Exploring political diversity in relation to health and stress, among graduate students in the mental health field.

ObjectiveExamine associations between political diversity, health, and stress in a student sample for whom examining political biases is necessary. Participants: Graduate students in mental health (N = 512) from July 2017 to June 2018. Methods: Participants completed an online survey of political views, health, and stress. Descriptive statistics reported sample characteristics; stepwise regressions tested whether political affiliation and perceived political majority/minority status predicted health and stress. Results: Students identified primarily as liberal, and perceived their counterparts as liberal. Liberal political identification generally predicted more stress and poorer health in several domains; however, those identifying as most politically conservative also reported relatively high stress. Conclusions: Liberal academic environments may relate to stress for those who identify as most politically conservative, while also not protecting liberals against broader sociopolitical stress and related health sequelae. Graduate students in mental health may benefit from increased curricular and supervisory focus on political diversity and related biases.

Developing Prepare2Thrive, a community-based intervention targeting treatment engagement among African American individuals living with HIV and serious mental illness.

African American individuals living with HIV and serious mental illness (SMI) may report relatively low treatment engagement, despite treatment engagement being critical to managing both health conditions. Here, we have two aims: to describe the methodology we used to collect focus group data on treatment engagement with a sample of African American individuals living with HIV and SMI, and to describe the results of those focus groups in the context of intervention development. We conducted two focus groups (N = 15), integrating a social-ecological model for our theoretical framework, Community-Based Participatory Research for study design and execution, and group concept mapping for data analysis. Three thematic clusters relating to treatment engagement emerged from each group, with overlap across groups: Medication knowledge, Patient-provider relationships, and Barriers to treatment engagement. Items related to the Patient-provider relationship loaded onto all emergent clusters, demonstrating the pervasive impact of this variable. Findings informed the design of Prepare2Thrive, a community-based, culture-specific intervention aiming to increase treatment engagement among African American individuals living with HIV and SMI. Both our design and findings can be used in future collaborations aiming to maximize treatment engagement, and more broadly health, among individuals in this community.

Engaging African Americans Living with HIV and Serious Mental Illness: Piloting Prepare2Thrive-A Peer-Led Intervention.

BACKGROUND: African American individuals living with HIV (AALWH) and serious mental illness (SMI) represent a vulnerable intersectional group with relatively poor health. These individuals may require consistent treatment engagement to manage both of their chronic conditions; however, due to multilevel factors they are relatively less likely to engage in treatment consistently. OBJECTIVES: To test the acceptability, feasibility, fidelity, and participant outcomes of a brief psychoeducational and behavioral peer-led intervention. METHODS: Participants engaged in four weekly 90-minute pilot intervention sessions developed by the current community-based participatory research (CBPR) team. Sessions focused on problem-solving, communication skills, and coping with stigma, and were delivered by CBPR peerinterventionists. Participants completed pre- and postintervention surveys assessing treatment engagement and self-efficacy. RESULTS: Participants (N = 16) rated the intervention as acceptable, and attendance rates were high (87% average). Intervention leaders demonstrated exceptionally high fidelity to the intervention protocol. Participants reported a trend toward increasing antiretroviral therapy (ART) adherence from pre- to post-intervention (on average, an 8% increase, p = 0.063), notable in the context of a pilot study. Those who attended all four intervention sessions reported a 17.5% increase in ART adherence. From pre- to post-intervention medical appointment attendance decreased, mental health appointment attendance increased, and HIV treatment selfefficacy significantly increased. CONCLUSIONS: This study provides initial evidence for the feasibility of a CBPR-designed and tested, peer-led psychoeducation and behavioral intervention aiming to improve treatment engagement among AALWH and SMI, a marginalized group who could benefit from additional communitybased health research efforts.

Examining Partnership-Health Associations Among Lesbian Women and Gay Men Using Population-Level Data.

PURPOSE: The aim was to provide the first broad assessment of partnership-health associations across partnership statuses among lesbian and gay individuals. METHODS: Using population-level data from the 2016 U.S. Behavioral Risk Factor Surveillance System, specifically the 26 states/territories that assessed sexual orientation and gender identity, we ran analyses of covariance and logistic regressions to compare lesbian and gay individuals (N = 2963) of different partnership statuses in general health, physical health and health conditions, mental health, health behaviors, and health care access/utilization domains. RESULTS: All omnibus and logistic regression models were significant (p < 0.001). Follow-up pairwise comparisons of mean differences across partnership groups revealed that in at least one variable in the general health, mental health, health behaviors, and health care access/utilization domains, married lesbian and gay individuals reported the best health, followed by partnered, single, and then divorced, separated, and widowed lesbian and gay individuals (p < 0.001). Exceptions included variables in the physical health and health conditions domain, the health behaviors of smoking and heavy drinking, and ever having an HIV test. When stratifying by sex, for both gay men and lesbian women being married or partnered related to the best health in at least one variable in each health domain, and in the majority of all outcome variables. CONCLUSION: This article provides the first evidence for partnership-health associations among gay and lesbian individuals based on a large-scale, multidomain test of population-level data. Future research could examine temporal links between same-sex marriage legislation and health outcomes among sexual minority individuals.

Examining Associations Between State-Level Transgender Policies and Transgender Health.

Compared with their cisgender counterparts, transgender individuals face both structural-level discrimination and health disparities across health domains. We used recent population-level data to examine associations between state-level policy ratings regarding transgender people and transgender health (poor physical and mental health days, health behaviors, and health care utilization). We hypothesized more inclusive and protective state-level policies would predict better health of transgender individuals. The sample (N=1116) was approximately half white (n=572, 51.2%) and half transgender women (n=551, 49.3%). More transgender-inclusive and protective state-level policies predicted better health in three of four health domains. Policy and research implications are discussed.

iTunes song-gifting is a low-cost, efficient recruitment tool to engage high-risk MSM in internet research.

This brief report describes methodology and results of a novel, efficient, and low-cost recruitment tool to engage high-risk MSM in online research. We developed an incentivization protocol using iTunes song-gifting to encourage participation of high-risk MSM in an Internet-based survey of HIV status, childhood sexual abuse, and adult behavior and functioning. Our recruitment methodology yielded 489 participants in 4.5 months at a total incentive cost of $1.43USD per participant. The sample comprised a critically high-risk group of MSM, including 71.0 % who reported recent condomless anal intercourse. We offer a "how-to" guide to aid future investigators in using iTunes song-gifting incentives.

Health care access and health behaviors among men who have sex with men: the cost of health disparities.

Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM (N = 871). The authors examined demographic differences in health care access and the relation between access and health-related attitudes, health behaviors, and HIV transmission risk. They operationalized health care access in terms of three indicators: perceived barriers, insurance status, and recent medical visit. Twenty-seven percent (n = 227) of MSM reported zero or one health care access indicator. African American and Latino race/ethnicity, lower income, and HIV-unknown status were associated with limited health care access. Limited health care access was related to health care attitudes (mistrust in the health care system and difficulty disclosing MSM status to providers), general health behaviors (smoking, never being HIV-tested, and drug abuse), and sexual risk-related variables (low self-efficacy for sexual safety, consistent drug use during sex, and HIV transmission risk). Overall, among MSM, less health care access relates to several adverse psychological constructs and health behaviors. Researchers and public health officials should address limited health care access, and its consequences, in this population.

A longitudinal analysis of HIV treatment adherence among men who have sex with men: a cognitive escape perspective.

HIV is best managed by adhering to both medication and HIV care appointment schedules. Nonetheless, many HIV-positive men who have sex with men (MSM) report low levels of adherence to both. To explain this, we tested a cognitive escape model whereby drug and alcohol use mediate the effects of depression on HIV medication and appointment adherence. We used longitudinal data (n=856) from a behavioral intervention promoting increased treatment adherence among HIV-positive MSM. All model variables predicted appointment adherence, and our mediation hypotheses were supported. Conversely, although depression related to medication adherence, substance use did not mediate this relationship, as predicted. Self-reported appointment, but not medication, adherence related to changes in viral load over time. Therefore, cognitive escape characterizes appointment, but not medication, adherence within this sample. Future behavioral interventions for this population should target HIV appointment adherence, given its relationship to important clinical, psychological, and behavioral outcomes.

Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study.

HIV disproportionately affects racial and ethnic minority young men who have sex with men (YMSM). HIV prevention research does not include these YMSM commensurate to their HIV burden. We examined racial and ethnic differences during a unique three-step recruitment process for an online, YMSM HIV prevention intervention study (N = 660). Step one was completed in-person; steps two and three online. Fewer Black and Latino YMSM completed step two-initiating online participation-than White YMSM. Internet use frequency accounted for the Latino versus White difference in initiating online participation, but not the Black versus White difference. Future online HIV prevention interventions recruiting diverse YMSM should focus on initiating online engagement among Black participants.

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions.

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.

Condom-related problems among a racially diverse sample of young men who have sex with men.

We described frequencies of condom-related problems in a racially diverse sample of young men who have sex with men (YMSM), and tested these condom-related problems as an explanation for racial disparities in HIV rates among YMSM. Participants were 119 YMSM from a longitudinal study of sexual minority health behaviors. Almost all participants (95.4%) experienced at least one condom error. On average, African American and non-African American YMSM experienced the same number of recent condom-related problems. Therefore, differences in condom-related problems are unlikely to explain racial disparities in HIV rates among YMSM. When serving YMSM, providers should both promote condom use and explain steps to correct condom use.