender, rank), severity of household financial impact, changes in work situation due to childcare issues, and family members' difficulty coping (both self and spouse/partner and/or child) were independently and consistently associated with greater odds of screening positive for probable clinical depression and generalized anxiety, respectively. These findings highlight how Army families were impacted similarly by the pandemic as their civilian counterparts. Army leadership may action these findings with targeted support for soldiers and their families to ensure they are utilizing supportive services available to them, and that military services continually evolve to meet soldier and family needs during times of crisis and beyond.
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COVID-19 , Personal Militar , Humanos , COVID-19/epidemiología , Estudios Transversales , Composición Familiar , Personal Militar/psicología , Pandemias , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: We examined the determinants of food insecurity among active duty Army households that transitioned into food insecurity during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: We compared Army households that recently transitioned into marginal food insecurity with those households that remained highly food secure (n 2832) to better understand how these households differ in their resilience to food insecurity during economic downturns using data from a military installation in the USA in 2020. SETTING: A US military installation in the USA. PARTICIPANTS: Active duty US Army soldiers. RESULTS: Prior to the pandemic, the prevalence of marginal food insecurity among Army households was similar to that reported for households in the general population. Marginal food insecurity among Army households increased over 1·5-fold - from 19 % to 33 % - with the onset of the pandemic. Relative to Army households with consistently high food security, the Army households that transitioned into marginal food insecurity after the onset of the pandemic were more likely to report concerns about financial insecurity and the job security of their family members. CONCLUSIONS: Army households, like their civilian counterparts, are vulnerable to food insecurity because of instability in their income during periods of economic uncertainty. Periods of economic uncertainty are more common for Army households because of the frequent relocations associated with military service which could lead to predictable periodic spikes in their food insecurity.
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BACKGROUND: Previous studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers' mental health and adherence to COVID-19 public health guidelines. METHODS: An electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers' ratings of their immediate supervisors' behaviors related to COVID-19. The outcomes were soldiers' mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors' general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates. RESULTS: High levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers' screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]). CONCLUSION: Higher levels of COVID-19 leadership behaviors may support soldiers' mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.
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COVID-19 , Personal Militar , Humanos , Liderazgo , Salud Mental , Personal Militar/psicología , Salud PúblicaRESUMEN
BACKGROUND: Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations. OBJECTIVES: The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave"). METHODS: A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n = 5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator. RESULTS: The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave. CONCLUSIONS: The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.
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Personal Militar , Estudios Transversales , Inseguridad Alimentaria , Abastecimiento de Alimentos , Humanos , Intención , Masculino , Salud Mental , Estados UnidosRESUMEN
The objective of the present study was to determine whether there is an association between pornography use and reported intimate partner violence (IPV) perpetration among a sample of soldiers in the US Army. The study was a secondary analysis of cross-sectional data collected from soldiers at a military installation in 2018 (n = 9,052). IPV was defined as any self-reported perpetration of physical, sexual, or psychological abuse of an intimate partner. Multivariable negative binomial regressions were used to assess the association between pornography use and any lifetime perpetration of IPV, controlling for gender, age group, race/ethnicity, relationship status, educational status, military rank, hazardous drinking, depression, stimulant use, depressant use, and post-traumatic stress disorder. Of the population analyzed, 41% of soldiers reported any pornography use per week, and 9.6% reported perpetrating any form of IPV. Soldiers who reported pornography use had between a 1.72- and 3.56-fold greater likelihood of reporting any lifetime perpetration of IPV, controlling for covariates. Given the prevalence and detrimental effects of IPV, longitudinal studies should be designed to further understand predictors of IPV in military populations.
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Violencia de Pareja , Personal Militar , Estudios Transversales , Literatura Erótica , Humanos , Prevalencia , Factores de RiesgoRESUMEN
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
RESUMEN: La consejería cognitiva personalizada (CCP) es una intervención basada en evidencia diseñada para poder modificar el comportamiento asociado con el riesgo de contraer VIH. Evaluamos el impacto de CCP en el compartimiento sexual, el drinking expectancy, y la incidencia de infecciones de transmisión sexual (ITS) a través de un estudio controlado aleatorio que duró seis meses e incluyó 153 hombres sin VIH que tienen relaciones sexuales con hombres (HSH) y mujeres transgéneros (MT) en Perú. La retención en el estudio fue ≥90%, con tres infecciones de VIH (3 Control) y 19 casos de GC/CT (10 Control, 9 CCP) a los seis meses. Hubo una disminución de las relaciones sexuales receptivas sin preservativos dentro del grupo Control (0.74, 95% CI: 0.60-0.91; p<0.01) y el grupo CCP (0.72, 0.55-0.94; p=0.02) a los seis meses. También hubo una disminución en el drinking expectancy a los seis meses dentro de los participantes quienes tomaban alcohol dentro del grupo CCP (0.89, 0.83-0.96; p<0.01), versus ningún cambio dentro del grupo Control (0.98, 0.92-1.04; p=0.54). La CCP fue eficaz en disminuir el drinking expectancy y el riesgo de contraer VIH dentro de HSH y MT en Perú.
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Consumo de Bebidas Alcohólicas/prevención & control , Terapia Cognitivo-Conductual/métodos , Consejo Dirigido/métodos , Infecciones por VIH/psicología , Homosexualidad Masculina/psicología , Conducta Sexual/estadística & datos numéricos , Personas Transgénero/psicología , Sexo Inseguro/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Condones , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/epidemiología , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Perú/epidemiología , Proyectos Piloto , Asunción de Riesgos , Sexo Inseguro/prevención & controlRESUMEN
OBJECTIVE: The relationship between nutrition and behavioural health (BH) outcomes has been established in the literature. However, the relationship between nutrition and anxiety is unclear. Furthermore, the relationship between nutrition and BH outcomes has not been examined in a US Army Soldier population. This study sought to understand the relationship between Soldiers' nutritional intake and anxiety as well as depression. DESIGN: This cross-sectional study utilised multivariable logistic regression analyses to examine the relationship between nutritional intake and BH outcomes. SETTING: The study utilised data collected in 2018 during a BH epidemiological consultation conducted at one Army installation. PARTICIPANTS: Participants were 7043 US Army Soldiers at one Army installation. RESULTS: Of the Soldiers completing the survey, 12 % (n 812) screened positive for anxiety and 11 % (n 774) for depression. The adjusted odds of anxiety were significantly higher among Soldiers who reported low fruit intake compared with Soldiers who reported high fruit intake (adjusted OR (AOR) 1·36; 95 % CI 1·04, 1·79). The adjusted odds of depression were higher for Soldiers who reported low fruit intake (AOR 1·35; 95 % CI 1·01, 1·79) and/or low green vegetable intake (AOR 1·37; 95 % CI 1·02, 1·83). Lastly, the adjusted odds of depression were lower for Soldiers who reported low sugary drink intake (AOR 0·62; 95 % CI 0·48, 0·81). CONCLUSIONS: This study is the first to examine the important connection between nutritional intake and anxiety and depression at a US military installation. The information learned from this study has implications for enhancing Soldiers' nutritional knowledge and BH, ultimately improving Soldiers' health and medical readiness.
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Conductas Relacionadas con la Salud , Personal Militar , Estado Nutricional , Estudios Transversales , Humanos , Encuestas y CuestionariosRESUMEN
PURPOSE OF REVIEW: Pre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation. RECENT FINDINGS: Injectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use. On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.
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Fármacos Anti-VIH/uso terapéutico , Antiinfecciosos/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/métodos , Administración Tópica , Adulto , Antiinfecciosos/administración & dosificación , Dispositivos Anticonceptivos Femeninos , Emtricitabina , Femenino , Homosexualidad Masculina , Humanos , Inyecciones , Masculino , Minorías Sexuales y de Género , Tenofovir/administración & dosificaciónRESUMEN
We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.
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Fármacos Anti-VIH/economía , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Seguro de Salud , Profilaxis Pre-Exposición/economía , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/administración & dosificación , Estudios de Cohortes , Estudios de Seguimiento , Infecciones por VIH/economía , Humanos , Incidencia , Estudios Longitudinales , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto JovenRESUMEN
PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.
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Antirretrovirales/administración & dosificación , Estimulantes del Sistema Nervioso Central/uso terapéutico , Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Cumplimiento de la Medicación , Profilaxis Pre-Exposición/métodos , Parejas Sexuales , Tenofovir/administración & dosificación , Adenina/análogos & derivados , Adulto , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina/psicología , Humanos , Estudios Longitudinales , Los Angeles , Masculino , Organofosfatos , Tenofovir/uso terapéutico , Sexo InseguroRESUMEN
BACKGROUND: Pre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California. METHODS: The present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period). RESULTS: In a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02). CONCLUSIONS: There were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.
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Profilaxis Pre-Exposición , Conducta Sexual/psicología , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Estudios Cruzados , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina , Humanos , Incidencia , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Profilaxis Pre-Exposición/estadística & datos numéricos , Enfermedades de Transmisión Sexual/psicología , Adulto JovenRESUMEN
BACKGROUND: Gay, bisexual, and other men who have sex with men (MSM) face higher rates of sexually transmitted infections (STIs) compared with the general population. The association between venues where sexual partners are met and STI transmission is dynamic and poorly understood, especially among those who use geosocial networking (GSN) apps. This study aimed to determine whether there is a difference in STI incidence between MSM who met their last sexual partner through a GSN app and MSM who met their last partner via other venues. METHODS: Data were analyzed from HIV-negative MSM attending the Los Angeles LBGT Center between August 2015 and July 2016 (n = 9499). Logistic regression models were used to investigate the relationship between STI incidence and whether or not an individual met his last partner through a GSN app. RESULTS: No relationship was detected between STI incidence and whether one's last sexual partner was met via GSN app. However, an association was detected between STI incidence and having used GSN apps to meet sexual partners in the past 3 months. A dose-response relationship was observed between the number of venues used to meet partners and testing positive for any STI (adjusted odds ratio, 1.08; 95% confidence interval, 1.02-1.14). CONCLUSIONS: The relationship between how people meet sexual partners and STI acquisition is much more nuanced than previously thought. Geosocial networking apps do not inherently expose users to high-risk reservoirs of STIs, but further understanding of the complexity of sexual networks and networking methods is warranted, given increasing rates of STIs.
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Homosexualidad Masculina/estadística & datos numéricos , Aplicaciones Móviles , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Estudios Transversales , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Modelos Logísticos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Red Social , Adulto JovenRESUMEN
OBJECTIVES: To quantify sexual orientation and gender identity (SOGI) disparities in incidence of HIV, other sexually transmitted infections (STIs), and viral hepatitis. METHODS: We performed a records-based study of 19 933 patients visiting a federally qualified health center in Los Angeles, California, between November 2016 and October 2017 that examined HIV, STIs, and viral hepatitis incidence proportions. We created multivariable logistic regression models to examine the association between incidence proportions and SOGI among people living with HIV and HIV-negative patients. RESULTS: Among those who were HIV-negative at baseline (n = 16 757), 29% tested positive for any STI during the study period, compared with 38% of people living with HIV. Stratified by birth sex, STI positivity was 32% among men and 11% among women. By SOGI, STI positivity was 35% among gay and bisexual cisgender men, 15% among heterosexual cisgender men, 11% among cisgender women, 25% among transgender women, 13% among gay and bisexual transgender men, 3% among heterosexual transgender men, and 26% among nonbinary people. CONCLUSIONS: Stratifying by SOGI highlighted disparities that are obscured when stratifying by birth sex. Public Health Implications. To monitor and reduce disparities, health jurisdictions should include SOGI data with infectious disease reporting.
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Identidad de Género , Hepatitis Viral Humana/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Disparidades en Atención de Salud , Humanos , Incidencia , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Recruitment for HIV research among gay, bisexual, and other men who have sex with men (MSM) has increasingly moved to the online sphere. However, there are limited data comparing the characteristics of clinic-based respondents versus those recruited via online survey platforms. MSM were recruited from three sampling sites (STI clinic, MTurk, and Qualtrics) to participate in a survey from March 2015 to April 2016. Respondents were compared between each of the sampling sites on demographics, sexual history, substance use, and attention filter passage. Attention filter passage was high for the online sampling sites (MTurk = 93%; Qualtrics = 86%), but significantly lower for the clinic-based sampling site (72%). Clinic-based respondents were significantly more racially/ethnically diverse, reported lower income, and reported more unemployment than online respondents. Clinic-based respondents reported significantly more male sexual partners in the previous 3 months (M clinic-based = 6; MTurk = 3.6; Qualtrics = 4.5), a higher proportion of gonorrhea, chlamydia, and/or syphilis in the last year, and a greater proportion of methamphetamine use (clinic-based = 21%; MTurk = 5%), and inhaled nitrates use (clinic-based = 41%; MTurk = 11%). The clinic-based sample demonstrated more demographic diversity and a greater proportion of HIV risk behaviors when compared to the online samples, but also a relatively low attention filter passage rate. We recommend the use of attention filters across all modalities to assess response validity and urge caution with online survey engines as samples may differ demographically and behaviorally when compared to clinic-based respondents.
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Bisexualidad , Colaboración de las Masas , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Internet , Masculino , Persona de Mediana Edad , Selección de Paciente , Autoinforme , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: HIV studies and risk assessments among men who have sex with men (MSM) frequently use self-reported STI history as a proxy for true STI history. The objective of our study was to assess the validity of self-reported STI history through comparison with laboratory-confirmed biomedical results. METHODS: Data were analysed for MSM attending the Los Angeles LGBT Center (the Center) from August 2011 to July 2015. We identified 10â 529 unique MSM who received testing for chlamydia, gonorrhoea and/or syphilis and had a later visit in which they self-reported their STI history to a clinic counsellor during a risk assessment. RESULTS: MSM who had an STI in the past year self-reported their STI history with 51%-56% accuracy, and MSM who had an STI more than a year ago self-reported their STI history with 65%-72% accuracy. Among MSM with any positive STIs at the Center, black/African-American and Hispanic MSM were more likely to inaccurately self-report their positive results for gonorrhoea (adjusted OR (aOR): 1.48, 95% CI 1.09 to 2.01; aOR: 1.39, 95% CI 1.14 to 1.70). Additionally, HIV-positive MSM were more likely to inaccurately self-report their positive results for gonorrhoea (aOR: 1.63, 95% CI 1.22 to 2.18) and/or syphilis (aOR: 2.19, 95% CI 1.08 to 4.47). CONCLUSIONS: This is the first study that attempts to evaluate the validity of self-reported STI history among MSM. We found that self-reported STI history may not be an appropriate proxy for true STI history in certain settings and minority populations. Clinical guidelines and research studies that rely on self-reported STI history will need to modify their recommendations in light of the limited validity of these data.
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Homosexualidad Masculina/estadística & datos numéricos , Autoinforme , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Instituciones de Atención Ambulatoria , Revelación , Humanos , Los Angeles/epidemiología , Masculino , Asunción de Riesgos , Estudios Seroepidemiológicos , Parejas Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/psicologíaRESUMEN
BACKGROUND: Preexposure prophylaxis (PrEP) has emerged as a human immunodeficiency virus (HIV) prevention tool for populations at highest risk for HIV infection. Current US Centers for Disease Control and Prevention (CDC) guidelines for identifying PrEP candidates may not be specific enough to identify gay, bisexual, and other men who have sex with men (MSM) at the highest risk for HIV infection. We created an HIV risk score for HIV-negative MSM based on Syndemics Theory to develop a more targeted criterion for assessing PrEP candidacy. METHODS: Behavioral risk assessment and HIV testing data were analyzed for HIV-negative MSM attending the Los Angeles LGBT Center between January 2009 and June 2014 (n = 9481). Syndemics Theory informed the selection of variables for a multivariable Cox proportional hazards model. Estimated coefficients were summed to create an HIV risk score, and model fit was compared between our model and CDC guidelines using the Akaike Information Criterion and Bayesian Information Criterion. RESULTS: Approximately 51% of MSM were above a cutpoint that we chose as an illustrative risk score to qualify for PrEP, identifying 75% of all seroconverting MSM. Our model demonstrated a better overall fit when compared with the CDC guidelines (Akaike Information Criterion Difference = 68) in addition to identifying a greater proportion of HIV infections. CONCLUSIONS: Current CDC PrEP guidelines should be expanded to incorporate substance use, partner-level, and other Syndemic variables that have been shown to contribute to HIV acquisition. Deployment of such personalized algorithms may better hone PrEP criteria and allow providers and their patients to make a more informed decision prior to PrEP use.
Asunto(s)
Centers for Disease Control and Prevention, U.S./normas , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/normas , Medicina de Precisión/normas , Medición de Riesgo/normas , Adulto , Teorema de Bayes , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Medicina de Precisión/métodos , Modelos de Riesgos Proporcionales , Medición de Riesgo/métodos , Estados UnidosRESUMEN
Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35-4.23) and 3.33 times higher hazard (CI 1.47-7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Infecciones por VIH/etnología , Homosexualidad Masculina/estadística & datos numéricos , Violencia de Pareja/etnología , Minorías Sexuales y de Género/estadística & datos numéricos , Adulto , Infecciones por VIH/diagnóstico , Humanos , Modelos Logísticos , Los Angeles/epidemiología , Masculino , Prevalencia , Factores de Riesgo , Conducta Sexual , Estados Unidos/epidemiologíaRESUMEN
Geosocial networking phone applications (GSN apps) used to meet sexual partners have become popular in the men who have sex with men (MSM) communities of the USA since 2009. Previous studies have shown greater incidence of gonorrhea and chlamydia and lower testing frequency for HIV testing among GSN app users when compared to non-users. The present study aims to determine the type, number, and frequency of apps used, as well as the association between dispositional self-control and health-related behaviors. Participants (n = 146) were recruited from Amazon's Mechanical Turk program to respond to a brief GSN app marketing survey. Multivariate regression was used to determine differences in app priorities, length of app use, and number of sexual partners between high self-control and low self-control participants. A majority of the participants reported using Grindr (78 %) followed by Scruff (19 %), Growlr (12 %), and Jack'd (12 %). Most individuals used one app only (58 %), but a significant proportion reported using two apps (28 %) or three or more apps (14 %). Respondents with low self-control were more likely to report a higher number of hours using GSN apps and a higher number of sexual partners, controlling for race/ethnicity, education, employment, and HIV status. Given the popularity of this burgeoning communication medium, these findings have important implications for developing prevention resources for different segments of GSN app users.