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1.
Arch Sex Behav ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897832

RESUMO

Sexual and gender identity have frequently been assessed in public health research as static states. However, a substantial and growing body of evidence indicates that both identities may have greater potential for change over time than once supposed. Despite this evidence, research into adult identity change remains relatively limited. Using longitudinal data from 1553 Black men who have sex with men (BMSM) aged 18-68 years and recruited from study locations in six major cities across the country, we examined changes in sexual and gender identities over a period of 12 months. The results showed that sexual and gender identity did indeed change among adult BMSM. Additionally, we explored internalized homophobia (IH) as a potential driver of identity change and found that IH significantly impacts the degree and direction of change, with individuals who reported higher baseline IH more likely to demonstrate a shift toward a heterosexual/straight identity at 6 and 12 months. The results are discussed in light of what is known and unknown regarding identity change, and potential avenues for future research are explored.

2.
J Health Care Poor Underserved ; 30(1): 378-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30827989

RESUMO

The aims of this study were to estimate the prevalence of hookah smoking and describe its associated knowledge, attitudes, and behaviors among Ethiopian and Eritrean Americans. Approximately 400 participants completed an online survey on hookah tobacco use, perceptions of harm and social acceptability. Nearly 80% had tried hookah in their lifetime (ever users), and about 43% had smoked hookah in the past 30 days (current users). Hookah ever use was highest among people 24-29 years of age, but there were no significant differences by gender, education or employment. Ever users were less supportive of bans on hookah smoking in a bar or restaurant compared with never users, X2 (3, N = 396) = 57.56, p<.001. Additionally, ever users more often reported hookah smoking was less harmful than cigarette smoking compared with never users. Future research is needed to understand the predictors of hookah smoking in this subpopulation and inform interventions.


Assuntos
Afro-Americanos/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Fumar Cachimbo de Água/etnologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Eritreia/etnologia , Etiópia/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medição de Risco , Adulto Jovem
3.
Arch Sex Behav ; 48(1): 213-224, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29623533

RESUMO

Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.

4.
J Acquir Immune Defic Syndr ; 78(5): 491-498, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29771782

RESUMO

BACKGROUND: Black men who have sex with men (BMSM) and some who also have sex with women (BMSMW) account for over 70% of new HIV infections in the United States representing an elevated HIV risk in this group, also informing risks of HIV transmission to other BMSM and female sexual partners. SETTINGS: We examined trajectories of self-reported substance use, HIV-related sexual risk behaviors, and psychosocial vulnerabilities among BMSMW versus BMSM over a 1-year study period. METHODS: We analyzed baseline, 6-, and 12-month follow-up data from the HIV Prevention Trials Network "BROTHERS" Study (HPTN 061; n = 1126). Categorizing participants by sexual partner type across 3 time points: (1) BMSMO: having male and no female partners across assessments and (2) BMSMW: having sex with male and one or more female partners at least at 1 time point. Using generalized estimating equations, we estimated associations between being BMSMW (versus BMSMO) and changes in psychosocial vulnerability, substance use, and HIV-related sexual risk behaviors. RESULTS: Generalized estimating equation models controlling for sociodemographics, time-varying effects, and intervention status showed that BMSMW versus BMSMO had 50% increased odds of crack use, 71% increased odds of alcohol use during condomless anal intercourse (CAI), 51% greater odds of using drugs at last CAI, and twice the odds of receiving goods at last CAI. CONCLUSIONS: Findings show stable and comparatively elevated illicit drugs, alcohol, and exchange sex during last CAI among BMSMW. Future intervention research should focus on ways to address changes in substance-related HIV-transmission behaviors over time in this population of men.


Assuntos
Afro-Americanos , Bissexualidade , Infecções por HIV/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
5.
AIDS Behav ; 22(8): 2615-2626, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29644493

RESUMO

We explored the correlates of linkage to HIV medical care and barriers to HIV care among PLWH in Louisiana. Of the 998 participants enrolled, 85.8% were successfully linked to HIV care within 3 months. The majority of participants were male (66.2%), African American (81.6%), and had limited education (74.4%). Approximately 22% of participants were Black gay and bisexual men. The most common reported barrier to care was lack of transportation (27.1%). Multivariable analysis revealed that compared with Black gay and bisexual men, White gay and bisexual men were significantly more likely to be linked to HIV care (adjusted prevalence ratio, aPR 1.08, 95% CI 1.02-1.13). Additionally, participants reporting moderate to high levels of stigma at intake (p < 0.05) were significantly more likely to be linked to HIV care compared with those reporting low or no stigma at enrollment. Study findings highlight the continued importance of client-centered interventions and multi-sector collaborations to link PLWH to HIV medical care.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Infecções por HIV/terapia , Serviços de Saúde/estatística & dados numéricos , Minorias Sexuais e de Gênero , Estigma Social , Adulto , Assistência ao Convalescente , Bissexualidade , Escolaridade , Feminino , Homossexualidade Masculina , Humanos , Louisiana , Masculino , Pessoa de Meia-Idade
6.
J Acquir Immune Defic Syndr ; 78(2): 163-168, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29424789

RESUMO

BACKGROUND AND SETTING: Black men who have sex with men (BMSM) in the United States have disproportionately high HIV infection rates. Social networks have been shown to influence HIV risk behavior; however, little is known about whether they affect the risk of HIV seroconversion. This study uses data from the BROTHERS (HPTN 061) study to test whether contextual factors related to social networks are associated with HIV seroconversion among BMSM. METHODS: We analyzed data from the BROTHERS study (2009-2011), which examined a multicomponent intervention for BMSM in 6 US cities. We ran a series of Cox regression analyses to examine associations between time-dependent measures of network support (personal/emotional, financial, medical, and social participation) and time to HIV seroconversion. We ran unadjusted models followed by models adjusted for participant age at enrollment and study location. RESULTS: A total of 1000 BMSM tested HIV negative at baseline and were followed at 6- and 12-month study visits. Twenty-eight men tested HIV positive. In adjusted hazard ratio models, study participants who remained HIV negative had higher proportions of social network members who provided personal/emotional {0.92 [95% confidence interval (CI): 0.85 to 0.99]}, medical [0.92 (95% CI: 0.85 to 0.99)], or social participation [0.91 (95% CI: 0.86 to 0.97)] support. CONCLUSION: Findings suggest that the increased presence of social network support can be protective against HIV acquisition. Future research should explore the processes that link social network support with sexual and other transmission risk behaviors as a basis to inform HIV prevention efforts.


Assuntos
Afro-Americanos , Bissexualidade , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Soroconversão , Rede Social , Apoio Social , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Estados Unidos/epidemiologia
7.
AIDS Res Hum Retroviruses ; 34(2): 171-177, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29145745

RESUMO

Most U.S. investigators in the HIV Prevention Trials Network (HPTN) have been of majority race/ethnicity and sexual orientation. Research participants, in contrast, have been disproportionately from racial/ethnic minorities and men who have sex with men (MSM), reflecting the U.S. epidemic. We initiated and subsequently evaluated the HPTN Scholars Program that mentors early career investigators from underrepresented minority groups. Scholars were affiliated with the HPTN for 12-18 months, mentored by a senior researcher to analyze HPTN study data. Participation in scientific committees, trainings, protocol teams, and advisory groups was facilitated, followed by evaluative exit surveys. Twenty-six trainees have produced 17 peer-reviewed articles to date. Research topics typically explored health disparities and HIV prevention among black and Hispanic MSM and at-risk black women. Most scholars (81% in the first five cohorts) continued HIV research after program completion. Alumni reported program-related career benefits and subsequent funding successes. Their feedback also suggested that we must improve the scholars' abilities to engage new research protocols that are developed within the network. Mentored engagement can nurture the professional development of young researchers from racial/ethnic and sexual minority communities. Minority scientists can benefit from training and mentoring within research consortia, whereas the network research benefits from perspectives of underrepresented minority scientists.


Assuntos
Pesquisa Biomédica/tendências , Grupos Étnicos , Infecções por HIV/prevenção & controle , Mentores , Grupos Minoritários , Pesquisadores , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
8.
J Assoc Nurses AIDS Care ; 28(4): 518-531, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28366556

RESUMO

Stigma is recognized as a barrier to the prevention, care, and treatment of HIV, including engagement in the HIV care continuum. HIV stigma in older Black women may be compounded by preexisting social inequities based on gender, age, and race. Using semi-structured interviews and survey questionnaires, we explore experiences of HIV stigma, retention in care, and antiretroviral therapy (ART) adherence in 35 older Black women with HIV from Prince George's County, Maryland. Study findings indicated that older Black women experienced high levels of HIV stigma, retention in care, and ART adherence. Findings suggest that experiences of HIV stigma were intensified for older Black women due to multiple stigmatized social positions. Participants also reported experiences of marginalization in health care that hindered retention in care and ART adherence. Interventions aimed at improving HIV prevention, care, and treatment outcomes should incorporate HIV stigma reduction strategies as core elements.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Africano/psicologia , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Estigma Social , Adulto , Fatores Etários , Envelhecimento , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Humanos , Entrevistas como Assunto , Maryland , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estereotipagem , Inquéritos e Questionários
9.
AIDS Behav ; 21(12): 3590-3598, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28229245

RESUMO

We described drug use, sex risk, and STI/HIV among men who have sex with men and women (MSMW) and their female partners. We used the Network, Norms and HIV/STI Risk among Youth (NNAHRAY) study to evaluate drug use, sex risk, and biologically-confirmed STI/HIV in (1) MSMW and men who had sex with men only (MSMO) versus men who had sex with women only (MSWO) and (2) female partners of MSMW versus female partners of MSWO (N = 182 men, 152 women). MSMW versus MSWO had 30 to 60% increased odds of substance use, over twice the odds of multiple partnerships, and almost five times the odds of sex trade and HIV infection. Female partners of MSMW versus female partners of MSWO had approximately twice the odds of substance use and 1.5-2 times the odds of multiple partnerships and sex trade. Interventions should address STI/HIV risk among MSMW and their female partners.


Assuntos
Bissexualidade , Infecções por HIV/transmissão , Heterossexualidade , Homossexualidade Masculina , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , New York/epidemiologia , Fatores de Risco , Assunção de Riscos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto Jovem
10.
Am J Mens Health ; 11(5): 1309-1321, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26758708

RESUMO

Exposure to childhood religious affiliations where the majority of members discourage homosexuality may have negative psychological impacts for Black men who have sex with men. This study tested the hypothesis that exposures to these environments during childhood were associated with adulthood human immunodeficiency virus (HIV)/sexually transmitted infection (STI) behavioral risk and HIV infection, because these exposures influenced HIV/STI risk by undermining race/sexual identity congruence and increasing internalized homophobia and interpersonal anxiety. Structural equation modeling as well as logistic and Poisson regressions were performed using baseline data from HIV Prevention Trials Network 061 ( N = 1,553). Childhood religion affiliations that were more discouraging of homosexuality were associated with increased likelihood of HIV infection; however, the association was no longer significant after adjusting for age, income, and education. Having a childhood religion affiliation with high prevalence of beliefs discouraging homosexuality was associated with increased numbers of sexual partners (adjusted odds ratio = 4.31; 95% confidence interval [3.76, 4.94], p < .01). The hypothesized path model was largely supported and accounted for 37% of the variance in HIV infection; however, interpersonal anxiety was not associated with HIV/STI risk behaviors. Structural interventions are needed that focus on developing affirming theologies in religious institutions with Black men who have sex with men congregants.


Assuntos
Afro-Americanos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Religião , Adolescente , Adulto , Idoso , Demografia , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Doenças Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
11.
Subst Abuse Rehabil ; 3(Suppl 1): 45-57, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-24500422

RESUMO

The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence.

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