Main Partner Relationships and the HIV Care Cascade: Examining the Predictive Utility of Sexual Agreements, Partner Concordance, and Drug Use Among Sexual Minority Men Living With HIV in the USA.

BACKGROUND: The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. PURPOSE: This study evaluated associations between relational covariates (relationship status, sexual agreements, and seroconcordance) and HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load (VL) testing, and VL detectability) above and beyond cannabis and stimulant drug use. METHODS: Adult SMM (n = 36,874) living with HIV in the USA were recruited between November 1, 2017 and March 15, 2020 through social networking applications. They completed a cross-sectional survey online. RESULTS: Nonmonogamous SMM with serodiscordant partners were most likely to have an ART prescription. Those with seroconcordant partners (regardless of sexual agreements) were least likely to be adherent. While relational covariates were not associated with VL testing, SMM in nonmonogamous relationships with serodiscordant partners were significantly more likely to have an undetectable VL. Those in monogamous relationships with seroconcordant partners were significantly less likely to have an undetectable VL. CONCLUSIONS: SMM with seroconcordant partners and monogamous sexual agreements may experience diminished interpersonal motivation for HIV care engagement. HIV care cascade retention messages that emphasize the prevention of onward transmission may have limited relevance for these SMM. Novel intervention strategies are needed to enhance HIV care outcomes in this population, ideally ones that incorporate attention to drug use.

The majority of people living with HIV in the USA are sexual minority men (SMM). Whereas substantial work has examined HIV prevention in male couples, relatively little has examined relationship factors associated with HIV care outcomes. This study examined whether relationship status, main partner serostatus (seroconcordant vs. serodiscordant), and sexual agreements (monogamous vs. nonmonogamous) were associated with HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load testing, and viral load detectability) above and beyond cannabis and stimulant drug use. We surveyed adult SMM (n = 36,874) living with HIV in the USA between November 2017 and March 2020. Across outcomes where significant between-group differences were observed, results generally indicated partnered SMM with serodiscordant partners­particularly those in nonmonogamous relationships­were more likely to be retained in the HIV care cascade; meanwhile, SMM with seroconcordant partners­particularly those in monogamous relationships­were most vulnerable to attrition in the HIV care cascade. Given this pattern of findings, it is conceivable that efforts to motivate linkage and retention along the HIV care cascade have emphasized the prevention of onward transmission while failing to capitalize on or acknowledge health enhancement as an additional (and coequal) source of motivation.

Comparing Repeated (Annual) Couples HIV Testing and Counseling to Individual HIV Testing and Counseling Among Male Couples at High Risk of HIV Infection: Protocol for a Randomized Control Trial.

BACKGROUND: Couples HIV testing and counseling (CHTC) is now a standard of care prevention strategy recommended by the Centers for Disease Control and Prevention for sexual minority men (SMM) in relationships. Despite standard recommendations that couples complete CHTC every 6-12 months, no study has empirically evaluated the effects associated with CHTC retesting. OBJECTIVE: This study aims to understand the benefits associated with continued dyadic engagement in the HIV prevention continuum through routine CHTC retesting, which is of particular importance for emerging-adult SMM in relationships who use drugs. METHODS: Eligible couples for this CHTC retesting trial must already be enrolled in the 4Us trial, where they completed a CHTC session after their baseline survey. The purpose of the original 4Us trial was to test the efficacy of 2 intervention components for CHTC: a communication skills training video and a substance use module. Couples were eligible for the original 4Us trial if they identified as cisgender male, were in a relationship for 3 months or longer, were aged 17 years or older, and communicated in English. At least 1 partner had to be aged 17-29 years, report HIV negative or unknown serostatus, report use of at least 1 drug (cannabis, cocaine or crack, crystal methamphetamine, ketamine, gamma-hydroxybuterate [GHB], psychedelics, ecstasy, prescription medication misuse, opiates, and nitrates) use, and engage in condomless anal sex (CAS) acts with a casual partner or have a main partner who is nonmonogamous or serodiscordant. Those who complete the 4Us 12-month follow-up and remain in a relationship with the partner they participated in 4Us with are offered the opportunity to participate in this CHTC retesting trial. Those consenting are randomized to either CHTC retesting or individual HIV testing. Follow-up assessments are conducted 3 and 6 months after randomization to evaluate the effects of repeat CHTC on 2 primary outcomes: (1) CAS with a casual partner in the absence of preexposure prophylaxis (PrEP), and (2) CAS with a serodiscordant main partner who is not virally suppressed or concurrent CAS between main and casual partners in the absence of PrEP. RESULTS: The CHTC retesting trial launched in January 2023, and enrollment is ongoing. As of February 2024, the study had enrolled 106 eligible participants (n=53 couples). CONCLUSIONS: Findings from this CHTC retesting study will contribute to knowledge about the benefits associated with regular (repeated) CHTC testing versus routine individual HIV testing for SMM in relationships. The results of this trial will inform CHTC retesting guidance. TRIAL REGISTRATION: ClinicalTrials.gov NCT05833074; htps://www.clinicaltrials.gov/study/NCT05833074. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53023.

The intersectional social patterning of early-COVID-era digital intimacies among transgender and gender-diverse young adults: effects on peri-pandemic sexual decision-making.

Interactive communications technologies facilitate identity formation and socio-sexual connection among transgender and gender-diverse young people. However, within their communities, variations in technology use along ethno-racial, sexual and gendered lines, and as facilitators of sexual resilience during the early COVID-19 pandemic, remain under-studied. Among N = 230 transgender and gender-diverse young adults, surveyed between October 2020 and September 2021, latent class analyses characterised participants by preferred functional affordances, such as finding dates, sex and friends (Model 1), and by simultaneous account-keeping across social, dating and 'hookup' apps (Model 2). Werron and Ringel's typology of pandemic practices characterised qualitative descriptions of sexual decision-making attributed to COVID-19. Both fit indices favoured two-class solutions. Model 1 detected an n = 89, 43% 'high interactive communications technologies-enabled intimacy' (versus 'low technology-enabled intimacy') class, in which digitally mediated friendships, dates, sexual encounters and gay/lesbian sexualities, predominated. An n = 38, 17% 'high socio-sexual polymedia' (versus 'low polymedia') class in Model 2 was characterised by simultaneous social media, 'hookup' and dating app usage. 'High' subgroups saw statistically significant reductions in sexual partners, with the high polymedia class also associated with reductions in HIV testing. Qualitative results contextualised these reductions as, predominantly, 'responsive' pandemic practices: reactions to stay-at-home orders.

Drug use during the second year of the COVID-19 pandemic: observations from repeated cross-sectional surveys of sexual minority men in the US active on social networking applications.

Studies conducted early in the COVID-19 pandemic - before vaccines were widely available - indicated that drug use may have declined among sexual minority men (SMM). This study evaluated drug use trends in the second year of the pandemic. Cross-sectional responses from cisgender SMM living in the US and recruited online (n = 15,897) were grouped for analyses: Time 1: 3/1/2021-5/30/2021; Time 2: 6/1/2021-8/31/2021; Time 3: 9/1/2021-11/30/2021; and Time 4: 12/1 2021-2/28/2022. Results of multivariable models indicated that illicit drug use (excluding cannabis) increased at Times 2 (OR = 1.249, p < .001), 3 (OR = 1.668, p < .001), and 4 (OR = 1.674, p < .001) compared to Time 1. In contrast, cannabis use was relatively stable over time. Rates did not differ significantly among Times 1, 2, and 4. While rates of COVID-19 vaccination increased over time, illicit drug use was negatively associated with the odds of vaccination (OR = 0.361, p < .001). These findings highlight the need for ongoing attention to the risks drug use poses among SMM. Illicit drug use - a long-standing health disparity among SMM - increased significantly across the second year of the pandemic. Because they are less likely to be vaccinated, SMM who use illicit drugs may be at greater risk of COVID-19 infection or complications.

Testing the Effectiveness of a Motivational Interviewing Intervention to Reduce HIV Risk and Drug Use in Young Sexual Minority Men in a Community-Based Organization Setting.

Younger sexual minority men (YSMM) remain at high risk for HIV infection and substance use increases this risk. This study evaluated the effectiveness of a (4-session) motivational interviewing (MI) intervention to reduce substance use and sexual risk taking when delivered at two community-based organizations (CBOs) in the New York City metropolitan area. Participants included 86 YSMM aged 15-29 who reported recent sexual HIV transmission risk and substance use. Overall, 86% of the sample identified as a racial or ethnic minority. Within each CBO, participants were randomized to receive either the MI intervention or enhanced treatment as usual (an HIV testing session plus PrEP information and referrals to CBO services). Contrary to hypotheses, results provided no indication that the MI intervention was associated with reductions in substance use (alcohol, cannabis, or other illicit drug use) or sexual risk taking or current PrEP use. Results are discussed in terms of challenges in real world intervention implementation, study enrollment, and the COVID-19 pandemic.

Mechanisms of Successful Implementation of Tailored Motivational Interviewing in a Multisite Study of Youth HIV Clinics in the United States.

BACKGROUND: A recent implementation science stepped-wedge trial of motivational interviewing (MI) in adolescent HIV clinics indicated variable degrees of implementation success. The present mixed-methods study analyzed trajectories of postimplementation MI competence scores and compared postimplementation qualitative interviews among the clinics with the highest levels of provider competency and the lowest levels of competency to further understand mechanisms of successful implementation. SETTING: Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions. METHODS: This study used a sequential explanatory mixed-methods design. Continuous MI competency data from the parent study were structured with repeated measurements nested within providers nested within 10 sites. A mixed-effects regression model rank ordered the clinics by competence scores. Key stakeholders (N = 77) at the 10 randomized clinics completed a 1-hour qualitative interview at 12-month follow-up (immediately postimplementation). Using the phases of reflexive thematic analysis, interviews from the 3 highest competence clinics and the 3 lowest competence clinics were pragmatically analyzed. RESULTS: Thematic analysis suggested 3 central themes that influenced successful evidence-based practice (EBP) implementation. Organizational culture included the leadership, collective effort, and resources that influenced how the organization at large responded to the implementation intervention. Staff attitudes encapsulated individual providers' mindsets and attitudes about MI and the implementation intervention. EBP integration reflected the perception and use of MI by individuals and the organization as a whole. These themes and their subthemes are interconnected and exerted an influence on each other through the implementation process. CONCLUSIONS: Findings suggest additional implementation strategies to improve implementation of EBPs. Such mixed-methods research is critical to understanding the mechanisms of successful implementation of EBP and improving future implementation strategies.

Substance Use, Sexual Agreements, and Sexual Risk Behaviors Among Adolescent Sexual Minority Males (Aged 13-17) in the United States.

PURPOSE: Despite the fact that adolescence represents a distinct developmental period wherein dating and sexual relationships are emergent, much of what is known about substance use, sexual agreements, and sexual risk behaviors among adolescent sexual minority males (ASMM) is extrapolated from research on adults. This study tested associations between substance use and sexual risk behaviors among ASMM and examined whether relationship status and sexual agreements moderated these associations. METHODS: Cross-sectional online survey data were collected from 2,892 HIV negative ASMM aged 13-17 years between November 2017 and March 2020. All were sexually active with male partners and not on pre-exposure prophylaxis. A multigroup hurdle model predicted the occurrence and frequency of condomless anal sex (CAS) with casual partners. RESULTS: Non-monogamous ASMM were more likely to use illicit drugs and more likely to have CAS with casual partners compared with single ASMM and those in monogamous relationships. Among ASMM who had CAS at least once, those in relationships (both monogamous and nonmonogamous) had CAS more frequently than single ASMM. Binge drinking (odds ratio (OR) = 1.47, p < .001), cannabis (OR = 1.30, p < .001), and illicit drug use (including prescription drug misuse) (OR = 1.77, p < .001) were associated with the occurrence of CAS with casual partners but only binge drinking (rate ratio (RR) = 1.23, p = .027) and illicit drugs (RR = 1.75, p < .001) were associated with its frequency. DISCUSSION: While results aligned with adult studies in many respects, unlike adult sexual minority males, these findings suggest partnered ASMM-particularly those in nonmonogamous relationships-were at highest risk of substance use and associated sexual HIV transmission risk.

Correlates of Mpox Vaccination among Sexual Minority Men in the United States: Sexual Behavior, Substance Use, and Main Partner Relationships.

Sexual minority men (SMM) have accounted for the majority of infections during the 2022 outbreak of the orthopox virus known as mpox (previously "monkeypox") in the US. This study examined correlates of mpox vaccination. Between July 28 and September 22, 2022, adult cisgender SMM (n = 2,620) not previously diagnosed with mpox responded to recruitment advertisements on social networking applications and completed an online survey. Of these, 730 (27.9%) received at least one vaccine dose. Logistic regression indicated sex with a casual partner was positively associated with vaccination. Stimulant drug use was negatively associated with vaccination; meanwhile, the use of ecstasy, ketamine, gamma-hydroxybutyrate (GHB) or psychedelics was positively associated with vaccination. Among partnered SMM, non-monogamous sexual agreements, relationship length of ≥2 years, and relationship functioning were positively associated with vaccination. Even at low levels of relationship functioning, SMM in non-monogamous relationships of ≥2 years were more likely to be vaccinated than single SMM. At very high levels of relationship functioning, partnered SMM were more likely to be vaccinated than single SMM regardless of sexual agreement or relationship length. Findings are discussed in relation to prior research on HIV, other STI prevention, and theories of dyadic functioning and health in this population.

Client Responses to Video-Based Communication Skills Training Involving PrEP for HIV: Tailoring an Individual Sexual Health Intervention for Sexual Minority Men in Relationships.

For many partnered sexual minority men (SMM), PrEP decisions are shaped by their relationships. Recent innovations in HIV risk reduction interventions tailored for partnered SMM include the integration of video-based communication skill building. The purpose of the current study was to examine the responses of 37 SMM in relationships with cismale partners to understand how actual or anticipated conversations between partners may influence PrEP decision making. Results suggested an individual intervention has the ability to elicit detailed content about interactions between partners. When SMM anticipated being in agreement with their partner about PrEP, they described few challenges to discussing HIV prevention. In contrast, when SMM anticipated relationship-related concerns about PrEP, they also anticipated conversations with their partner would be challenging and likely to involve conflict. This often-diminished SMM's motivation to engage partners and develop shared HIV-prevention goals. These SMM may benefit from integrated communications skills building to overcome challenges and work collaboratively with partners around PrEP use.

Comparing the Efficiency of Online and Field-Based Outreach for the Recruitment of Black and Latino Sexual Minority Men into an HIV Prevention Implementation Trial.

Rates of HIV diagnoses among young Black and Latino sexual minority men (SMM) have continued to increase since 2011; meanwhile, overall rates in the USA have decreased. Despite their importance, academic and medical institutions have often struggled to engage and recruit racial and ethnic minority SMM in HIV prevention services and research. The current study compares the success of two strategies for recruiting racial and ethnic minority SMM. Recruitment occurred in the context of a larger implementation study testing the effectiveness of a substance use and HIV prevention intervention among SMM at high risk for HIV infection. SMM (n = 778) were reached through either (1) field-based outreach conducted by two local community-based organizations (CBOs) delivering the intervention or (2) online recruitment coordinated by the trial's academic research partner. Field-based recruitment reached a significantly larger proportion of Black (42.9% vs. 18.2% reached online) and Latino individuals (40.3% vs. 28.1% reached online). Although online recruitment reached a greater proportion of SMM who met trial eligibility criteria (58.4% vs. 35.3% for field-based outreach; χ2(1) = 38.471, p < .001), a greater proportion of eligible participants identified through field-based outreach actually enrolled into the study trial (30.9% vs. 18.8% for online recruitment; χ2(1) = 7.82, p < .01). As a result, field-based recruitment required fewer recruitment staff hours (2.62 per enrolled participant) than online recruitment (3.46 recruitment staff hours per enrolled participant). Findings illustrate the potential for field-based, CBO-executed recruitment to reach Black and Latino SMM and for CBOs to successfully enroll those identified as eligible. Future prevention and implementation research should routinely engage community partners in the development of study recruitment strategies in a manner that can inform outreach and marketing efforts for HIV prevention research and prevention. Clinicaltrials.gov = NCT03488914.

Stress-Related Growth Among Transgender Women: Measurement, Correlates, and Insights for Clinical Interventions.

Although transgender women (TGW), and especially TGW of color, are disproportionately exposed to discrimination and violence, many of them experience stress-related growth. However, little is known about the experience of stress-related growth and its correlates among TGW. Using data from a racially-diverse sample of 210 TGW, the short version of the Stress-Related Growth Scale was modified to assess growth as a result of coming to terms with one's transgender identity among TGW. The psychometric properties of the modified scale were examined, along with its associations with various cognitive, emotional, and social factors. A confirmatory factor analysis revealed a unidimensional factor, along with excellent reliability. A stepwise regression revealed that positive reappraisal, internal locus of control, social support, and emotional expression were associated with greater stress-related growth. Findings suggest that cognitive, emotional, and social resources are related to stress-related growth in TGW. Interventions to foster stress-related growth among TGW are discussed.

Chronic High Risk Prescription Opioid Use Among Persons With HIV.

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016-December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

Marijuana and illicit drugs: Correlates of condomless anal sex among adolescent and emerging adult sexual minority men.

The association between "illicit drugs" (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partners above and beyond illicit drug use. The purpose of the current study was to evaluate associations between CAS and the use of marijuana and illicit drugs in a sample of young SMM (aged 15-24). Participants (n = 578) completed an online survey assessing demographics, current PrEP prescription, age, marijuana use, as well as drug use and sexual behavior in the past 90 days. A hurdle model simultaneously predicted the occurrence of CAS as well as the frequency of CAS among those reporting it. Illicit drug use was associated with both the occurrence (OR = 2.26; p = .01) and frequency of CAS (RR = 1.63; p = .02). In contrast, marijuana use was associated with the occurrence (OR = 1.69; p = .01), but not the frequency of CAS (RR = 1.07; p = .74). Findings mirror recent observations in large samples of adult SMM. While the effect size of marijuana is more modest than illicit drug use, marijuana does have significant and unique associations with the occurrence of CAS. HIV prevention services for young SMM may therefore benefit from assessing and addressing marijuana use in the context of HIV sexual behavior.

Heterosexual Cisgender Men Partnered with Transgender Women Exhibit Higher HIV/STI Sexual Risk than Their Gay, Bisexual, and Queer Counterparts: Findings from a U.S.-Based Convenience Sample Recruited Online.

Cisgender men are frequently vectors for HIV transmission among transgender women. Despite this, the correlates of sexual risk among these men remain under-examined. The purpose of the present study was to explore potential differences in relationship characteristics, sexual risk-taking, and risk-reduction strategies among cisgender men partnered with transgender women. The study utilized secondary screening data provided by adult cis men who reported being in a primary relationship with a trans woman (N = 710). Gay men (18%) were comparatively older, and most likely to report both HIV seropositivity and committed pairings. Heterosexual men (14%) were more likely to report exchange sex, briefer relationships, extra-dyadic sex, lesser serostatus awareness or PrEP uptake. Queer men (7%) were youngest, and most likely to access PrEP. Heterosexual cis men with trans women partners may be subject to unique socio-cultural drivers of sexual risk, such as heteronormative pressures and relationship stigma.

mHealth for transgender and gender-expansive youth: harnessing gender-affirmative cross-disciplinary innovations to advance HIV prevention and care interventions.

Transgender and gender-expansive (TGE) youth endure stark disparities in health and wellbeing compared to their cisgender peers. A key social determinant of health for TGE adolescents and emerging adults is gender affirmation, which encompasses multidimensional validations of an individual's lived gender. Lacking available resources for one's gender affirmation, TGE young people may engage in high-risk maladaptive coping behaviors, linked to their disproportionately high HIV-acquisition risk. A range of innovative mobile technologies are guided by the Gender-Affirmative Framework to promote the health of TGE communities, including through HIV prevention and care continuum outcomes. The aim of this review was to examine key features of existing mobile technologies that can be leveraged to advance the field of TGE-responsive mHealth. We systematically searched scientific records, gray literature, and the iOS and Android app distribution services. To be eligible, platforms and interventions needed to be tailored exclusively to a TGE user base, incorporate gender-affirming features, and be optimized for or adaptive to mobile technologies. Eligible interventions (N=24) were compared on evidence of utility, core functionalities, and dimensions of gender affirmation. Smartphone applications (apps) and webapps (n=16) were the most common delivery modality. Many interventions (n=9) aimed to address HIV-related outcomes and integrated gender-affirmative features. The most common gender-affirmative features originated in fields of human-computer interactions and informatics, or were crowdfunded by TGE developers. HIV-focused interventions incorporated evidence-based health behavior change strategies and utilized rigorous evaluation methods. Across modalities and disciplines, behavioral self-monitoring and access to HIV prevention services were the most frequent features. Over two-thirds of the interventions reviewed aimed to provide medical gender affirmation (e.g, provided guidance on obtaining medically sanctioned hormone therapies, or safely practicing non-medical options such as chest-binding) or psychological gender affirmation (e.g, provided linkage to mental health counseling). Our results show that mHealth and other technology-mediated interventions offer a diverse range of both evidence-based and innovative features; however, many have not been rigorously evaluated in a randomized controlled trial to support TGE users. A continuing commitment to evidence-based health behavior change strategies, exemplified by the HIV-focused interventions included in this review, is essential to advancing gender-affirmative mHealth. The unique and highly innovative features of platforms originating outside the fields of HIV prevention and care suggest new directions for TGE-responsive mHealth, and the need for more conscientious models of knowledge exchange with investigators across scientific disciplines, private-sector developers, and potential users.

Adolescent Sexual Minority Males, Relationship Functioning, and Condomless Sex.

PURPOSE: Adolescent sexual minority males (SMMs) are at a high risk of contracting HIV through condomless sex. Many develop serious partnerships, and sex with main partners accounts for many new infections. Previous research with adolescent SMMs largely focused on relationship seriousness and found a positive association with sexual HIV risk. This study tested associations between three relationship functioning indicators and condomless sex. METHODS: Adolescent SMMs aged 15-19 years (n = 85) completed a brief online survey. Respondents rated commitment, seriousness, and satisfaction on 7-point Likert-type scales. RESULTS: Among adolescent SMMs who had sex in their lifetime, those who were more satisfied in their relationship were less likely to have condomless in the past 90 days (odds ratio = .56, p = .04). CONCLUSIONS: Results support examining multiple domains of relationship functioning in this age group to identify relationship mechanisms that may serve as the target of HIV risk-reduction interventions among adolescent SMMs initiating relationships.

Developmental Barriers to Couples' HIV Testing and Counseling Among Adolescent Sexual Minority Males: A Dyadic Socio-ecological Perspective.

Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data from 28 ASMM recruited in 4 urban centers in the USA during the formative stage of Adolescent Trials Network study ATN-156. Participants were cis-male, HIV-negative, and in a relationship with a similarly-aged cis-male partner. Thematic analysis indicated low and high levels of commitment were barriers to CHTC. Concerns about caregiver attitudes towards HIV testing were salient. Adolescents' perception of structural barriers highlighted reliance on caregiver resources, which limited access to sexual health services. Prevention programming must address structural barriers to access encountered by adolescents. ASMM in relationships may benefit from programming that includes options for individual and dyadic participation.

Testing the drug use and condomless anal sex link among sexual minority men: The predictive utility of marijuana and interactions with relationship status.

BACKGROUND: The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered monogamish -outside partners permitted when main partners are together). METHODS: A nationwide sample of SMM (N = 65,707) were recruited through a geosocial networking app between November 2017 and November 2019. Participants reported on drug use and instances of CAS with casual partners in the previous 30 days. RESULTS: Both marijuana and club drug use were associated with the occurrence of CAS with casual partners among single men. Only club drug use was associated with CAS frequency in this group. The association between marijuana and the occurrence of CAS did not differ significantly among monogamous men, while the associations between club drug use and the occurrence as well as frequency of CAS were significantly weaker. Meanwhile, the associations between club drug use and the occurrence as well as frequency of CAS did not differ significantly between single and non-monogamous (open and monogamish) subgroups; however, the association between marijuana and the occurrence of CAS was significantly weaker. CONCLUSIONS: Findings largely replicated the robust association between club drug use and CAS with casual partners. They support the assertion that marijuana use predicts sexual risk for some SMM subgroups. Finally, they illustrate the potential for relationship status - and sexual agreements - to contextualize associations between drug use and CAS.

Evaluating the impact of COVID-19: A cohort comparison study of drug use and risky sexual behavior among sexual minority men in the U.S.A.

BACKGROUND: Sexual minority men who use drugs have high sexual HIV transmission risk. Sexual interactions may also increase COVID-19 risk.This study compared marijuana use, other illegal drugs use (i.e. cocaine/crack, methamphetamine, MDMA/ecstasy, GHB, and ketamine) and sexual behavior with casual partners among sexual minority cismen active on social networking and dating applications before and during the COVID-19 epidemic. METHODS: This cohort-control study compared 455 adult respondents (surveyed May 6th to 17th, 2020) and a matched sample selected from 65,707 respondents surveyed pre-COVID. Participants were recruited on social networking and dating applications and completed surveys online. RESULTS: The proportion reporting marijuana use declined significantly in the COVID cohort (34.5 % versus 45.7 % pre-COVID,p < .001) as did their illegal drug use (11.0 % versus 22.9 % pre-COVID, p < .001). While the number of casual partners per month was stable, the proportion reporting condomless anal sex with casual partners declined significantly during COVID (26.4 % versus 71.6 % pre-COVID, p < .001). The effect of illegal drug use (excluding marijuana) on number of casual partners per month (aRR = 1.45 pre-COVID versus 2.84, p < .01) and odds of condomless anal sex (aOR = 2.00 pre-COVID versus 5.22, p = .04) were significantly greater in the COVID cohort. CONCLUSIONS: While the proportion of participants reporting drug use and condomless anal sex with casual partners declined in the COVID cohort, the association between drug use and sexual behavior was magnified. Sexual minority men who use drugs are significantly more likely to engage in sexual behaviors that place them at risk for HIV and COVID-19 transmission.