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1.
Artigo em Inglês | MEDLINE | ID: mdl-32100193

RESUMO

BACKGROUND: The relationship context is influential in shaping HIV risk and preventive behaviors. Yet, there is little understanding about how shared or separate residence of partners shapes perceptions that affect HIV prevention. METHODS: We explored how shared or separate residence from one's partner impacts HIV testing intentions among Latino immigrants in the USA. We analyzed data from 206 Latino immigrants residing in New York City, and examined three potential models to assess the relationships between partner residence, partner approval of HIV testing, and HIV testing behaviors. RESULTS: Results indicated that shared residence was associated with greater partner approval to test for HIV (B = 0.48, 95% CI 0.01, 0.96, p = .04), and in turn, higher partner approval was associated with greater intention to test for HIV in the next 12 months (B = 0.38, 95% CI 0.15, 0.62., p < .01). CONCLUSIONS: Results suggest the need to consider partner residency as an important factor in shaping determinants of HIV testing behaviors. Conceptualization of couples as living separately, across national borders, is warranted for couple-based health interventions given the current socio-political climate in the USA. Future research focused on couple-based HIV prevention should examine strategies and policies to preserve or strengthen partner dynamics among couples living apart.

2.
Psychotherapy (Chic) ; 57(1): 58-67, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31999189

RESUMO

The efficacy of motivational interviewing (MI) to reduce substance use is well established; however, its use with couples has met with mixed results. The development of such interventions is particularly relevant for male couples, as rates of substance use in this population are comparatively high and use is associated with aspects of sexual relationship functioning. One challenge noted in conducting MI with couples is how to respond to situations in which partners disagree with one another or argue against change. Guided by the couples interdependence theory, we conceptualized conflicts within session as failures in the accommodation process. We used qualitative analysis to examine manifestations of conflict in session and to identify effective provider response strategies. The sample included 14 cis-male couples with at least 1 partner was aged 18-29 years, reported substance use, and was HIV negative. All couples completed 3 MI sessions lasting 60-75 min each. Manifestations of conflict included conflation of thoughts/feelings, vague or indirect communication, and inaccurate assumptions. Effective provider responses included correcting assumptions, shifting focus, relationship repair, "common ground" reflections, and relationship affirmations. Observed conflicts aligned with conceptualizations of destructive resolutions to the accommodation process (i.e., exit and neglect). Effective provider responses to conflict facilitated dyadic functioning and catalyzed constructive accommodation. These results provide an initial compendium of provider skills and strategies that may be particularly relevant in work with sexual minority male couples, for whom achieving accommodation around drug use and sexual health goals is often viewed as a key mechanism of intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

3.
JMIR Res Protoc ; 8(7): e13015, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31274114

RESUMO

BACKGROUND: Men who have sex with men (MSM) currently account for more than two-thirds of new HIV diagnoses in the United States and, among young MSM (YMSM) aged 20 to 29 years, as many as 79% to 84% of new infections occur between primary partners. Contributing to HIV risk, YMSM use drugs at comparatively high rates. To date, no interventions have been developed that specifically address the unique needs of partnered YMSM or incorporate a focus on relationship factors in addressing personal motivation for change. OBJECTIVE: The study's primary aim is to evaluate the efficacy of the PARTNER intervention and evaluate potential moderators or mediators of intervention effects. The study's secondary aims were to gather ideographic data to inform a future effectiveness implementation study and develop a novel biomarker for pre-exposure prophylaxis (PrEP) adherence by analyzing PrEP drug levels in fingernails. METHODS: PARTNER is a 4-session motivational interviewing-based intervention that integrates video-based communication training to address drug use and HIV prevention among partnered YMSM. This study utilizes a randomized controlled trial design to compare the PARTNER intervention with an attention-matched psychoeducation control arm that provides information about HIV-risk reduction, PrEP, and substance use. Participants are randomized in a 1-to-1 ratio stratified on age disparity between partners, racial composition of the couple, and relationship length. Follow-up assessments are conducted at 3-, 6-, 9-, and 12-months postbaseline. The study recruits and enrolls 240 partnered YMSM aged between 18 to 29 years at a research center in New York City. Participants will be HIV-negative and report recent (past 30-day) drug use and condomless anal sex with casual partners; a nonmonogamous primary partner (regardless of HIV status); or a serodiscordant primary partner (regardless of sexual agreement). Primary outcomes (drug use and HIV sexual transmission risk behavior) are assessed via a Timeline Follow-back interview. Biological markers of outcomes are collected for drug use (fingernail assay), sexual HIV transmission risk (rectal and urethral gonorrhea and chlamydia testing), and PrEP adherence (dried blood spots and fingernails for a novel PrEP drug level assay). RESULTS: The study opened for enrollment in February 2018. Anticipated completion of enrollment is October 2021. Primary outcome analyses will begin after final follow-up completion. CONCLUSIONS: Existing research on partnered YMSM within the framework of Couples Interdependence Theory (CIT) has suggested that relationship factors (eg, dyadic functioning and sexual agreements) are meaningfully related to drug use and HIV transmission risk. Results pertaining to the efficacy of the proposed intervention and the identification of putative moderators and mediators will substantially inform the tailoring of interventions for YMSM in relationships and contribute to a growing body of relationship science focused on enhancing health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT03396367; https://clinicaltrials.gov/ct2/show/NCT03396367 (Archived by WebCite at http://www.webcitation.org/78ti7esTc. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13015.

4.
Drug Alcohol Depend ; 201: 101-108, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31203148

RESUMO

BACKGROUND: Research suggests that substance use among partnered sexual minority men will be inversely associated with the quality of dyadic functioning. We tested whether dimensions of relationship functioning implied within Couples Interdependence Theory (e.g., rewards, costs, barriers, alternatives, investment, and comparison to an ideal) predicted drug use and problematic alcohol use consistent with this hypothesis. METHODS: This study utilized baseline data from a sample of 70 couples recruited in the New York City area. All participants were cis-gender male and 18 or older. In each couple, at least one partner reported recent drug use, at least one was aged 18 to 29, and at least one was HIV negative. Participants provided demographic information; completed measures of relationship functioning and problematic alcohol use; and reported recent (past 30 day) drug use. RESULTS: Actor-partner interdependence models were calculated. The use of miscellaneous recreational drugs (excluding marijuana) was positively associated with participants' perception of rewards, costs, and barriers to leaving and negatively associated with comparisons to an ideal, alternatives, and investment. In addition, partner perceptions of rewards were positively associated with this outcome. AUDIT scores were negatively associated with comparison to an ideal; and positively associated with partner perceptions of alternatives. Relationship functioning was unrelated to marijuana use. CONCLUSIONS: These findings provide support for the hypothesis that relationship functioning and substance use are related. Couples Interdependence Theory implies such an assumption and it underlies many couples-based approaches to drug use intervention. These findings point to the potential utility of integrating relationship skill building into substance use interventions for partnered sexual minority men.

5.
J Acquir Immune Defic Syndr ; 81(4): 419-428, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985555

RESUMO

BACKGROUND: Epidemiology research is limited on the characteristics of HIV pre-exposure prophylaxis (PrEP) using couples. SETTING: US nationwide sample recruited online in 2017. METHODS: HIV negative/unknown gay, bisexual, and other men who have sex with men with HIV negative/unknown partners (n = 3140) were asked about individual and main partner PrEP uptake. Men were coded into the following 5 groups: (1) neither participant nor partner on PrEP, (2) partner only on PrEP, (3) participant only on PrEP, (4) both on PrEP, and (5) unknown partner PrEP use. We examined associations of demographics, relationship factors, condomless anal sex (CAS) with main and causal partners, bacterial sexually transmitted infection diagnoses, and sexual positioning with reported dyadic PrEP use using fully adjusted multinomial logistic regressions. RESULTS: PrEP use was 3.2% for the partner only, 5.7% for the participant only, and 4.9% for both the participant and partner; 5.6% reported not knowing their partner's PrEP use status. Men who reported any CAS with their main partner or any CAS with male casual partners were both more likely to be classified in the dyadic PrEP use group compared with the neither on PrEP group. Compared with monogamous, men in open arrangements were more likely to be classified in each of the 3 PrEP groups compared with the neither on PrEP group. Six-month bacterial sexually transmitted infection prevalence was 2.8%, 8.1%, 8.3%, 15.6%, and 4.0% for the 5 groups, respectively. CONCLUSIONS: PrEP use occurred during times of higher risk behavior engagement, but further efforts are needed to expand PrEP use to more partnered gay, bisexual, and other men who have sex with men.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Bissexualidade/psicologia , Bissexualidade/estatística & dados numéricos , Feminino , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Assunção de Riscos , Sexo Seguro , Parceiros Sexuais/psicologia , Minorias Sexuais e de Gênero , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Estados Unidos
6.
AIDS Behav ; 23(9): 2407-2420, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30887190

RESUMO

Men who have sex with men (MSM) experience high rates of substance use and HIV infection. Main partners are the source of many (35-68%) of these new HIV infections. This study developed and examined the efficacy of two adjunct components to couples HIV testing and counseling (CHTC)-communication training (CT) videos and a substance use module (SUM)-to reduce drug use and sexual HIV transmission risk in MSM couples. Participants included 70 male couples randomized into one of four conditions: CHTC, CHTC + CT videos, CHTC + SUM, and CHTC + CT videos + SUM. Participants completed a survey pre-intervention and 1-, 3-, and 6-months later. Completion of the SUM in the absence of CT videos was associated with significant immediate decreases in drug use and related problems; however, at 3- and 6-month follow ups, the SUM was only associated with reductions in drug use and related problems among men who also viewed the CT videos. There were no between-condition differences in sexual behavior. CHTC may serve as a vehicle for the delivery of brief substance use intervention for MSM couples.ClinicalTrails.gov NCT # 03125915.


Assuntos
Comunicação , Aconselhamento/métodos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Programas de Rastreamento/métodos , Testes Sorológicos/métodos , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Características da Família , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Cidade de Nova Iorque , Projetos Piloto , Comportamento de Redução do Risco , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
7.
Arch Sex Behav ; 48(1): 369-382, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30465312

RESUMO

Sexual agreements have received considerable attention as an aspect of dyadic functioning associated with HIV risk. To date, this research has primarily utilized convenience samples which overrepresented men from large urban areas and with higher HIV risk. The current study utilized a national cohort of 1061 HIV-negative gay and bisexual men recruited to be geographically diverse within the U.S. The sample included 531 (50.0%) men who identified as single. Of the 530 partnered men, 240 (45.3%) were monogamous; 238 (44.9%) were in open relationships (where sex with outside partners was permitted); and 52 (9.8%) were in monogamish relationships (where sex with outside partners was limited to instances where both primary partners were present). Regardless of urban (vs. non-urban) residence, men in monogamous relationships engaged in less anal sex generally and condomless anal sex (CAS) specifically with casual partners. Single men reported significantly more frequent anal sex with casual partners compared to open and monogamish men; however, there were no significant differences among these three groups with respect to CAS with casual partners. In multivariable models, monogamish men reported significantly more frequent marijuana use and alcohol consumption compared to all other groups. Urban (vs. non-urban) residence moderated associations between sexual arrangements and depression as well as the use of illicit drugs other than marijuana. These findings point to the need to better examine the potentially unique mechanisms which confer risk and resilience for gay male couples in urban versus non-urban settings. The observed association between sexual arrangements and substance use suggests interventions which facilitate the negotiation of sexual agreements may present an opportunity to engage in dyadic substance use intervention.


Assuntos
Bissexualidade/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Coortes , Humanos , Masculino , Uso da Maconha/epidemiologia , Prevalência , Estados Unidos/epidemiologia
8.
J Health Care Poor Underserved ; 28(1): 127-152, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28238993

RESUMO

Transgender people face numerous barriers when utilizing health care in the United States. The current study sought to highlight transgender consumer perspectives in order to present theoretically informed, concrete recommendations for increasing transgender health care utilization. The search yielded several prominent themes associated with barriers to health care for transgender people: 1) provider lack of knowledge concerning transgender identity issues and transgender health issues, 2) transgender patients' previous negative experiences with the health care system or anticipation of these experiences, 3) transgender patients' inability to pay for health care services, and 4) health care provider refusal to provide health care services to transgender people. We present a modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals as a guiding theoretical framework that informs our recommendations for increasing transgender health care utilization.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pessoas Transgênero/psicologia , Atitude do Pessoal de Saúde , Financiamento Pessoal , Acesso aos Serviços de Saúde/economia , Humanos , Satisfação do Paciente , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
9.
Glob Public Health ; 10(3): 318-30, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25330110

RESUMO

While the Caribbean has the second highest global human immunodeficiency virus (HIV) prevalence, insufficient attention has been paid to contributing factors of the region's elevated risk. Largely neglected is the potential role of drugs in shaping the Caribbean HIV/acquired immune deficiency syndrome epidemic. Caribbean studies have almost exclusively focused on drug transportation and seldom acknowledged local user economies and drug-related health and social welfare consequences. While tourism is consistently implicated within the Caribbean HIV epidemic, less is known about the intersection of drugs and tourism. Tourism areas represent distinct ecologies of risk often characterised by sex work, alcohol consumption and population mixing between lower and higher risk groups. Limited understanding of availability and usage of drugs in countries such as the Dominican Republic (DR), the Caribbean country with the greatest tourist rates, presents barriers to HIV prevention. This study addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. A two-step qualitative data analysis process was utilised and interview transcripts were systematically coded using a well-defined thematic codebook. Results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviours in tourism areas.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Viagem , Adulto , República Dominicana/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Prevalência , Pesquisa Qualitativa , Fatores de Risco , Trabalho Sexual
10.
Behav Med ; 39(3): 52-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23930896

RESUMO

Black men who have sex with men (BMSM) are disproportionately affected with HIV, and nearly half are unaware of their status. Those unaware of their status are more likely to engage in risky behavior; thus, HIV-testing uptake is crucial. This study explored correlates of past-two-year HIV-testing history. BMSM (n = 102) completed self-administered questionnaires. Fisher exact test indicated that BMSM at clubs/bars and Gay Pride events had higher rates of being tested within the past two years (86%-65%) than did participants who responded to online advertisements (44%, p < .001). Among those untested for HIV, slightly half reported receptive anal sex without a condom (48%, p = .033), used the Internet seeking sex (54%, p < .001), low HIV knowledge (52%, p = .005), and less education. Literacy and tailored online interventions might be worth considering to increase HIV-testing uptake.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por HIV/diagnóstico , Soropositividade para HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Homossexualidade Masculina , Humanos , Los Angeles , Masculino , Inquéritos e Questionários
11.
Arch Sex Behav ; 42(7): 1255-65, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23436038

RESUMO

Expansion of the tourism industry in the Dominican Republic has had far-reaching health consequences for the local population. Research suggests families with one or more members living in tourism areas experience heightened vulnerability to HIV/STIs due to exposure to tourism environments, which can promote behaviors such as commercial and transactional sex and elevated alcohol use. Nevertheless, little is known about how tourism contexts influence family dynamics, which, in turn, shape HIV risk. This qualitative study examined family relationships through in-depth interviews with 32 adults residing in Sosúa, an internationally known destination for sex tourism. Interviewees situated HIV risk within a context of limited employment opportunities, high rates of migration, heavy alcohol use, and separation from family. This study has implications for effective design of health interventions that make use of the role of the family to prevent HIV transmission in tourism environments.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV/transmissão , Assunção de Riscos , Trabalho Sexual , Comportamento Sexual , Adulto , República Dominicana , Emprego , Relações Familiares , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Trabalho Sexual/estatística & dados numéricos , Meio Social , Viagem , Sexo sem Proteção , Adulto Jovem
12.
AIDS Behav ; 17(3): 961-75, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23001411

RESUMO

The present study examined cognitive and emotional correlates of sexual decision-making among three groups of Dominican adolescents: (a) Dominican youth who were born and raised in New York City, (b) Dominican youth who recently immigrated to New York City from the Dominican Republic, and (c) Dominican adolescents who were born and currently reside in the Dominican Republic. Data were collected via self-administered questionnaires from Dominican mother-adolescent dyads in New York City (n = 1,008) and the Dominican Republic (n = 213). Across groups, positive emotion constructs were consistently among the most important correlates of intentions to engage in sexual intercourse while issues related to STIs and HIV showed the lowest correlations. Interestingly, positive correlations with intentions to engage in intercourse were found among Dominican-residing males, as were positive correlations with intentions among Dominican-residing females. The implications for HIV prevention programs for Dominican youth are discussed.


Assuntos
Comportamento do Adolescente , Cognição/fisiologia , Emoções/fisiologia , Hispano-Americanos/etnologia , Comportamento Sexual , Adolescente , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Tomada de Decisões/fisiologia , República Dominicana/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Masculino , Cidade de Nova Iorque/etnologia , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Inquéritos e Questionários , Estados Unidos/etnologia
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