Changes in high-risk sexual behavior, HIV and other STI testing, and PrEP use during the COVID-19 pandemic in a longitudinal cohort of adolescent men who have sex with men 13 to 18 years old in the United States.

The COVID-19 pandemic has disrupted sexual health services among those most vulnerable to HIV acquisition, such as adolescent men who have sex with men (AMSM). We sought to characterize the changes in sexual-risk behaviors, HIV and other STI testing, and pre-exposure prophylaxis (PrEP) use among a longitudinal cohort of AMSM aged 13 to 18 years before and during the COVID-19 pandemic. We observed a significant decline in HIV testing and a marginal decrease in other STI testing since the pandemic began in March 2020. Outreach efforts and innovative remote delivery of sexual health services are needed to support access to healthcare services among AMSM as the pandemic persists.

RESUMEN: La pandemia de COVID-19 ha afectado la prestación de servicios de salud sexual para los más vulnerables, tales como los hombres adolescentes que tienen relaciones sexuales con hombres (AMSM; por sus siglas en ingles). En una cohorte longitudinal de AMSM de 13 a 18 años, examinamos los cambios en comportamientos sexuales de alto riesgo, la prueba de VIH, las pruebas de otras enfermedades de transmisión sexual, y el uso de Profilaxis Preexposición (PrEP) para el VIH antes y durante la pandemia. Desde el inicio de la pandemia en marzo de 2020, observamos una disminución significativa en la frecuencia de pruebas de VIH y una disminución marginal en la frecuencia de pruebas de otras enfermedades de transmisión sexual. Mientras persista la pandemia, serán necesarios más esfuerzos de divulgación e innovaciones en la prestación remota de servicios de salud sexual para apoyar el acceso a dichos servicios por parte de AMSM.

Space within the Scientific Discourse for the Voice of the Other? Expressions of Community Voice in the Scientific Discourse of Community-Based Participatory Research.

Community-based participatory research (CBPR) has captured public health attention and support because it is positioned as an approach that involves researchers and communities as equitable partners in addressing health disparities. However, it is unknown the extent to which CBPR creates a participatory space in the scientific discourse to signal "community voice," which we define as textual expression of community-centered perspectives on collective roles, interests, and worldviews. In this study, we utilized the culture-centered approach to examine the expression of community voice in the abstracts and public health relevance statements of 253 extramural CBPR projects in the U.S. that received funding from the National Institute of Health and Centers for Disease Control and Prevention in 2009. We found that project abstracts and public health relevance statements contain four textual domains, or potential sites of contest to signal the articulation of community agency and voice within the CBPR projects. These domains include: 1) the rationale for the community health issue, 2) the roles of community partners, 3) community-centered outcomes of the partnership, and 4) elements of participatory research process. The degree of culture-centeredness of the texts is suggested in the extent to which articulations of community agency and voice are signaled across the four domains. We conclude that the dynamics of CBPR may shape culture-centered expressions of problem identification, solution configuration, structural transformations, reflexivity, values, and agency in the project abstracts and public health relevance statements.

Third-Party Intervention in Peer Victimization: Self-Evaluative Emotions and Appraisals of a Diverse Adolescent Sample.

African American, European American, Mexican American, and Native American adolescents (N = 270) described how they felt and appraised their own actions in response to a peer's victimization. Analyses compared times they had calmed victim emotions, amplified anger, avenged, and resolved conflicts peacefully. Adolescents felt prouder, more helpful, more like a good friend, and expected more peer approval after calming and resolving than after amplifying anger or avenging peers. They also felt less guilt and shame after calming and resolving. Avenging elicited more positive self-evaluation than amplifying. Epistemic network analyses explored links between self-evaluative and other emotions. Pride was linked to relief after efforts to calm or resolve. Third-party revenge reflected its antisocial and prosocial nature with connections between pride, relief, anger, and guilt.

Personal Outcomes in Community-based Participatory Research Partnerships: A Cross-site Mixed Methods Study.

Community-based participatory research (CBPR) has been embraced by diverse populations to address health inequities within their communities. CBPR has been shown to produce favorable health outcomes, but little is known about personal outcomes (e.g., individual growth and capacities) resulting from the direct involvement in a CBPR partnership. We empirically examine which CBPR partnerships' processes and practices are associated with personal outcomes. We hypothesize that higher levels of collaborative approaches and adherence to CBPR principles and practices would be associated with personal outcomes. Based on a national cross-site CBPR study, Research for Improved Health, we utilized mixed-method data from a comprehensive community-engagement survey (N = 450) and seven in-depth case studies to explore the hypothesized relationships. Our multivariate mixed-effects model revealed the importance of various partnering practices. Relationship dynamics emerged as key predictors including the following: respect in the partnership, voice and influence in decision-making among partners, and stewardship. Qualitative findings highlighted individual, partnership, and community-level impacts, within and beyond the partnership. Our findings have implications for CBPR best practices and highlight the potential role of personal outcomes for partnerships' sustainability, long-term outcomes, and health equity research.

Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women.

An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.

Building a Tribal-Academic Partnership to Address PTSD, Substance Misuse, and HIV Among American Indian Women.

OBJECTIVES: To describe our partnership and research infrastructure development strategies and discuss steps in developing a culturally grounded framework to obtain data and identify a trauma-informed evidence-based intervention. METHOD: We present funding strategies that develop and maintain the partnership and tools that guided research development. We share how a community research committee was formed and the steps taken to clarify the health concern and develop a culturally tailored framework. We present results from our needs/assets assessment that led to the selection of a trauma-informed intervention. Finally, we describe the agreements and protocols developed. RESULTS: We produced a strong sustainable research team that brought program and research funding to the community. We created a framework and matrix of program objectives grounded in community knowledge. We produced preliminary data and research and publication guidelines that have facilitated program and research funding to address community-driven concerns. CONCLUSIONS: This study highlights the importance of bidirectional collaboration with American Indian communities, as well as the time and funding needed to maintain these relationships. A long-term approach is necessary to build a sustainable research infrastructure. Developing effective and efficient ways to build culturally based community research portfolios provides a critical step toward improving individual and community health outcomes.

Mentoring the Mentors of Underrepresented Racial/Ethnic Minorities Who are Conducting HIV Research: Beyond Cultural Competency.

The majority of literature on mentoring focuses on mentee training needs, with significantly less guidance for the mentors. Moreover, many mentoring the mentor models assume generic (i.e. White) mentees with little attention to the concerns of underrepresented racial/ethnic minorities (UREM). This has led to calls for increased attention to diversity in research training programs, especially in the field of HIV where racial/ethnic disparities are striking. Diversity training tends to address the mentees' cultural competency in conducting research with diverse populations, and often neglects the training needs of mentors in working with diverse mentees. In this article, we critique the framing of diversity as the problem (rather than the lack of mentor consciousness and skills), highlight the need to extend mentor training beyond aspirations of cultural competency toward cultural humility and cultural safety, and consider challenges to effective mentoring of UREM, both for White and UREM mentors.

Place and sexual partnership transition among young American Indian and Alaska native women.

Multiple challenges expose American Indian and Alaska Native (AIAN) women to high-risk sexual partnerships and increased risk for HIV/STI. Using a unique sample of sexually-active young AIAN women (n = 129), we examined characteristics of last three partners and whether transitional partnerships were associated with different risk profiles, including where partners met, lived, and had sex. Respondents were more likely to have met their previous or current secondary partner (P2) at a friend's or family setting (versus work or social setting) (AOR = 3.92; 95 % CI 1.31, 11.70). Condom use was less likely when meeting a partner at friend's or family settings (AOR = 0.17; 95 % CI 0.05, 0.59). Sexual intercourse with P2 (compared to P1) usually took place in "riskier" settings such as a car, bar, or outside (AOR = 4.15; 95 % CI 1.59, 10.68). Perceived "safe" places, e.g., friend's or family's house, were identified with risky behaviors; thus, homogeneous messaging campaigns may promote a false sense of safety.

Prospective predictors of unprotected anal intercourse among HIV-seropositive men who have sex with men initiating antiretroviral therapy.

Contemporary HIV prevention efforts are increasingly focused on those already living with HIV/AIDS (i.e., "prevention with positives"). Key to these initiatives is research identifying the most risky behavioral targets. Using a longitudinal design, we examined socio-demographic and psychosocial factors that prospectively predicted unprotected anal intercourse (UAI) in a sample of 134 HIV-seropositive men who have sex with men (MSM) initiating, changing, or re-starting an antiretroviral therapy regimen as part of a behavioral intervention study. Computer-based questionnaires were given at baseline and 6 months. In a sequential logistic regression, baseline measures of UAI (step 1), socio-demographic factors such as Latino ethnicity (step 2), and psychosocial factors such as crystal methamphetamine use, greater life stress, and lower trait anxiety (step 3) were predictors of UAI at 6 months. Problem drinking was not a significant predictor. Prevention efforts among MSM living with HIV/AIDS might focus on multiple psychosocial targets, like decreasing their crystal methamphetamine use and teaching coping skills to deal with life stress.

Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities.

The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.

Structural violence of racism and colonization are social determinants of suicide.Collaborative and power-sharing implementation strategies can disrupt oppression.Strengths-based collectivist strategies can buffer structural suicide risk.

A Cross-sectional Study of Perceived Stress and Racial Discrimination Among a National Sample of Young Men Who Have Sex With Men.

ABSTRACT: Research regarding the impact of racism on stress among young men who have sex with men (YMSM) is sparse. Secondary data were assessed from a 2018-2020 national mHealth prevention trial for YMSM aged 13-18 years (N = 542). Linear regression models examined associations between perceived stress and interpersonal and vicarious racism, adjusting for covariates. Stratified models by race/ethnicity were included. A subanalysis (n = 288) examined associations between nine interpersonal racial discriminatory events and perceived stress. Over 50% of participants experienced racial discrimination. In the multivariable models, exposure to interpersonal (ß = 1.43, p-value: .038) and vicarious (ß = 1.77, p-value: .008) racism was associated with perceived stress because there were four interpersonal racial discriminatory events. Stratified analysis by race/ethnicity found significant associations between interpersonal and vicarious racism and perceived stress among some racial/ethnic groups. Racial discrimination was common among YMSM, making them susceptible to the possible effects of vicarious and interpersonal racism on stress.

Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives.

BACKGROUND: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools. OBJECTIVES: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school. METHOD: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use. RESULTS: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others.

Predictors of Past-Year Health Care Utilization Among Young Men Who Have Sex with Men Using Andersen's Behavioral Model of Health Service Use.

Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.

'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men.

BACKGROUND: American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. PURPOSE: This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. METHODS: AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. RESULTS: Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. CONCLUSIONS: Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

Change in sexual activity 12 months after ART initiation among HIV-positive Mozambicans.

We assessed sexual behaviors before and 12-months after ART initiation among 277 Mozambicans attending an HIV clinic. Measured behaviors included the number of sexual partners, condom use, concurrent relationships, disclosure of HIV status, alcohol use, and partners' serostatus. Compared to before ART initiation, increases were seen 12 months after ART in the proportion of participants who were sexually active (48% vs. 64% respondents, P < 0.001) and the proportion of participants with HIV-negative or unknown serostatus partners (45% vs. 80%, P < 0.001). Almost all (96%) concurrent partnerships reported at 12 months formed after ART initiation. Although reported correct and consist condom use increased, the number of unprotected sexual relationships remained the same (n = 45). Non-disclosure of HIV-serostatus to sexual partners was the only significant predictor of practicing unprotected sex with partners of HIV-negative or unknown serostatus. Sexual activity among HIV-positive persons on ART increased 12 months after ART initiation. Ongoing secondary transmission prevention programs addressing sexual activity with multiple partners, disclosure to partners and consistent condom use with serodisconcordant partners must be incorporated throughout HIV care programs.

Honor, face, and dignity norm endorsement among diverse North American adolescents: Development of a Social Norms Survey.

This article examined the psychometric properties and validity of a new self-report instrument for assessing the social norms that coordinate social relations and define self-worth within three normative systems. A survey that assesses endorsement of honor, face, and dignity norms was evaluated in ethnically diverse adolescent samples in the U.S. (Study 1a) and Canada (Study 2). The internal structure of the survey was consistent with the conceptual framework, but only the honor and face scales were reliable. Honor endorsement was linked to self-reported retaliation, less conciliatory behavior, and high perceived threat. Face endorsement was related to anger suppression, more conciliatory behavior, and, in the U.S., low perceived threat. Study 1b examined identity-relevant emotions and appraisals experienced after retaliation and after calming a victimized peer. Honor norm endorsement predicted pride following revenge, while face endorsement predicted high shame. Adolescents who endorsed honor norms thought that only avenging their peer had been helpful and consistent with the role of good friend, while those who endorsed face norms thought only calming a victimized peer was helpful and indicative of a good friend. Implications for adolescent welfare are discussed.

Sexual partner concurrency and sexual risk among gay, lesbian, bisexual, and transgender American Indian/Alaska natives.

BACKGROUND: American Indian and Alaska Natives suffer pervasive health disparities, including disproportionately high rates of HIV. Sexual network dynamics, including concurrency and sexual mixing patterns, are key determinants of HIV disparities. METHODS: We analyzed data from the first national study of gay, lesbian, bisexual, and transgender American Indian and Alaska Natives to examine the prevalence of concurrency, sex and race of partners, and level of risk across different partnership patterns. Egocentric network data were analyzed at the level of the respondents, who were grouped according to the sex of their last 3 partners. RESULTS: Overall rates of HIV and concurrency were high in this population. HIV prevalence (34%) and cumulative prevalence of concurrency (55%) were highest among men who had sex with only men, while women who had sex with only women reported lower concurrency and HIV. Women who had sex with women and men also had high HIV prevalence (15%) and reported slightly higher concurrency risk and low condom use, making them effective bridge populations. CONCLUSIONS: The uniformly high rates of Native partner selection creates the potential for amplification of disease spread within this small community, while the high rates of selecting partners of other races creates the potential for bridging to other groups in the transmission network. These findings provide some of the first insights into sexual networks and concurrency among Native gay, lesbian, bisexual, and transgender populations and suggest that both men and women deserve attention in HIV prevention efforts at individual, dyadic and population levels.

Risk factors for HIV disease progression in a rural southwest American Indian population.

OBJECTIVES: Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (AIs) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural AI community. METHODS: From January 2004 through December 2006, we interviewed 36 HIV-positive AIs regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome. RESULTS: Participant characteristics included being male (58.3%), being transgender (13.9%), having ever been incarcerated (63.9%), having a household income of < $1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p < 0.05), household income of < $1,000/month (p < 0.05), and provider-assessed alcohol abuse (p < 0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p < 0.05) and use of traditional medicine (p < 0.05). CONCLUSIONS: Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural AI population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.

Discussion and revision of the mathematical modeling tool described in the previously published article "Modeling HIV Transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy".

Mathematical models are increasingly used in social and behavioral studies of HIV transmission; however, model structures must be chosen carefully to best answer the question at hand and conclusions must be interpreted cautiously. In Pearson et al. (2007), we presented a simple analytically tractable deterministic model to estimate the number of secondary HIV infections stemming from a population of HIV-positive Mozambicans and to evaluate how the estimate would change under different treatment and behavioral scenarios. In a subsequent application of the model with a different data set, we observed that the model produced an unduly conservative estimate of the number of new HIV-1 infections. In this brief report, our first aim is to describe a revision of the model to correct for this underestimation. Specifically, we recommend adjusting the population-level sexually transmitted infection (STI) parameters to be applicable to the individual-level model specification by accounting for the proportion of individuals uninfected with an STI. In applying the revised model to the original data, we noted an estimated 40 infections/1000 HIV-positive persons per year (versus the original 23 infections/1000 HIV-positive persons per year). In addition, the revised model estimated that highly active antiretroviral therapy (HAART) along with syphilis and herpes simplex virus type 2 (HSV-2) treatments combined could reduce HIV-1 transmission by 72% (versus 86% according to the original model). The second aim of this report is to discuss the advantages and disadvantages of mathematical models in the field and the implications of model interpretation. We caution that simple models should be used for heuristic purposes only. Since these models do not account for heterogeneity in the population and significantly simplify HIV transmission dynamics, they should be used to describe general characteristics of the epidemic and demonstrate the importance or sensitivity of parameters in the model.

Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska Native women.

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.