Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study.

Internalized homophobia, or the internalization of negative attitudes toward one's sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health.

Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.

Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort Study.

We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18-22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development-the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.

Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men.

Associations between social support network characteristics and sexual risk among racially/ethnically diverse young men who have sex with men (YMSM) were examined using egocentric network data from a prospective cohort study of YMSM (n = 501) recruited in New York City. Bivariate and multivariable logistic regression analyses examined associations between social support network characteristics and sexual risk taking behaviors in Black, Hispanic/Latino, and White YMSM. Bivariate analyses indicated key differences in network size, composition, communication frequency and average relationship duration by race/ethnicity. In multivariable analyses, controlling for individual level sociodemographic, psychosocial and relationship factors, having a sexual partner in one's social support network was associated with unprotected sexual behavior for both Hispanic/Latino (AOR = 3.90) and White YMSM (AOR = 4.93). Further examination of key network characteristics across racial/ethnic groups are warranted in order to better understand the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.

Resistance to HIV infection.

The biological correlates of an effective immune response that could contain or prevent HIV infection remain elusive despite substantial scientific accomplishments in understanding the interactions among the virus, the individual and the community. The observation that some individuals appear to possess resistance to HIV infection or its consequences has generated a host of epidemiologic investigations to identify biological or behavioral characteristics of these individuals. These data might hold the keys to developing appropriate strategies for mimicking the effective responses of those who appear immune. In this paper we review genetic mechanisms including the role of chemokines and their receptors, cytokines, host genetic immune response to HIV infection, local immune response correlating with behavioral variables, co-infection and immune based mechanisms that have been elucidated so far. We offer suggestions for how to use these observations as platforms for future research to further understand natural resistance to HIV infection through cohort studies, population genotype sampling, mathematical modeling of virus-host interactions and behavioral analyses.

Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the internet.

While unsafe sex has been reported throughout the HIV epidemic, the underlying assumption has been that most persons do not seek to purposely ham unprotected sex. Within the gay community, the term 'barebacking' has emerged to refer to intentional unsafe anal sex. The prevalence of barebacking is evidenced among gay men, particularly those who are HIV-positive, by the number of internet sites devoted to barebacking and the number of men seeking sexual partners through the use of the internet. To gain insight into barebacking, a sample of 112 HIV-positive gay men were recruited from internet sites where men seek to meet each other for sex. The major it of participants (84%)reported engaging in barebacking in the past three months, and 43% of the men reported recent bareback sex with a partner of unknown serostatus. These results indicate the potential for widespread transmission of HIV to uninfected men by the partners they meet on the internet. Analyses revealed that men who reported bareback sex only with HIV-positive partners scored lower in sexual adventurism than those who had bareback sex regardless of partner serostatus. A significant correlation was observed between defining masculinity as sexual prowess and intentional unprotected anal sex. There are serious implications for HIV prevention efforts, in that internet-based education should be a priority in order to reach men who rely on this mechanism to find sexual partners.

Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men.

Data regarding HIV antiretroviral treatment regimens, access to treatment and medical care, and adherence to medications were collected as part of the Seropositive Urban Men's Study, a formative study of HIV-positive men who have sex with men. Participants (N = 456) were recruited from AIDS service organizations, mainstream gay venues and public/commercial sex environments. The sample was 94% gay or bisexually-identified; 29% were African American, 24% Latino and 30% white. The majority (71%) indicated being on antiretroviral treatment, and most were taking a protease inhibitor/nucleoside reverse transcriptase inhibitor combination. African American men in New York City were less likely to be on treatment. Among those on treatment (n = 322), 51% reported at least one day in which they had missed a dose of their medication and the mean number of days in which a dose was missed (in the past 30 days) was 1.72. Multivariate analyses indicated that avoidant coping, frequency of drinking alcohol and difficulty in communicating with sex partners about HIV were related to days of missed doses, suggesting the need or desire to escape from the reality of life with HIV as a potential explanation for poor adherence.

Sexual and drug-using practices of HIV-positive men who frequent public and commercial sex environments.

An ethnically diverse sample (69.7% men of colour) of HIV-seropositive MSM from the New York City and San Francisco metropolitan areas were recruited from a variety of social settings. While only 27.0% of the participants were recruited from PSEs (public sex environments where men 'cruise' for potential sex partners, such as parks) and CSEs (commercial sex environments where an admission is paid for entrance, such as bathhouses and sex clubs), 49.6% reported attending PSEs and 40.7% reported attending CSEs. Only a minority of participants from the full sample reported sexual behaviours that would have placed a partner at highest risk for HIV seroconversion. However, differences between those who frequented CSEs and those who did not emerged on several psychosocial factors (sexual sensation seeking, depression, perceived responsibility towards protecting sexual partners from HIV infection), sexual risk behaviours (unprotected oral and anal sex) and types of recreational drugs used. Fewer differences were found between those who frequented PSEs and those who did not.

Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men.

We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.

Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men.

Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.

A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men.

Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large "circuit" parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphetamine use by gay men.

Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students.

To assess the differential effects of the perceived benefits and costs associated with both condom use and unprotected sex on sexual risk behaviors, data were collected from 704 ethnically diverse male and female sexually experienced late adolescent college students (aged 17-25). Perceived benefits and costs for condom use and perceived benefits and costs for unprotected sex were measured separately through an anonymous self-report survey. In addition, participants completed measures of self-efficacy for practicing safer sex and temptation for unsafe sex in various situations, and three measures of sexual risk-taking (stage of change for condom use, consistency of condom use during the past month, and whether or not a condom was used for the last act of intercourse). Univariate analyses indicated that benefits and costs of condom use, benefits of unprotected sex, self-efficacy and situational temptation were all related to sexual risk-taking. Gender differences were identified, with females reporting more benefits of condom use and costs of unprotected sex, fewer benefits of unprotected sex and costs of condom use, greater self-efficacy for practicing safer sex, and less situational temptation for unsafe sex. Multivariate analyses indicated that sexual risk behaviors were most related to situational temptation, self-efficacy for safer sex, and perceived benefits of unprotected sex. The results suggest that, among late adolescents, perceived benefits of the unhealthy behavior (unprotected sex) were better determinants of sexual risk-taking than were perceived benefits (or costs) associated with the healthy behavior (condom use). Perceived costs associated with unprotected sex were unrelated to sexual behaviors. These findings support previous work identifying adolescents as more driven by their perceptions of the positive benefits associated with risky behaviors, rather than knowledge of the costs or dangers involved in risk-taking.

Beyond complacency: the effects of treatment on HIV transmission.

AIDS: The novel optimistic view of the HIV epidemic, which seems to be associated with the success of HIV antiviral therapy and prevention, may lead to an increase in the number of HIV infected people. Overall, risky sexual behaviors are increasing due to optimism regarding the manageability and reduced threat of HIV disease. In addition, the beliefs that some people have regarding the success of treatment and the meaning of viral load are often not supported by scientific research. In order to regain proper prevention methods, misconceptions about the HIV epidemic should be cleared, through greater educational efforts by clinicians, educators, and AIDS service organizations with regards to new treatments, adherence, the meaning of viral activity, and the dangers of drug-resistant viral transmission.^ieng

The effect of item pool restriction on the precision of ability measurement for a Rasch-based CAT: comparisons to traditional fixed length examinations.

This paper describes a method for examining the precision of a computerized adaptive test with a limited item pool. Standard errors of measurement ascertained in the testing of simulees with a CAT using a restricted pool were compared to the results obtained in a live paper-and-pencil achievement testing of 4494 nursing students on four versions of an examination of calculations of drug administration. CAT measures of precision were considered when the simulated examine pools were uniform and normal. Precision indices were also considered in terms of the number of CAT items required to reach the precision of the traditional tests. Results suggest that regardless of the size of the item pool, CAT provides greater precision in measurement with a smaller number of items administered even when the choice of items is limited but fails to achieve equiprecision along the entire ability continuum.

Helping clients with HIV disease navigate managed care.

AIDS: The transition of medical care from fee-for-service to managed care is having an impact on health and mental health practitioners who provide care to people with HIV and AIDS. Evidence suggests that the quality of managed care is not adequate for older patients and patients with chronic diseases. Satisfaction with a managed care plan is often linked to perception of the plan's convenience, the relationship with one's primary health care provider, and the limits on out-of-pocket expenses. Dissatisfaction is linked to inefficient service, limits on choice of provider, and substandard care. The experiences of mental health care providers and recipients in the managed care system are discussed. Advocates note enhanced communication among health care providers and opponents voice concerns about regulation. The greatest concern is that treatment decisions will be based on factors other than the client's needs and best interests. Managed care has the potential to constrain psychotherapeutic treatment, however, understanding managed care plans can result in creative treatment approaches and strategies.^ieng