"It's like our own little world": resilience as a factor in participating in the Ballroom community subculture.

We are well into the third decade of the HIV epidemic. While strides have been made in HIV prevention, rates for African American men who have sex with men (AAMSM) and young AAMSM continue to increase-perhaps indicating that traditional deficit-approaches of HIV prevention are not effective for all populations. Following a recent call to investigate the resiliency of young gay men, this study identifies sources of resilience and strength within the House and Ball communities, a subculture comprised primarily of AAMSM. The mixed-methods design included survey data (N = 263) collected at community events, interviews with Ball attendees and focus group data with House members. Survey data indicate a relationship between participating in the House and Ball communities and seeking support, acceptance and entertainment. Qualitative data validate these findings and provide detail on motivations for AAMSM to participate and the perceived benefits of participation. Findings are discussed in relation to building strengths-based interventions, using concepts of resiliency including shamelessness, social creativity, social support and volunteerism.

Personal social network factors associated with overdose prevention training participation.

We investigated social network factors associated with participation in overdose prevention training among injection drug users (IDUs). From 2008 to 2010, 106 IDUs who had witnessed an overdose in the past year from two syringe exchange programs in Los Angeles provided data on overdose prevention training status (trained vs. untrained), social networks, history of overdose, and demographics. In multivariate logistic regression, naming at least one network member who had been trained in overdose prevention was significantly associated with being trained (Adjusted Odds Ratio 3.25, 95% Confidence Interval 1.09, 9.68). Using social network approaches may help increase training participation. Limitations are noted.

Becoming a medical marijuana user.

BACKGROUND: Since marijuana became legal for medical use in California in 1996, reasons for medical use among medical marijuana patients (MMP) have become increasingly well described in qualitative studies. However, few studies have detailed how the use of marijuana for medical purposes fits into the broader career trajectories of either becoming a marijuana user or becoming a MMP, including the social influences on medical use. METHODS: Young adult MMP (N=40) aged 18 to 26 years old were recruited in Los Angeles, CA in 2014-15 and administered a semi-structured interview that included questions focusing on marijuana use practices before and after becoming MMP. RESULTS: MMP were categorized into three trajectory groups: primarily medical users (n=30); primarily non-medical users (n=3); and medical users who transitioned to non-medical users (n=7). Most medical users discovered medicinal effects from marijuana in the context of non-medical use as adolescents prior to becoming MMP. Becoming a mature MMP followed interactions with dispensary staff or further self-exploration of medical uses and often involved a social process that helped confirm the legitimacy of medical use and identity as a medical user. In some cases, MMP transitioned back to non-medical users as health conditions improved or remained primarily non-medical users even after becoming MMP for reasons unrelated to health, e.g., protection against arrest. CONCLUSION: Becoming a medical marijuana user was an important career trajectory that was influenced by early discoveries of effective medicinal use, interaction with proponents of medical use at dispensaries, experiences with new kinds of medical use, and the demands of particular health condition requiring more or less treatment with marijuana.

Living a secret: Disclosure among adolescents and young adults with chronic illnesses.

Objectives This qualitative study examines how and why adolescents living with visible and invisible chronic illnesses choose to share their condition with individuals within their social environments. Methods A sample of 25 adolescents were recruited from five subspecialty services: Spina bifida, rheumatology, cardiology, cystic fibrosis, and renal transplant/dialysis. Recruits completed a semi-structured interview designed to explore: (1) to whom adolescents disclose their conditions, (2) motivation and conditions under which they disclose, (3) content of disclosure, and (4) barriers to disclosure. Results Family members closely connected to treatment or management are most likely to be primary targets of disclosure. Regardless of social network size, respondents disclosed their illness to few peers. Common reasons for disclosure were perceived trust and shared experience with illness and disability. Reasons for withholding disclosure include perceived fear of rejection, pity, and perceptions of being seen as vulnerable or different. Discussion Disclosure was found to be influenced by (a) the visibility of a condition, (b) the anticipated response from the recipient, (c) practical needs, and (d) a decision that disclosure is justified. These findings inform clinical practice, warrant the need for further study, and insinuate practical solutions to combat the socio-emotional impact of nondisclosure among adolescents.

"Same-sex relationship in a straight world": individual and societal influences on power and control in young men's relationships.

Young men who have sex with men (YMSM) continue to experience higher rates of HIV infection than other populations. Recently, there have been recommendations to consider HIV prevention at the dyadic or couple level. Using a dyadic approach to HIV prevention would also address an unaddressed concern related to intimate partner violence (IPV) among YMSM. Although research on IPV among YMSM is still in its infancy, great strides have been made in the past 10 years to describe the prevalence and related correlates of IPV within older adult same-sex relationships. These studies have found rates of IPV among MSM to be similar to rates among heterosexual women, and to be on the rise. The present study is designed to provide insight into how power is conceptualized within YMSM relationships and the role it may play in relationship challenges. This study draws from qualitative data collected from 11 focus groups with 86 YMSM and 26 individual semi-structured interviews to understand relationship challenges and the experiences of YMSM involved in partner violence. YMSM described relationship power as stemming from numerous sources including sexual positioning, gender roles, education, income, prior relationship experiences, and internalized homophobia. The findings have a number of implications for service providers and program design. Interventionists and other researchers need to consider power dynamics and other contextual elements of IPV before effective interventions can be developed for YMSM and other sexual minority populations.

"I felt like a superhero": the experience of responding to drug overdose among individuals trained in overdose prevention.

BACKGROUND: Overdose prevention programs (OPPs) train people who inject drugs and other community members to prevent, recognise and respond to opioid overdose. However, little is known about the experience of taking up the role of an "overdose responder" for the participants. METHODS: We present findings from qualitative interviews with 30 participants from two OPPs in Los Angeles, CA, USA from 2010 to 2011 who had responded to at least one overdose since being trained in overdose prevention and response. RESULTS: Being trained by an OPP and responding to overdoses had both positive and negative effects for trained "responders". Positive effects include an increased sense of control and confidence, feelings of heroism and pride, and a recognition and appreciation of one's expertise. Negative effects include a sense of burden, regret, fear, and anger, which sometimes led to cutting social ties, but might also be mitigated by the increased empowerment associated with the positive effects. CONCLUSION: Findings suggest that becoming an overdose responder can involve taking up a new social role that has positive effects, but also confers some stress that may require additional support. OPPs should provide flexible opportunities for social support to individuals making the transition to this new and critical social role. Equipping individuals with the skills, technology, and support they need to respond to drug overdose has the potential to confer both individual and community-wide benefits.

Community-engaged research to identify house parent perspectives on support and risk within the House and Ball scene.

This article describes a community-engaged study with the Los Angeles House and Ball scene in which the perspectives of the leaders of these communities are captured to better understand how the House and Ball communities may protect or increase its members' risks for HIV infection. Data were collected through in-depth interviews with House parents (N = 26). This study identified key features of both support (e.g., family and support, acceptance, and validation and recognition) and risk (e.g., members' struggles to maintain status in the Ballroom scene, sex work, substance use, danger of becoming too involved in the Ball community, and perception and stigma of the Ballroom scene within the larger gay community) within these communities. Findings are discussed in relation to framing how to leverage the supportive aspects of the House and Ball communities to design relevant HIV-prevention interventions.