Correlates of concordance between self-reported and lab-confirmed viral load among Black and Latine men who have sex with men (BLMSM) living with HIV in New York City.

Sustained viral suppression is one of the four strategies in the U.S. Department of Health and Human Services' (HHS) plan to end the HIV epidemic in the United States. Individuals living with HIV must understand their viral load accurately for this strategy to be effective. We conducted cross-sectional analyses using baseline data from the NNHIV longitudinal study among men who have sex with men (MSM) living with HIV in New York City to identify factors associated with concordant knowledge between self-reported and lab-confirmed viral load. Of 164 Black and/or Latine participants, 67% (n = 110) reported that their viral load was undetectable, however lab tests showed only 44% (n = 72) had an undetectable viral load (<20 copies/ml). Overall, 62% of the sample (n = 102) had concordant HIV viral load knowledge (agreement of self-reported and lab viral load). In multivariable regression, those with unstable housing (PR = 0.52, 0.30-0.92) and those who had higher levels of beliefs of racism in medicine scale (PR = 0.76, 0.59-0.97) were less likely to have concordant knowledge. Our study underscores the need for implementing measures to improve viral load knowledge, U = U messaging, and strategies to achieve and maintain undetectable viral load status to reduce the burden of HIV at the population level.

The Moderating Effects of HIV Relevant Factors on the Relationship Between Intimate Partner Violence and Intention to Start HIV Pre-exposure Prophylaxis (PrEP) Among Cisgender Women.

Intimate partner violence (IPV) and HIV are serious and related public health problems that detrimentally impact women's health. Because women who experience IPV are more likely to acquire HIV, it is critical to promote HIV prevention strategies, such as HIV pre-exposure prophylaxis (PrEP), that increase autonomy. This study of cisgender women eligible for HIV PrEP took place between 2017 and 2019 in Philadelphia and New York City. This study aimed to examine the relationship between four types of IPV (control, psychological, physical, sexual) and intention to start PrEP among PrEP-eligible cisgender women and assess the extent to which HIV relevant factors moderated the association between IPV experience and intention to start PrEP. In this sample of PrEP-eligible women (n = 214), 68.7% indicated intention to start PrEP in the next 3 months. Ethnicity was strongly associated with intention to start PrEP, with Hispanic women having the highest odds of intending to start PrEP in the next 3 months. Having a controlling partner significantly predicted intention to start PrEP. Women with more than one sex partner and a controlling partner had higher odds of intending to start PrEP as compared with those who had one or no partners and had no IPV control. These findings point to a need for patient-centered interventions that address the need for safety and autonomy among cisgender, PrEP-eligible women.

A Randomized Controlled Pilot Study of Just4Us, a Counseling and Navigation Intervention to Promote Oral HIV Prophylaxis Uptake Among PrEP-Eligible Cisgender Women.

HIV pre-exposure prophylaxis (PrEP) uptake among cisgender women in the United States is low. Just4Us, a theory-based counseling and navigation intervention, was evaluated in a pilot randomized controlled trial among PrEP-eligible women (n = 83). The comparison arm was a brief information session. Women completed surveys at baseline, post-intervention, and at three months. In this sample, 79% were Black, and 26% were Latina. This report presents results on preliminary efficacy. At 3 months follow-up, 45% made an appointment to see a provider about PrEP; only 13% received a PrEP prescription. There were no differences in PrEP initiation by study arm (9% Info vs. 11% Just4Us). PrEP knowledge was significantly higher in the Just4Us group at post-intervention. Analysis revealed high PrEP interest with many personal and structural barriers along the PrEP continuum. Just4Us is a promising PrEP uptake intervention for cisgender women. Further research is needed to tailor intervention strategies to multilevel barriers.Clinicaltrials.gov registration NCT03699722: A Women-Focused PrEP Intervention (Just4Us).

RESUMEN: La aceptación de la profilaxis previa a la exposición (PrEP) al VIH entre las mujeres cisgénero en los Estados Unidos es baja. Just4Us, una intervención de asesoramiento y navegación basada en la teoría, se evaluó en un ensayo piloto controlado aleatorizado con mujeres aptas para la PrEP (n = 83). El brazo de comparación fue una breve sesión de información. Las mujeres completaron encuestas al inicio, después de la intervención ya los 3 meses. En la muestra, el 79% eran negros y el 26% eran latinas. Este informe presenta resultados sobre la eficacia preliminar. A los 3 meses de seguimiento, el 45% hizo una cita para ver a un proveedor acerca de la PrEP; solo el 13% recibió una receta de PrEP. No hubo diferencias en el inicio de la PrEP por brazo de estudio (9% Info frente a 11% Just4Us). El conocimiento fue significativamente mayor en el grupo Just4Us después de la intervención. El análisis reveló un alto interés por la PrEP con muchas barreras personales y estructurales a lo largo del continuo de la PrEP. Just4Us es una prometedora intervención de adopción de PrEP para mujeres cisgénero. Se necesita más investigación para adaptar las estrategias de intervención a las barreras multinivel.

Vasculo-toxic and pro-inflammatory action of unbound haemoglobin, haem and iron in transfusion-dependent patients with haemolytic anaemias.

Increasing evidence suggests that free haem and iron exert vasculo-toxic and pro-inflammatory effects by activating endothelial and immune cells. In the present retrospective study, we compared serum samples from transfusion-dependent patients with ß-thalassaemia major and intermedia, hereditary spherocytosis and sickle cell disease (SCD). Haemolysis, transfusions and ineffective erythropoiesis contribute to haem and iron overload in haemolytic patients. In all cohorts we observed increased systemic haem and iron levels associated with scavenger depletion and toxic 'free' species formation. Endothelial dysfunction, oxidative stress and inflammation markers were significantly increased compared to healthy donors. In multivariable logistic regression analysis, oxidative stress markers remained significantly associated with both haem- and iron-related parameters, while soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble endothelial selectin (sE-selectin) and tumour necrosis factor α (TNFα) showed the strongest association with haem-related parameters and soluble intercellular adhesion molecule 1 (sICAM-1), sVCAM-1, interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) with iron-related parameters. While hereditary spherocytosis was associated with the highest IL-6 and TNFα levels, ß-thalassaemia major showed limited inflammation compared to SCD. The sVCAM1 increase was significantly lower in patients with SCD receiving exchange compared to simple transfusions. The present results support the involvement of free haem/iron species in the pathogenesis of vascular dysfunction and sterile inflammation in haemolytic diseases, irrespective of the underlying haemolytic mechanism, and highlight the potential therapeutic benefit of iron/haem scavenging therapies in these conditions.

Prognostic factors associated with COVID-19 related severity in sickle cell disease.

BACKGROUND: Equipoise exists regarding sickle cell disease (SCD) as a risk factor for COVID-19 disease severity and variables that increase risk of COVID-19 severity in SCD. Given our health system's large SCD patient catchment, we analyzed our own experience in this regard. STUDY METHODS: Retrospective analysis of the clinical course and factors associated with need for hospitalization and ICU admission of SCD patients diagnosed with COVID-19 through the Northwell Health system from March 1 to Dec 31, 2020. RESULTS: Of 1098 patients with SCD, 3.3% were diagnosed with COVID-19. Overall rates of hospitalization, ICU admission, cohort mortality, and in-hospital mortality were 80%, 19%, 2.5%,and 3.1%, respectively. By multivariable analysis, hospitalization risk was decreased by 60% for every 1 g/dL increase in admission Hb. ICU admission risk was increased by 84% as a health care worker; increased by 45% for every 1000/uL increase in admission immature granulocyte count; and decreased by 17% with hydroxyurea use. DISCUSSION: High hospitalization rates are compatible with worsened severity upon COVID-19 infection in SCD compared to the general population. Patients should be placed on hydroxyurea to increase their Hb and perhaps lower their neutrophil counts. Health care workers with SCD may warrant special safety precautions.

Safety and benefits of automated red cell depletion-exchange compared to standard exchange in patients with sickle cell disease undergoing chronic transfusion.

BACKGROUND: The Spectra Optia allows automated performance of red blood cell reduction and isovolemic hemodilution (IHD) prior to standard red cell exchange (RCE), and is primarily intended for patients with sickle cell disease (SCD) undergoing chronic RCE. Data on the safety of inducing transient further anemia and the benefits of IHD-RCE is limited and occasionally contradictory. STUDY DESIGN AND METHODS: In this retrospective crossover analysis of six patients with SCD who underwent chronic exchange with standard RCE (Cobe Spectra) followed by IHD-RCE (Spectra Optia), we compared safety and benefit outcomes with IHD-RCE vs standard RCE. RESULTS: There were statistically but not clinically significant drops in blood pressure in the post-IHD phase. With IHD-RCE, there were significant reductions in red blood cell (RBC) usage and/or lower fraction of cells and significant increases in postprocedure hematocrit (Hct) associated with increased preprocedure Hct. There were no differences achieved in the time interval between procedures or in the net RBC gain with IHD-RCE. Overall, there were also no significant differences in pre- and postprocedure percentage of hemoglobin S, reticulocyte count, interval daily hemoglobin A decrement, or postprocedure white blood cell, neutrophil, or platelet counts. CONCLUSIONS: Our study supports that IHD-RCE can be safely used in patients with stroke risk and compared to standard RCE, results in benefits of lower RBC usage and/or fraction of cells remaining and higher postprocedure Hct associated with higher preprocedure Hct. These findings support wider use of IHD-RCE, especially in the current environment with reduced availability of minority units.

Characteristics of coronavirus disease 19 convalescent plasma donors and donations in the New York metropolitan area.

BACKGROUND: Convalescent plasma (CP) is an important initial treatment in pandemics and the New York (NY) metropolitan area is likely to remain a hotspot for collection and distribution of such units. This study reports characteristics of coronavirus disease 19 CP (CCP) donors and their donations to the New York Blood Center (NYBC). STUDY DESIGN AND METHODS: All CCP data from our first day of collection on March 26th through July 7th, 2020 are included in this retrospective analysis. Donor and donation data were extracted from NYBC electronic databases. SARS-CoV-2 antibody testing was initially performed by the NY State Department of Health, and later by NYBC using Ortho and Abbott platforms. RESULTS: CCP donor age and ABO distributions were consistent with reported lower COVID-19 susceptibility in O blood types. CCP versus whole blood donors had similar on-site deferrals, but higher post-donation deferral rates. CCP versus routine plasmapheresis donations had higher vasovagal reactions but similar product rejection rates. Changes in antibody (Ab) test platforms resulted in significant changes in the percent of donors regarded as antibody positive. Donor correlates with higher anti-spike total Ig S/CO ratios were Hispanic ethnicity, overweight body mass index, and longer symptom duration; and with higher anti-nucleocapsid IgG S/CO ratios were male gender, older age, Hispanic ethnicity, and fewer days between symptom onset and first donation. DISCUSSION: We identify donor characteristics not previously reported to correlate with Ab titer. Our analysis should assist with donor outreach strategies, blood center operating logistics, and recruitment of high titer donors.

TRUST: Assessing the Efficacy of an Intervention to Increase HIV Self-Testing Among Young Black Men Who have Sex with Men (MSM) and Transwomen.

HIV testing among young Black MSM and transwomen (YBMSM/TW) is the gateway to biomedical HIV prevention or treatment. HIV self-testing (HST) is a method that may increase consistent HIV testing. TRUST, a brief, peer-based behavioral intervention, was designed to increase uptake of consistent (every three months) HST among YBMSM/TW in New York City. To test the efficacy of the intervention, we randomized 200 friend pairs into either the intervention condition (TRUST) or a time and attention control condition. A modified intent-to-treat analysis found that self-reported HST at 3-month follow-up was statistically significantly higher (uOR 2.29; 95% CI 1.15, 4.58) and at 6-month follow-up was marginally statistically significantly higher (uOR 1.94; 95% CI 1.00, 3.75) in the intervention arm as compared with the control arm. There were no statistically significant differences by arm at 9- or 12-month follow-up. TRUST, a culturally-congruent intervention to increase HST among YBMSM/TW, had short-term impact on past-three month HST.Clinical Trials Registration ClinicalTrial.gov NCT04210271.

Validation of simple prediction algorithms to consistently achieve CD3+ and postselection CD34+ targets with leukapheresis.

BACKGROUND: Cellular therapies using engineered T cells, haploidentical transplants, and autologous gene therapy are increasing. Specified CD3+ or high CD34+ doses are typically required for subsequent manufacturing, manipulation, or CD34+ selection. Simple, practical, and reliable lymphocyte and hematopoietic progenitor cell (HPC) collection algorithms accounting for subsequent CD34+ selection have not been published. STUDY DESIGN AND METHODS: In this analysis of 15 haploidentical donors undergoing tandem lymphocyte and HPC collections, we validated one-step, practical prediction algorithms (Appendix S1, available as supporting information in the online version of this paper) that use conservative facility-specific collection efficiencies, CD34+ selection efficiency, and donor-specific peripheral counts to reliably achieve the target CD3+ and CD34+ product doses. These algorithms expand on our previously published work regarding predictive HPC collection algorithms. RESULTS: Ninety-three percent of lymphocyte and 93% of CD34+ collections achieved the final target CD3+ and CD34+ product dose when our algorithm-calculated process volumes were used. Linear regression analysis of our algorithms for CD3+, preselection CD34+, and postselection CD34+ showed statistically significant models with R2 of 0.80 (root mean square error [RMSE], 31.3), 0.72 (RMSE, 385.7), and 0.56 (RMSE, 326.0), respectively, all with p values less than 0.001. CONCLUSION: Because achievement of CD3+ or CD34+ dose targets may be critical for safety and efficacy of cell therapies, these simple, practical, and reliable prediction algorithms for lymphocyte and HPC collections should be very useful for collection facilities.

The Role of Social Support in HIV Testing and PrEP Awareness among Young Black Men and Transgender Women Who Have Sex with Men or Transgender Women.

Young black men and transgender women (transwomen) who have sex with men or transwomen are most vulnerable in terms of risk for HIV infection, also reflected in their extremely high incidence rates. As testing rates and pre-exposure prophylaxis (PrEP) uptake remain suboptimal among these groups, primarily due to unique structural barriers, the present analyses draw on data from an online survey, administered October 2014 to August 2015, to explore social support-related predictors of knowledge and behavior around HIV prevention.Participants were 169 biological men who identified as black, with a mean age of 24 (SD = 2.97, range 17-29); 8% identified as transwomen. Logistic regression models assessed whether HIV-related social support predicted HIV testing patterns, PrEP awareness, and use. Those with higher HIV-related social support reported having been more likely to have ever tested (adjusted odds ratio (aOR) = 1.48; p < 0.001) and tested in the past 6 months (aOR = 1.22; p < 0.01). They were also more likely to intend to test in the next 6 months (aOR = 1.16; p < 0.001), including at a medical office or community-based organization (aOR = 1.20; p < 0.001), yet less likely to intend to self-test (aOR = 0.81; p < 0.001). Lastly, higher social support was significantly associated with prior knowledge of self-testing (aOR = 1.19; p < 0.05), couples testing (aOR = 1.26; p < 0.001), and PrEP (aOR = 1.22; p < 0.01), as well as prevention self-efficacy (aOR = 1.30; p < 0.001), but inversely associated with prior self-testing (aOR = 0.80; p < 0.05). For young black men and transwomen who have sex with men or transwomen, HIV-related social support, which likely has a strong peer component, appears to be a facilitator of optimal testing and intentions to test, as well as awareness of novel prevention strategies (like self-testing or PrEP). However, community resourcefulness needs to be bolstered by other mechanisms, such as changes within healthcare settings, to increase actual use of novel prevention modalities.

Acculturation as a Moderator of HIV Risk Behavior Correlates Among Latino Men Who Have Sex with Men.

Acculturation is associated with increased sexual risk behaviors among heterosexual Latinos, but its influence among Latino gay, bisexual, and other men who have sex with men (MSM) remains less clear. Elements of acculturation may create distinct lived experiences among sexual minority Latinos, moderating how beneficial and adverse influences contribute to their sexual risk behaviors. Latino MSM living in New York City (n = 412) were recruited using a modified time-space venue- and web-based sampling method. Negative binomial regression models estimated associations between indicators of acculturation (i.e., language use, nativity status, ethnic identification), sexual minority stressors (i.e., internalized homophobia, sexual orientation-based discrimination), peer condom use norms, and the number of serodiscordant condomless anal intercourse (SDCAI) encounters. Acculturation indicators were then tested as simultaneous moderators of the influence of each predictor variable on the outcome. The association between internalized homophobia and SDCAI was significant only among English language speakers (aIRR = 3.05 [2.13, 4.37]) and those born outside of the U.S. (foreign-born = 0, aIRR = 0.17 [0.08, 0.36]). Sexual orientation-based discrimination and SDCAI were also positively associated among both English-speaking (aIRR = 1.82 [1.22, 2.72]) and foreign-born men (aIRR = 0.34 [0.14, 0.84]). Stronger ethnic identification also moderated the protective effects of peer condom use norms on SDCAI (aIRR = 0.28 [0.15, 0.52]). Results suggest that different dimensions of acculturation help shape how both stressors and protective factors influence HIV risk among Latino MSM. Future research is needed to examine the mechanisms through which these differences in acculturation may act on sexual risk behaviors among Latino MSM.

Donor incentives improve cardiovascular disease risk profile and donation rates.

BACKGROUND: Blood centers may offer point-based reward systems or cardiovascular disease (CVD) screening to incentivize donors. However, combining these incentives to improve CVD risk and blood donation rates has not been studied. STUDY DESIGN AND METHODS: Study was a three-arm prospective controlled trial: Group 1, control (routine points, no CVD screening); Group 2, CVD screening with routine points; and Group 3, CVD screening plus incentive double points. The primary objective was to determine if double versus routine incentive points led to improvement or maintenance of CVD risk profile assessed using self-reported changes in 1) reading food labels for calorie and fat content, 2) exercising daily, 3) reduced fat intake, and 4) increase in eating fruits and vegetables. Outcomes were compared at first and final (2-year) follow-up visits. As secondary outcome, median blood donation rates before enrollment and during study were compared. RESULTS: A total of 570 donors (290 in Group 1, 134 in Group 2, 146 Group 3) were selected. At first follow-up visit, 71.4% in Group 3 versus 62.0% in Group 2 subjects reported at least one of four positive behavioral changes (p < 0.001). Increase in reading food labels for calorie and fat content was the most common change and higher in Group 3 (Group 3 from 60.9% to 79.1%; Group 2 from 67.6% to 77.5%; p < 0.001). Final evaluation showed significant increase in self-reported exercise in Group 3 only (from baseline 52.9% to 68.3%; p < 0.05). Group 3 reported higher increase in median number of donations/year during study enrollment (6.8 [IQR, 4.3-12] vs. baseline 4.6 [IQR, 3.2-7.1] donations/year) than Group 2 (5.6 [IQR, 4.2-10.5] vs. baseline 4.9 [IQR, 3.5-10.2]) and Group 1 (4.4 [IQR, 2.7-8.0] vs. baseline 4.4 [IQR, 2.5-6.0] donations/year; p < 0.001). CONCLUSION: Positive donor reinforcement (double vs. routine points) resulted in better self-reported health maintenance behavior and increased donation rates.

A dual strategy to optimize hematopoietic progenitor cell collections: validation of a simple prediction algorithm and use of collect flow rates guided by mononuclear cell count.

BACKGROUND: Previous prediction algorithms to achieve target CD34+ goals have not been widely adopted, with many centers still using a set volume to process for hematopoietic progenitor cell collections. This may be because previous algorithms are challenging to implement. Additionally, no study has yet examined the utility of adjusting the collect flow rate (CFR) based on the donor's preprocedure total mononuclear cell (MNC) count, which correlates with CD34+ yield. STUDY DESIGN AND METHODS: In this retrospective analysis of mobilized allogeneic donors collected using MNC (COBE Spectra, Terumo BCT) or continuous mononuclear cell collection (CMNC) (Spectra Optia, Terumo BCT) procedures, we validated a one-step prediction algorithm to achieve the target CD34+ product dose (Appendix S1, available as supporting information in the online version of this paper). The COBE Spectra MNC Collect Flow Tool (Appendix S2, available as supporting information in the online version of this paper) was used to select the collect flow rate for both MNC and CMNC procedures. Procedural collection efficiency (CE) was compared to that of historical procedures utilizing fixed CFRs (1.0-1.5 mL/min). RESULTS: Ninety-three percent of collections achieved the target CD34+ goal using our algorithm-calculated process volumes. The remaining 7% of cases had CEs lower than the algorithm CE (0.40), and thus were below goal. Second, an MNC-based CFR improved MNC and CD34+ CEs in patients with higher MNC counts compared to our historical controls. CONCLUSION: We validated that this simple, single-step prediction algorithm achieves the target CD34+ goal in most HPC collections. Secondly, we showed that an MNC-based CFR for hematopoietic progenitor cell collections improves CE at higher MNCs; this may be preferable to a WBC-based CFR because of variability of MNC counts at a given WBC count.

Minihepcidin peptides as disease modifiers in mice affected by ß-thalassemia and polycythemia vera.

In ß-thalassemia and polycythemia vera (PV), disordered erythropoiesis triggers severe pathophysiological manifestations. ß-Thalassemia is characterized by ineffective erythropoiesis, reduced production of erythrocytes, anemia, and iron overload and PV by erythrocytosis and thrombosis. Minihepcidins are hepcidin agonists that have been previously shown to prevent iron overload in murine models of hemochromatosis and induce iron-restricted erythropoiesis at higher doses. Here, we show that in young Hbb(th3/+) mice, which serve as a model of untransfused ß-thalassemia, minihepcidin ameliorates ineffective erythropoiesis, anemia, and iron overload. In older mice with untransfused ß-thalassemia, minihepcidin improves erythropoiesis and does not alter the beneficial effect of the iron chelator deferiprone on iron overload. In PV mice that express the orthologous JAK2 mutation causing human PV, administration of minihepcidin significantly reduces splenomegaly and normalizes hematocrit levels. These studies indicate that drug-like minihepcidins have a potential as future therapeutics for untransfused ß-thalassemia and PV.

Safety and efficacy of plerixafor dose escalation for the mobilization of CD34+ hematopoietic progenitor cells in patients with sickle cell disease: interim results.

Gene therapy for sickle cell disease is limited by the yield of hematopoietic progenitor cells that can be harvested for transduction or gene editing. We therefore performed a phase I dose-escalation study of the hematopoietic progenitor cell mobilizing agent plerixafor to evaluate the efficacy and safety of standard dosing on peripheral blood CD34+ cell mobilization. Of 15 patients enrolled to date, only one was chronically transfused and ten were on hydroxyurea. Of eight patients who achieved a CD34+ cell concentration >30 cells/µL, six were on hydroxyurea. There was no clear dose response to increasing plerixafor dosage. There was a low rate of serious adverse events; two patients developed vaso-occlusive crises, at the doses of 80 µg/kg and 240 µg/kg. Hydroxyurea may have contributed to the limited CD34+ mobilization by affecting baseline peripheral blood CD34 counts, which correlated strongly with peak peripheral blood CD34 counts. Plerixafor administration did not induce significant increases in the fraction of activated neutrophils, monocytes, or platelets. However, increased neutrophils positive for activated ß2 integrin and Mac-1 were associated with serious adverse events. In summary, plerixafor was well tolerated but did not achieve consistent CD34+ cell mobilization in this cohort of patients, most of whom were being actively treated with hydroxyurea and only one was chronically transfused. The study will continue with escalation of the dose of plerixafor and modification of hydroxyurea administration. Clinicaltrials.gov identifier: NCT02193191.

Post-exposure Prophylaxis Awareness, Knowledge, Access and Use Among Three Populations in New York City, 2016-17.

Post-exposure prophylaxis (PEP) is a cost-effective, but underused HIV prevention strategy. PEP awareness, knowledge, access, and usage was assessed among young men of color who have sex with men (YMSMOC; n = 177), transgender women (TW; n = 182), and cisgender women of color (CWOC; n = 170) in New York City. 59% were aware of PEP: 80% among YMSMOC, 63% among TW and 34% among CWOC (p < 0.001). 13% had ever used PEP. PEP awareness was higher among YMSMOC with a recent HIV test and lower among those with ≥ 4 partners. PEP awareness was lower among TW who anticipated stigma and reported barriers to taking PEP, and higher among TW who exchanged sex for resources. Among CWOC, more barriers to taking PEP reduced the odds of PEP awareness. PEP education and outreach needs to be deliberate about population-specific campaigns, with a need to focus on reducing PEP stigma and other barriers which impede PEP access.

Associations Among Neighborhood Characteristics and Sexual Risk Behavior Among Black and White MSM Living in a Major Urban Area.

Identifying neighborhood characteristics associated with sexual HIV risk behavior among gay, bisexual and other men who have sex with men (MSM) living in urban areas may inform the development of policies and programs to reduce risk and subsequently HIV prevalence in urban areas. New York City M2M was a cross-sectional study designed to identify neighborhood-level characteristics associated with sexual risk behaviors among MSM living in New York City. This paper presents results of an analysis of neighborhood-level indicators of three distinct social theories of influence of the neighborhood environment on human behavior: physical disorder, social disorganization and social norms theories. Using multilevel modeling on a sample of 766 MSM stratified by race/ethnicity, we found little support for the role of social disorganization on the sexual risk behavior of MSM, whereas different indicators of physical disorder exerted negative effects across race groups. Our results suggest that the beneficial effects of housing stock maintenance and general neighborhood physical orderliness and cleanliness may have positive effects beyond those traditionally studied for African American MSM and that the field needs novel theorizing regarding whether and how neighborhood or virtual community-level factors relate to sexual behavior among MSM.

Congruence of Home, Social and Sex Neighborhoods among Men Who Have Sex with Men, NYCM2M Study.

Substantial literature demonstrates the influence of the neighborhood environment on health behaviors and outcomes. But limited research examines on how gay and bisexual men experience and exist in various geographic and virtual spaces and how this relates to their sexual behavior. New York City Men 2 Men (NYCM2M) was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use, and depression among men who have sex with men (MSM) living in NYC. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. Whether key neighborhoods of human activity, where a participant resided (termed home), socialized (termed social), or had sex most often (termed sex), were the same or different was evaluated. "Congruence" (or the sameness) of home, social, and most often sex neighborhood was reported by 17 % of men, while 30 % reported that none of their neighborhoods were the same. The largest group of men (39 %) reported that their home and sex neighborhoods were the same but their social neighborhood was different while 10 % reported that their home neighborhood was different than their social and sex neighborhood; 5 % men reported same home and social neighborhoods with a different sex neighborhood. Complete neighborhood incongruence was highest among men who were Black and/or Latino, had lower education and personal income levels, and had greater financial insecurity. In adjusted analysis, serodiscordant condomless anal intercourse and condomless anal intercourse with partners from the Internet or mobile applications were significantly associated with having the same social and sex (but not home) neighborhoods. Understanding the complexity of how different spaces and places relate to the health and sexual behavior of MSM is essential for focusing interventions to best reach various populations of interest.

Neighborhood determinants of mood and anxiety disorders among men who have sex with men in New York City.

PURPOSE: We examined the relationship between economic, physical, and social characteristics of neighborhoods, where men who have sex with men (MSM) lived and socialized, and symptom scores of depression and generalized anxiety disorder (GAD). METHODS: Participants came from a cross-sectional study of a population-based sample of New York City MSM recruited in 2010-2012 (n = 1126). Archival and survey-based data were obtained on neighborhoods, where the men lived and where they socialized most often. RESULTS: MSM who socialized in neighborhoods with more economic deprivation and greater general neighborhood attachment experienced higher GAD symptoms. The relationship between general attachment to neighborhoods where MSM socialized and mental health depended on the level of gay community attachment: in neighborhoods characterized by greater gay community attachment, general neighborhood attachment was negatively associated with GAD symptoms, while in low gay community attachment neighborhoods, general neighborhood attachment had a positive association with GAD symptoms. CONCLUSIONS: This study illustrates the downsides of having deep ties to social neighborhoods when they occur in the absence of broader access to ties with the community of one's sexual identity. Interventions that help MSM cross the spatial boundaries of their social neighborhoods and promote integration of MSM into the broader gay community may contribute to the reduction of elevated rates of depression and anxiety in this population.

Evidence of relative iron deficiency in platelet- and plasma-pheresis donors correlates with donation frequency.

BACKGROUND: The loss of iron stores and resulting iron deficiency is well documented in whole blood or red blood cell donors. We hypothesized that relative iron deficiency also occurs as a result of more frequent platelet- and plasma-pheresis (apheresis) donation. MATERIALS AND METHODS: To test this hypothesis, we proposed a pilot cross-sectional study to analyze erythropoiesis- and iron-related parameters in white male apheresis donors: (1) relative to controls, (2) in correlation with apheresis donation frequency, and (3) in correlation with pre-donation platelet count. RESULTS: Fifty eligible apheresis donors and eight controls were enrolled in the study. Apheresis donors were found to have a lower serum ferritin and serum hepcidin and exhibited evidence of iron restricted erythropoiesis relative to controls. Furthermore, among donors, lower MCV, CHr , hepcidin concentration, and serum ferritin were observed in more frequent apheresis donors. Correlations between donation frequency and hepcidin and ferritin were noted in apheresis donors. CONCLUSIONS: This pilot study demonstrates that apheresis donors are relatively iron deficient compared to controls and supports the premise that frequent apheresis donation correlates with relatively iron restricted erythropoiesis. An analysis of iron- and erythropoiesis-related parameters in a broader population of frequent apheresis donors (i.e., female and non-white donors) may demonstrate larger deficits and an even greater potential benefit of iron replacement. J. Clin. Apheresis 31:551-558, 2016. © 2015 Wiley Periodicals, Inc.