Addressing food insecurity in HIV care: perspectives from healthcare and social service providers in New York state.

Ending the HIV epidemic in the United States will require addressing social determinants contributing to poor care engagement among people living with HIV (PLH), such as food insecurity. Food insecurity is associated with poor care engagement among PLH. Yet, few studies have examined the perspectives of healthcare and social services providers on addressing food insecurity in HIV care. Guided by the Social Ecological Model, we conducted semi-structured interviews with 18 providers in New York State to understand barriers and facilitators to addressing food insecurity in HIV care. Thematic analysis illustrated eight themes across various levels of the Social Ecological Model. At the patient-level, providers perceived patients' feelings of embarrassment, shame, and judgement, and low health literacy as barriers. At the provider-level, challenges included limited time. Facilitators included fostering strong, patient-provider relationships. Barriers at the clinic-level included limited funding, while clinic resources served as facilitators. At the community-level, challenges included intersecting stigmas arising from community norms towards PLH and people who receive food assistance and limited access to healthy food. Findings suggest the need to incorporate their insights into the development of interventions that address food insecurity in HIV care.

Factors correlated with pre-exposure prophylaxis (PrEP) awareness and use among black adults in the United States: implications for improving HIV prevention.

HIV remains a significant public health concern for Black adults (BA) in the United States. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool prescribed to protect the health of HIV-uninfected individuals. Yet, low rates of PrEP awareness and utilization persist among BA. Less is understood about the pathways that may promote PrEP uptake. The present study explored factors associated with PrEP awareness and use among BA. Using a cross-sectional sample of 666 BA, we employed multivariable logistic regression models to examine the relationship between PrEP and several covariates. Most participants were unaware of PrEP (71%). Reporting history of incarceration and lifetime sexually transmitted infection testing [aOR 1.76 (1.19, 2.59), p < 0.05] had greater odds of PrEP awareness. Only 6% of respondents had ever taken PrEP. Reports of incarceration history [aOR 9.96 (2.82, 35.14), p < 0.05], concurrent sexual partners [aOR 1.09 (1.00, 1.18), p < 0.05], and substance use during sex [aOR 4.23 (1.02, 17.48), p < 0.05] had greater odds of PrEP use. Interventions aiming to improve PrEP uptake among BA must consider the individual, social, and structural contexts associated with its awareness and use. Enhanced efforts by healthcare providers and institutions may better facilitate access to PrEP for HIV prevention and control transmission.

"Shades of risk": Understanding current PrEP users' sexually transmitted infection perceptions.

ABSTRACTPre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention strategy. Given the possibility of increased sexual risk-taking and acquisition of other sexually transmitted infections (STIs) following PrEP initiation, it is important to explore STI risk perceptions both before and after PrEP initiation to understand the extent to which these perceptions inform decisions to engage in condomless sex. Semi-structured qualitative interviews were conducted with men who have sex with men currently using PrEP (n = 30). Prior to analysis, PrEP users were categorized into four subgroups based on condom use behavior post-PrEP initiation: (1) condom continuers (2) condomless sex continuers, (3) condomless sex increasers, and (4) condomless sex decreasers. Thematic analysis revealed two major themes that elucidated differences in (1) the appraisal of HIV risk relative to other STIs and (2) the importance of partner communication in determining STI risk perceptions by subgroup. Most PrEP users demonstrated no behavioral change after PrEP initiation. Those engaging in condomless sex prior to PrEP initiation also continued that behavior while taking PrEP. Results of this study support a tailored approach to PrEP counseling based on individual STI risk appraisal and motivations to initiate and continue PrEP.

Racial Variations in Psychosocial Vulnerabilities Linked to Differential Poppers Use and Associated HIV-Related Outcomes among Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas.

Background: Poppers use has become increasingly prevalent and is associated with elevated HIV risk among young men who have sex with men (YMSM) in urban settings. However, knowledge regarding racial variations of poppers use and their psychosocial determinants to inform culturally-targeted interventions remain limited. Methods: We conducted a cross-sectional study among YMSM recruited from two US metropolitan areas (Nashville, TN and Buffalo, NY) to investigate the differences of socio-environmental and mental health factors associated with poppers use and important HIV-related outcomes [e.g., HIV testing, pre-exposure prophylaxis (PrEP, substance use, and risky sexual behaviors] among White and Black YMSM (i.e., YWMSM and YBMSM). Results: Among 347 YMSM aged 18-35 years, 32.3% reported poppers use. Notably, poppers-using YWMSM were more likely (p < 0.05) to report mental health burdens (e.g., depression, anxiety, loneliness), while poppers-using YBMSM were more likely (p < 0.05) to experience adverse social-environmental events (e.g., unstable housing, food insecurity, no health insurance, perceived HIV stigma, internalized homonegativity). Poppers-using YMSM showed a higher prevalence of sexual risk behaviors (e.g., event-level alcohol/drug use, condomless insertive/receptive anal sex, group sex) compared to their non-user counterparts, with YWMSM showing the highest likelihood to engage in these risk behaviors. Compared to poppers-using YBMSM, poppers-using YWMSM were associated with a higher likelihood of ever testing for HIV, ever using PrEP and willingness to use PrEP in the next 12 months. Conclusion: Given the distinctive patterns of psychosocial determinants of poppers use between YWMSM and YBMSM, culturally-tailored poppers reduction programs should be designed to tackle the associated HIV risks among YMSM with effectivenes.

Women's Motivators to Engage in Opioid Use Disorder Treatment While Enrolled in an Opioid Intervention Court.

IntroductionTo address the rising presence of opioid use disorder in the United States, states have begun to implement specialized opioid intervention courts to provide immediate support for individuals at risk of opioid overdose. The present study sought to understand the motivations of women to engage in treatment while enrolled in an opioid intervention court. MethodsWe conducted 31 in-depth, qualitative interviews with women enrolled in an opioid intervention court in Buffalo, NY, to better understand their motivation regarding opioid use treatment. The data indicated a combined social-ecological and self-determination theory framework. ResultsThematic analysis revealed four themes across the Social-Ecological Model that aligned with motivation-related needs of autonomy, competence, and relatedness, as defined by Self-Determination Theory. Themes at each level of the Social-Ecological Model described either support for or undermining of women's motivation for treatment: (1) individual level: personal motivation for change, (2) interpersonal level: support for OUD treatment-related autonomy, competence, and relatedness, (3) community level: court systems provide pathways to treatment, and (4) society level: insufficient social resources can undermine competence. ConclusionsThe findings provide new insights into various factors across all levels of the Social-Ecological Model that influence motivation for opioid use disorder treatment among women enrolled in opioid intervention court. Results support the possibility to integrate programs rooted in Self-Determination Theory to support opioid use disorder treatment among justice-involved persons.

Provider-Patient Communication on Pre-Exposure Prophylaxis (Prep) for HIV Prevention: An Exploration of Healthcare Provider Challenges.

Pre-exposure prophylaxis (PrEP) is a once-daily pill prescribed by healthcare providers to protect patients from contracting HIV. Current data suggests that a minority of healthcare providers have ever prescribed it to clinically-eligible patients. The present study employed a social ecological framework to understand the factors that influence providers' engagement in patient-centered communication regarding PrEP. Semi-structured interviews (N = 20) with physicians, physician assistants, and nurse practitioners working in primary and specialty care practices in Western New York were thematically analyzed to understand provider-based PrEP communication challenges. Although participants never prescribed PrEP, all had clinical experience with patient populations at risk for HIV, such as people who inject drugs, men who have sex with men, transgender women, and people who exchange sex for resources. Results revealed three themes affecting provider engagement in PrEP-related discussions, which emerged across three levels of the social ecological model. At the individual level, challenges affecting provider engagement in patient-centered discussions included lacking PrEP knowledge to educate and counsel patients and discomfort with prescribing PrEP based on its perceived newness. At the interpersonal level, participants expressed varying degrees of discomfort discussing HIV risk behaviors with patients. At the organizational level, providers expressed that time constraints and managing concurrent health conditions were competing clinical priorities. Findings indicate expanding implementation efforts will require multilevel interventions that target potential PrEP-adopting healthcare providers to mitigate the perceived and real challenges surrounding provider-patient communication on PrEP for HIV prevention. Practical implications are discussed.

Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV.

While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46-1.85); OR 1.65 (95% CI 1.14-2.39); OR 2.88 (95% CI 2.01-4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.

Perspectives on Injectable HIV Pre-Exposure Prophylaxis: A Qualitative Study of Health Care Providers in the United States.

The introduction of injectable HIV pre-exposure prophylaxis (PrEP) has the potential to significantly change the biomedical HIV prevention landscape. However, effective implementation will require health care providers to adopt, prescribe, and administer injectable PrEP within clinical settings. This study qualitatively examined challenges and benefit of injectable PrEP implementation from the perspective of health care providers. From April to August 2022, we conducted 19 in-depth interviews with current PrEP-prescribing health care providers in New York State, including 3 physician assistants, 5 physicians, and 11 nurse practitioners. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to report semantic-level themes regarding injectable PrEP implementation. More than half of participants (61%) were aware of injectable PrEP; only 21% had experience prescribing it. Qualitative findings highlighted five themes. Three themes represented implementation challenges, including speculative concerns about side effects, appointment compliance, and practical and logistical considerations. The remaining two themes described benefits of injectable PrEP relative to oral PrEP, which included greater convenience and enhanced privacy. Findings from this qualitative study make significant applied contributions to the sparse knowledge on health care provider perspectives of injectable PrEP post-US Food and Drug Administration approval and their concerns and considerations regarding implementation in real-world clinical settings.

Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Education in Healthcare Professional Graduate Programs: A Comparison of Medical, Nursing, and Pharmacy Students.

Relative to cisgender heterosexual persons, lesbian, gay, bisexual, and transgender (LGBT) people experience greater health inequities, thereby affecting their engagement in care. One strategy to address these disparities is to educate future healthcare professionals to provide nondiscriminatory care to LGBT people. The goal of this study was to explore the perceived coverage of LGBT health education topics in graduate-level medical (MD), pharmacy (PharmD) and nursing (DNP) curricula. Cross-sectional data were collected from web-based surveys (N = 733) completed by healthcare professional students enrolled at two universities in New York State. Of those who responded, 50.5% were MD, 38.9% were PharmD, and 10.6% were DNP students. Overall, mean scores indicated a dearth of perceived LGBT health coverage. Results demonstrated variations in coverage by degree program. Findings highlight the need to develop educational curricula inclusive of topics concerning LGBT patient health. Adequately educating the next generation of healthcare professionals can further promote healthcare engagement among LGBT persons and improve pedagogical practices in healthcare professional education programs.

Serostatus disclosure to sexual partners among people living with HIV: examining the roles of partner characteristics and stigma.

HIV serostatus disclosure among people living with HIV/AIDS (PLWHA) is an important component of preventing HIV transmission to sexual partners. Due to barriers like stigma, however, many PLWHA do not disclose their serostatus to all sexual partners. This study explored differences in HIV serostatus disclosure based on sexual behavior subgroup (men who have sex with men [MSM]; heterosexual men; and women), characteristics of the sexual relationship (relationship type and HIV serostatus of partner), and perceived stigma. We examined disclosure in a sample of 341 PLWHA: 138 MSM, 87 heterosexual men, and 116 heterosexual women who were enrolled in SafeTalk, a randomized, controlled trial of a safer sex intervention. We found that, overall, 79% of participants disclosed their HIV status to all sexual partners in the past 3 months. However, we found important differences in disclosure by subgroup and relationship characteristics. Heterosexual men and women were more likely to disclose their HIV status than MSM (86%, 85%, and 69%, respectively). Additionally, disclosure was more likely among participants with only primary partners than those with only casual or both casual and primary partners (92%, 54%, and 62%, respectively). Participants with only HIV-positive partners were also more likely to disclose than those with only HIV-negative partners, unknown serostatus partners, or partners of mixed serostatus (96%, 85%, 40%, and 60%, respectively). Finally, people who perceived more HIV-related stigma were less likely to disclose their HIV serostatus to partners, regardless of subgroup or relationship characteristics. These findings suggest that interventions to help PLWHA disclose, particularly to serodiscordant casual partners, are needed and will likely benefit from inclusion of stigma reduction components.

Racial Differences of Psychosocial Characteristics, HIV Risk-Taking and HIV Prevention Uptake between Men Who Have Sex with Men Only and Men Who Have Sex with Men and Women: A Community-Based Study in Two US Cities.

Bisexual behavior preference plays an important role in shaping HIV risks among men who have sex with men (MSM), yet few studies have examined the racial differences in the patterns of sexual risk and HIV prevention uptake between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). We conducted a community-based study to identify and compare psychosocial characteristics, sexual risks, HIV testing frequency, and pre-exposure prophylaxis (PrEP) engagement between Black and White MSMW and MSMO in two US cities. Findings indicate that White MSMW were most likely to engage in HIV risk-taking behaviors (e.g., alcohol/drug use before sex, condomless/group sex), while Black MSMW were least likely to recently test for HIV or report awareness (aPR: 0.32, 95% CI: 0.17-0.61), willingness (aPR: 0.58, 95% CI: 0.30-0.98), and use (aPR: 0.59, 95% CI: 0.31-0.93) of PrEP. Findings from our study supplement salient information for designing culturally tailored HIV prevention interventions for specific MSM subgroups in the US.

The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis.

Introduction: Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression. Methods: We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations. Results: The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (ORNIE: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (ORNIE: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (ORNIE: 1.27, 95% CI: 1.07, 1.47). Discussion: Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.

Modern public pealth problems and solutions: An undergraduate capstone course to prepare the next generation of public health practitioners to enhance health equity.

With a growing emphasis on health equity in public health practice and research, ensuring a competent and skilled public health workforce is critical to advancing the public health mission of a healthier nation. The expansion of undergraduate public health programs provides a unique opportunity for more extensive training and education of the next generation of public health professionals and to center undergraduate public health education around the need to be competent in addressing health disparities to achieve health equity. Following national accreditation standards set by the Council on Education for Public Health (CEPH), undergraduate Bachelor of Public Health (BSPH) students at the University at Buffalo (UB) must complete a capstone course before graduation. This course focuses on integrating and synthesizing knowledge acquired from the BSPH core curriculum through analysis, explanation, and addressing public health problems via an interdisciplinary approach. We designed the most recent iterations of the capstone class based on the model that includes cross-cutting skills as defined by CEPH, evidence-based decision-making skills, established learning objectives of the course, and centering on health equity. This course also builds on the students' previously acquired knowledge with an ultimate goal to prepare the graduating seniors for the "real world" health equity-related public health activities. As a part of the coursework, students complete case studies, article reviews, and active learning group activities that target each component of the model. The final products of the course are a synthesis paper and oral presentation based on a public health problem as identified through surveillance data, analyzing causes of this problem, identifying critical stakeholders, creating an evidence-based solution to the problem, and explaining how health inequities may be addressed through the proposed solution. Centering the culminating course for BSPH undergraduate students on health equity will help ensure a competent and skilled workforce, informed by accreditation standards and prepared to lead our national public health goal of improved and equitable population health.

Infusing high-impact practices in undergraduate public health curricula: Models, lessons learned, and administrative considerations from two public universities.

High-impact practices (HIPs) can improve the rigor, quality, and outcomes of undergraduate education. Several high-impact practices are explicitly woven into the overarching goals, learning objectives, and curricular competencies for undergraduate public health degree programs, while others are natural fits. However, capitalizing on the value of HIPs for public health undergraduates requires a conscious effort in the process of curriculum design, course delivery, and administration of these programs. In this paper, we discuss both conceptual approaches and practical steps involved in the integration of HIPs in curriculum design and implementation. We discuss two exemplars of undergraduate programs that incorporate high-impact practices, illustrating how the same practices can be developed and implemented in different but equally effective ways across programs. We close with practical suggestions for designing or refining an undergraduate program to maximize the inclusion and effectiveness of high-impact practices.

Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas.

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men's physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention.

Characterizing Racial Differences of Mental Health Burdens, Psychosocial Determinants, and Impacts on HIV Prevention Outcomes Among Young Men Who have Sex With Men: a Community-based Study in Two U.S. Cities.

Few studies examine racial differences (e.g., Black vs. White) regarding the psychosocial pathways linking mental health burdens and various HIV-related outcomes among young men who have sex with men (MSM) in the U.S. We conducted a community-based study to examine the racial differences of mental health burdens (e.g., depression, anxiety, stress), the psychosocial determinants (e.g., HIV stigma, homonegativity, resilience, social support, loneliness, housing/food security) and impact on HIV-related outcomes (e.g., event-level alcohol/drug use before sex, condomless insertive/receptive anal sex, recent HIV testing, and PrEP awareness/willingness/use) among young Black MSM (YBMSM; n = 209) and young White MSM (YWMSM; n = 109) from two cities (Nashville, TN and Buffalo, NY) in the United States. Overall, we found YBMSM were more likely (p < 0.05) to experience anxiety and depression compared to YWMSM. Among YBMSM, we found structural inequities (housing instability, food insecurity, internalized homonegativity) were positively associated with anxiety/depression/stress (p < 0.001); we also found anxiety/depression was associated with increased alcohol/drug use before sex, and stress was associated with reduced recent HIV testing and pre-exposure prophylaxis awareness/willingness/use. Among YWMSM, we found psychological buffers (perceived social support, resilience) were associated with reduced anxiety/depression/stress (p < 0.001); anxiety was associated with increased condomless insertive/receptive anal sex and recent HIV testing among this subgroup. YBMSM and YWMSM differed in psychosocial determinants and HIV-related consequences regarding their mental health. Our findings provide important implications for developing culturally and contextually tailored interventions to address mental health burdens and HIV prevention outcomes among young MSM at highest risk for HIV acquisition.

Suboptimal Follow-Up on HIV Test Results among Young Men Who Have Sex with Men: A Community-Based Study in Two U.S. Cities.

Frequent HIV testing and knowledge of HIV serostatus is the premise before timely access to HIV prevention and treatment services, but a portion of young men who have sex with men (YMSM) do not always follow up on their HIV test results after HIV testing, which is detrimental to the implementation of HIV prevention and care among this subgroup. The comprehensive evaluation of factors associated with inconsistent follow-up on HIV test results may inform relevant interventions to address this critical issue among YMSM. To this end, we conducted a cross-sectional study in Nashville, Tennessee and Buffalo, New York from May 2019 to May 2020 to assess demographic, behavioral, and psychosocial correlates of inconsistent follow-up on HIV test results among YMSM. Of the 347 participants, 27.1% (n = 94) reported inconsistent follow-up on their HIV test results. Multivariable logistic regression showed that inconsistent follow-up on HIV test results was positively associated with condomless receptive anal sex, group sex, recreational drug use before or during sex, internalized homophobia, and stress; while negatively associated with housing stability, social support, and general resilience. Future HIV prevention intervention efforts should target these modifiable determinants to enhance the follow-up on HIV test results among YMSM.

Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States.

Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive-deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19.

An Analysis of Sex Practices and Behaviors Among African Americans in Sexually Concurrent and Sexually Exclusive Relationships.

Historically, sexually concurrent relationships have been associated with increased risk for sexually transmitted infections (STIs), including HIV. Due to socio-structural factors, African Americans (AAs) have higher rates of STIs compared to other racial groups and are more likely to engage in sexually concurrent (SC) relationships. Current research has challenged the assumption that SC is the only risky relationship type, suggesting that both SC and sexually exclusive (SE) relationships are at equal risk of STI and HIV acquisition and that both relationship types should engage in safer sex practices. This study aimed to compare sex practices and behaviors among AA men and women in SC and SE relationships (N = 652). Results demonstrate differences in sexual practices and behaviors between SC and SE men and women. Overall, SC and SE women report condom use with male partners less frequently than SC and SE men. SC men were more likely to report substance use during sex compared to SC and SE women. Pre-exposure prophylaxis (PrEP) use did not differ across groups. SE men were less likely to report STI testing and diagnosis compared to SC women. Findings support the need to focus on culturally and gender-specific safer sex interventions among AAs.

Substance Use and Adherence to Antiretroviral Therapy among People Living with HIV in the United States.

People with HIV (PWH) report substance use at higher rates than HIV-uninfected individuals. The potential negative impact of single and polysubstance use on HIV treatment among diverse samples of PWH is underexplored. PWH were recruited from the Center for Positive Living at the Montefiore Medical Center (Bronx, NY, USA) from May 2017-April 2018 and completed a cross-sectional survey with measures of substance use, antiretroviral therapy (ART) use, and ART adherence. The overall sample included 237 PWH (54.1% Black, 42.2% female, median age 53 years). Approximately half of the sample reported any current substance use with 23.1% reporting single substance use and 21.4% reporting polysubstance use. Polysubstance use was more prevalent among those with current cigarette smoking relative to those with no current smoking and among females relative to males. Alcohol and cannabis were the most commonly reported polysubstance combination; however, a sizeable proportion of PWH reported other two, three, and four-substance groupings. Single and polysubstance use were associated with lower ART adherence. A thorough understanding of substance use patterns and related adherence challenges may aid with targeted public health interventions to improve HIV care cascade goals, including the integration of substance use prevention into HIV treatment and care settings.