An exploratory study of community violence and HIV care engagement among Black gay and bisexual men.

This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

Coronavirus Disease 2019 Vaccination by Gender and Age in a Sample of Black Adults in Chicago.

Although vaccine behaviors differ greatly by gender and age, few studies have examined vaccination at the intersection of gender and age within the Black community. We examined COVID-19 vaccination by gender and age using a survey of over 500 Black adults in Chicago, Illinois, fielded from September 2021 to March 2022. Although 54% had received at least one COVID-19 vaccine, the proportion vaccinated was considerably lower for Black men (28%) and women (37%) under 40 years old than Black men (92%) and women (86%) over 40 years (p < .001). Concern about vaccine side effects was the most reported barrier for unvaccinated women (56%) and men (38%) under 40 years. Our results suggest that targeted efforts to improve COVID-19 vaccine uptake in the Black community in Chicago after the initial rollout should have focused on young adults, particularly young Black men, with emphasis on addressing concern about vaccine side effects.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago.

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Trusted Sources of Information and COVID-19 Vaccination Among Black Adults in Chicago.

PURPOSE: Examine trust in sources of COVID-19 information and vaccination status. DESIGN: Cross-sectional. SETTING: Chicago, Illinois. SUBJECTS: Convenience sample of 538 Black adults surveyed between September 2021 and March 2022. MEASURES: Trust in sources of COVID-19 information, COVID-19 vaccination. ANALYSIS: Using latent class analysis, we identified classes of trust in sources of COVID-19 information. We considered predictors of class membership using multinomial logistic regression and examined unadjusted and adjusted associations between trust class membership and COVID-19 vaccination while accounting for uncertainty in class assignment. RESULTS: Our analytic sample (n = 522) was predominantly aged 18-34 (52%) and female (71%). Results suggested a four-class solution: (1) low trust, (2) high trust in all sources, (3) high trust in doctor and government, and (4) high trust in doctor, faith leader, and family. Unadjusted odds of vaccination were greater in the high trust in all sources (OR 2.0, 95% CI 1.2-3.2), high trust in doctor and government (OR 2.7, 95% CI 1.4-5.3), and high trust in doctor, faith leader, and family classes (OR 2.1, 95% CI 1.2, 3.9) than the low trust class. However, these associations were not significant after adjustment for sociodemographic and health status factors. CONCLUSION: Although COVID-19 vaccination varied across trust classes, our adjusted findings do not suggest a direct association between trust and vaccination, reflecting complexities in the vaccine decision-making process.

AIDSImpact special issue: factors associated with PrEP use in a community sample of African American men who have sex with men (MSM) and transgender women (TGW) in the United States Midwest.

Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.

The Inherent Violence of Anti-Black Racism and its Effects on HIV Care for Black Sexually Minoritized Men.

The goal of this study was to examine the effects of racial discrimination, depression, and Black LGBTQ community support on HIV care outcomes among a sample of Black sexually minoritized men living with HIV. We conducted a cross-sectional survey with 107 Black sexually minoritized men living with HIV in Chicago. A path model was used to test associations between racial discrimination, Black LGBTQ community support, depressive symptoms, and missed antiretroviral medication doses and HIV care appointments. Results of the path model showed that men who had experienced more racism had more depressive symptoms and subsequently, missed more doses of HIV antiretroviral medication and had missed more HIV care appointments. Greater Black LGBTQ community support was associated with fewer missed HIV care appointments in the past year. This research shows that anti-Black racism may be a pervasive and harmful determinant of HIV inequities and a critical driver of racial disparities in ART adherence and HIV care engagement experienced by Black SMM. Black LGBTQ community support may buffer against the effects of racial discrimination on HIV care outcomes by providing safe, inclusive, supportive spaces for Black SMM.

Expanding Psychiatric Treatment in Primary Care Settings: Improved Care Through the Wisconsin Child Psychiatry Consultation Program.

The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.

People Living With HIV in St. Petersburg, Russia: Gender and Exposure Group Differences in HIV Care Engagement, Psychosocial Health, Substance Use, and Transmission Risk Behavior.

This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg (N = 872). Samples were recruited between 2014 and 2018 by enrolling a PLWH seed who was either out-of-care or treatment nonadherent as well as network members surrounding each seed, assessing each participant's HIV care, transmission risk, substance use, and mental health characteristics. Almost one-quarter of participants said they were never offered antiretroviral therapy (ART), and-among those offered ART-one-quarter refused or discontinued therapy and 45% were <95% ART-adherent. Almost half of participants had detectable viral load, and many reported continued condomless intercourse with potentially nonconcordant serostatus partners or needle sharing. Over 46% of participants had elevated scores on measures of depression, hopelessness, state anxiety, or poor social support. Study findings illustrate unmet needs of PLWH in Russia.

The comparative effectiveness of different models of permanent supportive housing on problematic substance use, depression, and anxiety symptoms over time.

OBJECTIVES: To compare the effectiveness of different models of permanent supportive housing (PSH), housing configuration, and service provision model on substance use, depression, and anxiety symptoms among residents over time. METHODS: Linear mixed model regression was used with 888 residents of PSH to investigate the relationship between supportive housing type, service model, and housing configuration and change in mental health and substance use at baseline, 6-, 12-, and 18-month follow-up. RESULTS: There were few significant differences in problematic substance use, depression, or anxiety symptoms among those in different PSH types, different housing configuration models, or different service provision models. Similarly, there were no significant differences in PSH type, housing configuration, or service delivery model among those with severe mental illness (SMI), substance use disorder (SUD), or those with dual diagnoses. CONCLUSIONS: There is little evidence that different models of PSH result in differences in mental health and substance use outcomes. Future research should consider the number of services clients receive and critical periods in PSH residency in improving mental health and substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Various Supportive Housing Models on ART Adherence Among Persons Living With HIV in Supportive Housing.

BACKGROUND: Providing permanent supportive housing to chronically homeless persons living with human immunodeficiency virus (PLH) contributes to improved human immunodeficiency virus (HIV) outcomes, including adherence to antiretroviral therapy (ART). This study seeks to understand whether certain components of housing, namely intensity of case management and specialized HIV housing programs, affects ART adherence for PLH in supportive housing. METHODS: From 2015 to 2019 we conducted quantitative assessments with 157 PLH in supportive housing at baseline, 6-, 12-, and 18-month postbaseline to identify factors associated with ART adherence. General Estimating Equations for repeated measures were performed to assess bivariate and multivariate measures. RESULTS: Two thirds of PLH in supportive housing reported 95% or greater adherence to ART. Multivariate analyses indicate that neither intensity of case management services nor specialized housing for PLH were associated with greater ART adherence. Greater time since diagnosis was positively associated with ART adherence. Greater depressive symptoms and African American race were negatively associated with ART adherence. CONCLUSIONS: Study findings reveal that although prior research has established the importance of receipt of housing for homeless PLH, the type or intensity of case management services associated with that housing may not be as important as simply being housed. Our results highlight the importance of considering mental health and more recent HIV diagnosis when developing treatment and case management plans to enhance residents' ART adherence.

Levels of HIV Testing Among Young Men Who Have Sex with Men in Bulgaria: Very Low Testing by Ethnic Minority Roma (Gypsy) Men.

Little is known about HIV testing among young men who have sex with men (MSM) in Southeastern European countries, nor about differences in testing by young ethnic majority and young Roma MSM, the region's most disadvantaged minority population. 271 young MSM (153 non-Roma and 118 Roma) were recruited in Sofia, Bulgaria and completed measures of HIV testing, psychosocial characteristics related to testing, sexual behavior, and substance use. While 74% of ethnic majority MSM had an HIV test (and 56% had multiple prior tests), only 4% of Roma MSM had ever been tested. Roma MSM had lower knowledge about HIV testing, perceived greater barriers and weaker social norms for testing, and held more negative testing attitudes and intentions. Although all had male partners, no Roma MSM self-identified as gay and most reported transactional sex. Efforts are urgently needed to increase HIV testing uptake by young Roma MSM.

Mobilizing individual social capital resources for HIV care support: results of a pilot intervention in St. Petersburg, Russia.

Half of HIV-positive persons in Russia are on antiretroviral therapy (ART), and only 27% are virally suppressed. A feasibility pilot intervention to mobilize social capital resources for HIV care support was conducted in St. Petersburg. Out-of-care or ART-nonadherent HIV-positive persons (n = 24) attended a five-session intervention to increase access social capital resources (i.e., family, friends, or providers) to mobilize supports for entering care, initiating care, and adhering to ART. HIV care indicators were assessed at baseline, an immediate followup (FU-1), and 6-month followup (FU-2) points. At FU-1, participants more frequently discussed their care experiences with others, verifying the intervention's mechanism of action. Participants increased in scales of medication taking adherence (p = 0.002, FU-1; p = 0.011, FU-2), self-efficacy (p = 0.042; FU-1), and outcome expectancies (p = 0.016, FU-2). Among persons not on ART, HIV Medication Readiness scale scores increased at FU-1 (p = 0.032) but became attenuated at FU-2. Participants tended to more frequently keep care appointments (79%, baseline to 90%, FU-1, p = 0.077); to have undetectable viral load (54%, baseline to 74%, FU-2; p = 0.063); and to have fewer past-month days with delayed or incomplete medication doses (7.8, baseline to 4.2, FU-1; p = 0.084). This novel social capital intervention is promising for improving HIV care-related outcomes and warrants a full-scale evaluation.

Health-related quality of life and related factors among chronically homeless adults living in different permanent supportive housing models: a cross-sectional study.

PURPOSE: Permanent supportive housing (PSH) is an effective intervention to improve residential stability and reduce the utilization of costlier healthcare services for the chronically homeless. However, there has been little focus on health-related quality of life (HRQL) once they enter PSH, and the potential influence of other factors including the PSH model. Study results can shed light on the HRQL of the PSH population and inform strategies to improve PSH program effectiveness in this area. METHODS: In this cross-sectional study, survey methods were used to assess the HRQL of PSH residents in the Chicago metropolitan area. The survey also included questions on socio-demographics, health behaviors, housing and neighborhood characteristics, and housing satisfaction. The SF-36 was used to obtain physical (PCS) and mental component summary (MCS) scores for HRQL. Other variables were selected using the Wilson and Cleary HRQL model. Statistical analyses included summary statistics, bivariate analyses, and fully adjusted linear regression models. RESULTS: The study sample included 855 adults currently in PSH. The sample was predominantly African American men with an average age of 53 years. Mean scores for PCS and MCS were 39.4 and 46.1, respectively, (out of 100). In adjusted analyses, older age and being on disability were associated with worse PCS. Having HIV was associated with better PCS. Being non-Hispanic Black, living in fixed-sited housing, and being in PSH for longer durations were associated with better MCS. More depressive symptoms was associated with worse PCS and MCS. CONCLUSION: While both aspects of the PSH model (housing configuration and service provision) were initially associated with HRQL in unadjusted analyses, housing configuration was the only PSH model variable that remained significant once accounting for other factors. Depressive symptomology and the social environment also appear to be important correlates of HRQL and are potential areas to target in PSH programs.

Prevalence of Alcohol Use and Factors Associated With Problem Drinking in Social Networks of People Living With HIV Infection in St. Petersburg, Russia.

Russia has over 1.2 million HIV infections and Europe's highest HIV incidence. Although its HIV epidemic is intertwined with high alcohol consumption rates, the interaction between alcohol use and HIV care in Russia is understudied. Five hundred eighty-six HIV-positive persons were recruited using social network methods in St. Petersburg. Fifty-nine percent of males, and 45% of females, drank regularly. Thirty percent of alcohol users reported binge drinking (males: ≥ 5 drinks; females ≥ 4 drinks) in the past week. Alcohol use was associated with lower HIV care engagement and having a detectable viral load. Multivariate analyses showed that any alcohol consumption, number of alcohol drinks consumed, and having a binge drinking day in the past week were associated with male gender, use of illicit drugs, drug injection, smaller social network size, lower social supports, being unmarried, and reporting condomless intercourse with non-main partners. Interventions to improve HIV care in Russia must comprehensively address the use of alcohol and substances that interfere with care engagement.

HIV Testing and Mistaken Beliefs about Immigration Laws.

Evidence suggests that migrants may underutilize USA health care because of misconceptions about immigration-related consequences of health care use. This study aimed to explore whether common misconceptions about the immigration consequences of seeking health care, receiving an HIV test, and being diagnosed with HIV were associated with participant self-report of never having received an HIV test. The study sample comprised 297 adult, sexually active, documented and undocumented Spanish-speaking Latino migrants. Participants completed a cross-sectional survey via ACASI. In multiple logistic regression analyses controlling for sociodemographic variables and HIV stigma, misconceptions about laws emerged as a strong predictor of never having received an HIV test (p < .001). Associations between participants' endorsement of misconceptions and their HIV testing history suggest that incorrect perceptions of laws do deter some subgroups of USA Latino migrants from HIV testing. Identifying misconceptions about negative immigration consequences of engaging in important health behaviors should be a community health research priority.

Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia.

Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6 months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.

The Health and Sociocultural Correlates of AIDS Genocidal Beliefs and Medical Mistrust Among African American MSM.

This study examined social and health-related correlates of AIDS conspiracy theories among 464 African American men who have sex with men (MSM). Exploratory factor analysis revealed two subscales within the AIDS conspiracy beliefs scale: medical mistrust and AIDS genocidal beliefs. Multiple regression analyses revealed medical mistrust and AIDS genocidal beliefs were both associated negative condom use attitudes and higher levels of internalized homonegativity. Medical mistrust was also associated with lower knowledge of HIV risk reduction strategies. Finally, we conducted bivariate regressions to examine the subsample of participants who reported being HIV-positive and currently taking HIV antiretroviral therapy (ART) to test associations between sexual behavior and HIV treatment and AIDS conspiracy theories. Among this subsample, medical mistrust was associated with having a detectable viral load and not disclosing HIV-status to all partners in the previous 3 months. Collectively, these findings have implications for HIV prevention and treatment for African American MSM.

Gender Norms and Age-Disparate Sexual Relationships as Predictors of Intimate Partner Violence, Sexual Violence, and Risky Sex among Adolescent Gang Members.

Unequal gender norms and age-disparate sexual relationships can lead to power imbalances and are also associated with intimate partner violence (IPV), sexual coercion and violence, and sexual risk behaviors. The present study examined these variables from both victim and perpetrator perspectives among adolescent gang members. Age-disparate sexual relationships were defined as sex partners 5 or more years older among female participants and 5 or more years younger among male participants. Participants were recruited from a mid-sized Midwestern city and completed a 60-90-min audio computer-assisted self-interview in a community-based setting. Participants in this study included 107 female gang members (68 % African-American, 19 % Latina; mean age, 17.6) and 169 male gang members (62 % African-American, 28 % Latino; mean age, 17.7). As hypothesized, endorsing unequal gender norms toward women was significantly related to IPV victimization among female participants and perpetration among male participants, and engagement in group sex in the past month among both female and male participants (ps < 0.05). Additionally, unequal gender norms were significantly related to male participants' perpetrating rape (p < 0.05). As hypothesized, female gang members who had been in age-disparate sexual relationships were significantly more likely to have experienced more IPV and report being raped and males gang members who had age-disparate sexual relationships were significantly more likely to perpetrate IPV in the past year and perpetrate rape (ps < 0.05). Age-disparate sexual relationships were also significantly related to being gang raped among female gang members and participating in a gang rape among male gang members, and engaging in group sex among both female and male gang members (ps < 0.05). Female participants who had been in age-disparate sexual relationships were more likely to have been pregnant (ps < 0.05). It is essential for researchers and public health practitioners to create programs for female adolescents to reduce or avoid risky situations, such as inability to negotiate condom use with older sex partners. Additionally, programs must be developed for both female and male gang members to help them understand and identify unequal gender norms, and interpersonal and sexual coercion/violence. Early intervention will also be necessary as these adolescent gang members are already engaged in extremely high-risk, coercive, and violent behaviors.

Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men.

OBJECTIVES: We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). METHODS: We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. RESULTS: Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. CONCLUSIONS: Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.

Correlates of internalized homonegativity among black men who have sex with men.

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.