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1.
J Homosex ; 67(2): 223-243, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30403570

RESUMO

This qualitative study explores the social lives of older gay men. In-depth interviews were conducted with 10 gay men over the age of 65 to elicit details about their relationships with other people. Findings paint a complex picture of older gay social life that is compounded by significant events affecting gay men from a particular socio-historical period. Three overarching themes emerged that capture the social lives of the participants: (1) coming of age as a gay man in the 20th century; (2) dealing with the aging body; and (3) enduring loss and the consequent impact on social life. The participants reported that being in a gay environment and closing the gay generational divide helped them adjust to their changing social lives in later life. This study adds to the ongoing discussion about the experiences of older gay men and makes suggestions for future research and practice considerations.


Assuntos
Envelhecimento/psicologia , Homossexualidade Masculina/psicologia , Idoso , Nível de Saúde , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Minorias Sexuais e de Gênero , Condições Sociais
2.
J Homosex ; 67(1): 79-103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30307800

RESUMO

Young Black Men Who Have Sex With Men (BMSM) have been the subject of much research focused on health disparities in HIV occurrence, stigma, and mental health. Although such research is important, fewer studies focus on other equally salient areas of their lives such as spirituality, religious practices, and social support. Informed by literature on social support, this research endeavors to better understand these dynamics for a group of young BMSM who reside in a metropolitan city in Tennessee. Focus group results and content analysis uncover themes related to religion and resilience; queering Christianity; and virtual spirituality. Participants expressed an overarching need for support, safe spaces, genuine relationships, and godly instruction, conveyed through traditional Black Church involvement and nontraditional Internet usage. Findings are important for strategic, proactive, cross-generational collaboration with young BMSM to holistically meet their varied needs.


Assuntos
Afro-Americanos/psicologia , Homossexualidade Masculina/psicologia , Minorias Sexuais e de Gênero/psicologia , Mídias Sociais , Espiritualidade , Adolescente , Adulto , Grupos Focais , Infecções por HIV/psicologia , Humanos , Masculino , Estigma Social , Tennessee , Adulto Jovem
3.
J Homosex ; 67(1): 58-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30307840

RESUMO

Masculine overcompensation-a phenomenon where men react to masculinity threats by endorsing hypermasculine ideals-has been demonstrated among straight men but has yet to be examined among gay men. The current study therefore proposed to examine whether gay men overcompensate similarly to their straight counterparts by providing participants with randomized feedback that threatened their masculinity. Overcompensation was measured in 867 online respondents by administering a series of questionnaires regarding views of pornography, rape, sex roles, and political orientation. Although our hypothesis was not confirmed, results revealed the intersectionality of both sexual orientation and self-reported gender expression regarding the formation of different views and beliefs. Specifically, masculinity was differentially related to homophobic attitudes, more callous views toward victims of sexual assault, and various components of attitudes toward pornography in gay and straight men. Masculine gay males held stereotypically masculine views less strongly than their masculine straight counterparts, providing evidence that gay males adopt a different type of masculinity than straight males-something of a "masculinity lite." Such findings point to the converging influence of sexual orientation and gender expression as contributors relevant to the attitudes of gay and straight men. This information adds to a growing body of literature on differences between gay and straight men and can be used to inform theory, education, and clinical practice, particularly in settings where men grapple with the implications of their masculinity.


Assuntos
Identidade de Gênero , Homossexualidade Masculina/psicologia , Masculinidade , Adolescente , Adulto , Idoso , Atitude , Humanos , Masculino , Pessoa de Meia-Idade , Estereotipagem , Inquéritos e Questionários , Adulto Jovem
4.
Medicine (Baltimore) ; 98(50): e18232, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852085

RESUMO

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Prevenção Primária/métodos , Comportamento Sexual , Parceiros Sexuais , Pessoas Transgênero , Adulto , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Adesão à Medicação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
5.
BMC Public Health ; 19(1): 1360, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651293

RESUMO

BACKGROUND: HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not. METHODS: This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex. RESULTS: Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM. CONCLUSIONS: A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use.


Assuntos
Alcoolismo/epidemiologia , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Estudos Transversais , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários
6.
MMWR Morb Mortal Wkly Rep ; 68(40): 873-879, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600183

RESUMO

Correct and consistent condom use and human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) are protective against sexual transmission of HIV (1,2). The incidence of HIV infection among Hispanic/Latino men who have sex with men (MSM) in the United States is increasing (3). HIV risk among Hispanic/Latino MSM differs based on their place of birth and years of U.S. residence (4). Data from CDC's National HIV Behavioral Surveillance (NHBS)* for 2011-2017 were analyzed to assess changes in sexual risk behaviors among Hispanic/Latino MSM by place of birth and years of U.S. residence. Overall, condomless anal sex during the previous 12 months increased from 63% in 2011 to 74% in 2017, and PrEP use during the previous 12 months increased from 3% in 2014 to 24% in 2017. Regardless of place of birth, nearly 75% of Hispanic/Latino MSM reported condomless anal sex during 2017. However, because of PrEP use, <60% of non-U.S.-born Hispanic/Latino MSM and <50% of U.S.-born Hispanic/Latino MSM reported unprotected anal sex (condomless anal sex and no PrEP use) during 2017. Results indicate that PrEP can be a vital tool for reducing HIV transmission among Hispanic/Latino MSM, especially those who have condomless anal sex. Interventions to prevent HIV acquisition, including increasing PrEP uptake, could address cultural and linguistic needs of Hispanic/Latino MSM, as well as other barriers to prevention of HIV infection typically faced by all MSM.


Assuntos
Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Assunção de Riscos , Sexo sem Proteção/etnologia , Adolescente , Adulto , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
7.
BMC Public Health ; 19(1): 1314, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638943

RESUMO

BACKGROUND: Chongqing reportedly has a large MSM population and a high STI prevalence in previous studies. However, most studies are attributed to independent cross-sectional studies, few studies have investigated trends in the prevalence of syphilis and HIV, as well as behavioural characteristics among MSM using serial surveillance surveys. METHODS: Data were collected in Chongqing through face-to-face questionnaire interview and laboratory testing in Chongqing. The respondents were recruited among MSM by snowball sampling from May 2013 to December 2017. The self-report questionnaire primarily included socio-demographics, HIV knowledge, and HIV-related behaviour characteristics over the year. Blood specimens were tested to diagnose HIV and syphilis infection by Chongqing CDC. Cochran-Armitage trend test and multivariate logistic regression were conducted to compare the changes in STI prevalence and independent behavioural factors among MSM. RESULTS: There were 6568 eligible participants (98.4%). The overall HIV prevalence was 20.5% among MSM in Chongqing, with a decrease from 23.0% in 2013 to 19.2% in 2017. The overall syphilis prevalence was 5.8%, with an increase from 3.2% in 2013 to 6.7% in 2017. The proportion of consistent condom use (CCU) during anal intercourse (46.3 to 57.7%, P<0.001),CCU with regular male partners(47.7 to 59.7%, P<0.001), CCU with casual male partners (51.5 to 62.3%, P<0.001) and drug use during anal intercourse (0.3 to 1.4%, P<0.05) were increasing. By contrast, a significant decrease was reported in the percentage of MSM with more than two regular male partners (66.0 to 21.4%, P<0.001) and more than two casual male partners (38.3 to 20.7%, P<0.001). A significant difference was observed in syphilis infection, testing for HIV antibodies and drug use during anal intercourse in the past years between the HIV-positive and HIV-negative respondents. CONCLUSION: A decreasing trend of HIV prevalence was showed during among MSM from 2013 to 2017 in Chongqing. While gradual reduction of high-risk behaviors along with HIV prevalence supported development of STI counselling and testing, increasing syphilis infection and drug use during anal intercourse warrants further understanding.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Idoso , China/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Comportamento de Redução do Risco , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 807, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521123

RESUMO

BACKGROUND: HIV self-testing (HIVST) is a promising approach to expand HIV testing. HIVST is a process in which a person performs an HIV test and interprets the result. Negative HIVST results may encourage men who have sex with men (MSM) to use HIV prevention services. The objective of this study was to examine behaviors (e.g., facility-based HIV testing, condom use) after a negative HIVST test result among Chinese MSM. METHODS: We collected data from MSM in eight Chinese cities over a 12-month period. This is a secondary analysis of longitudinal cohort data collected as part of an intervention trial to increase HIV testing. Men completed a survey that described sociodemographic information, sexual behaviors, HIV self-testing, and facility-based HIV testing. Men who completed at least one follow-up survey were included in this analysis. Generalized linear mixed models were used to evaluate whether HIVST increased subsequent facility-based HIV testing and consistent condom use. RESULTS: We included 1219 men. Most men (78.7%) were under 30 years old and had never been married (87.0%). 755 (61.9%) men tested for HIV and 593 (49.3%) men self-tested during the study period. At baseline, among men who had never been tested for HIV, 44.9% (314/699) initiated HIVST during the study period. HIVST was associated with subsequent facility-based testing (aOR of 1.87, 95% CI: 1.47-2.37). HIVST was also associated with subsequent consistent condom use (aOR = 1.53, 95% CI: 1.13-2.06). CONCLUSION: HIVST was associated with subsequent facility-based HIV testing and consistent condom use. HIVST may enhance uptake of related HIV prevention services at facilities, suggesting the need for more implementation research.


Assuntos
Sorodiagnóstico da AIDS/métodos , Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , HIV/imunologia , Homossexualidade Masculina/psicologia , Minorias Sexuais e de Gênero/psicologia , Adulto , China , Preservativos , Seguimentos , Infecções por HIV/prevenção & controle , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Assunção de Riscos , Sexo Seguro , Inquéritos e Questionários , Adulto Jovem
9.
AIDS Behav ; 23(Suppl 3): 331-339, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31541391

RESUMO

Black men who have sex with men (MSM) in the South have the highest rates of HIV diagnosis in the country adding to the persistent racial disparities in HIV experienced by this population. The current HIV prevention and care landscape is heavily driven by individual-level clinical and biomedical approaches that have shown progress in reducing HIV diagnoses, but yield less than adequate results in reducing the HIV racial disparities for Black MSM in the South. In efforts to enhance focus on reducing the racial HIV disparities and more completely address the needs of Black MSM in the South, we offer insight on comprehensive approaches that can complement our current HIV prevention and care portfolio. There are five domains we discuss which include: (1) leveraging and integrating resources; (2) building upon existing program models designed to reduce disparities; (3) workforce development and cultural sensitivity; (4) social determinants of health data utilization; and 5) policy considerations. We urge public health practitioners and healthcare providers to consider and incorporate the outlined approaches to improve HIV outcomes along the continuum of care and ultimately reduce disparities in HIV affecting the quality of life of Black MSM living in the South.


Assuntos
Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Determinantes Sociais da Saúde/etnologia , Adulto , Fortalecimento Institucional , Assistência à Saúde Culturalmente Competente , Infecções por HIV/etnologia , Disparidades nos Níveis de Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Qualidade de Vida , Estigma Social
10.
MMWR Morb Mortal Wkly Rep ; 68(37): 801-806, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31536484

RESUMO

In 2017, preliminary data show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of human immunodeficiency virus (HIV) infection, that MSM who inject drugs accounted for an additional 3%, and that African American/black (black) and Hispanic/Latino (Hispanic) MSM were disproportionately affected (1). During 2010-2015, racial/ethnic disparities in HIV incidence increased among MSM; in 2015, rates among black and Hispanic MSM were 10.5 and 4.9 times as high, respectively, as the rate among white MSM (compared with 9.2 and 3.8 times as high, respectively, in 2010) (2). Increased use of preexposure prophylaxis (PrEP), which reduces the risk for sexual acquisition of HIV infection by approximately 99% when taken daily as prescribed,* would help to reduce these disparities and support the Ending the HIV Epidemic: A Plan for America initiative† (3). Although PrEP use has increased among all MSM since 2014 (4), racial/ethnic disparities in PrEP use could increase existing disparities in HIV incidence among MSM (5). To understand racial/ethnic disparities in PrEP awareness, discussion with a health care provider, and use (steps in the HIV PrEP continuum of care) (6), CDC analyzed 2017 National HIV Behavioral Surveillance (NHBS) data. Black and Hispanic MSM were significantly less likely than were white MSM to be aware of PrEP, to have discussed PrEP with a health care provider, or to have used PrEP within the past year. Among those who had discussed PrEP with a health care provider within the past year, 68% of white MSM, 62% of Hispanic MSM, and 55% of black MSM, reported PrEP use. Prevention efforts need to increase PrEP use among all MSM and target eliminating racial/ethnic disparities in PrEP use.§.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
11.
MMWR Morb Mortal Wkly Rep ; 68(37): 801, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31538632

RESUMO

National Gay Men's HIV/AIDS Awareness Day, September 27, directs attention to the impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on gay, bisexual, and other men who have sex with men (MSM). In 2017, MSM accounted for 67% of new diagnoses of HIV infection, and MSM who inject drugs an additional 3% (1).


Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Aniversários e Eventos Especiais , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia
12.
BMC Public Health ; 19(1): 1210, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477063

RESUMO

BACKGROUND: There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. METHODS: This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. RESULTS: The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. CONCLUSION: HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.


Assuntos
Usuários de Drogas/psicologia , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Estudos Transversais , Usuários de Drogas/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Nigéria/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
13.
BMC Public Health ; 19(1): 1236, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492120

RESUMO

BACKGROUND: Increasing rates of sexually transmitted infections (STIs) in men-who-have-sex-with-men (MSM) in England is a pressing public health concern. Interventions targeting MSM, including information provision that effectively promotes sexual health, are needed. To support such intervention development, it is necessary to understand acceptable ways of delivering sexual health information. We explored the acceptability and potential uses and impacts of delivering sexual health information to MSM through social media and geosocial networking apps or dating apps. METHODS: Semi-structured interviews were conducted in person or by telephone with 25 MSM resident in England recruited via dating apps and social media advertisements. Interviews explored sexual health information sources, perceptions and uses. Attitudes towards sexual health promotion through social media and dating apps were then discussed. The data were analysed using thematic analysis. RESULTS: Sexual health information delivery through social media and dating apps was considered acceptable. Receiving information when browsing social media was viewed positively by most, as people have time to absorb information. In contrast, concerns were expressed that sharing or commenting on social media sexual health information may lead to judgements and discrimination. While social media reaches a high proportion of the population, dating apps can easily target MSM. However, tensions exist between the ability to provide information at an opportune time through dating apps, when users are connecting with new sexual partners, with the potential to adversely affect the app user's experience. Hypothetical and actual uses and impacts of sexual health information ranged from no impact to reading information, sharing with peers, and increased awareness, to influencing healthcare-seeking, decision-making and risk-taking behaviours. Ensuring that information is engaging, positive in tone, not too clinical, focused on building social norms and delivered by trusted organisations were viewed as important for supporting its use. CONCLUSIONS: Overall, these findings support the development of new interventions that use dating apps and social media for sexual health promotion.


Assuntos
Promoção da Saúde/métodos , Homossexualidade Masculina/psicologia , Disseminação de Informação/métodos , Aplicativos Móveis , Saúde Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Mídias Sociais , Adulto , Inglaterra/epidemiologia , Estudos de Viabilidade , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
14.
AIDS Behav ; 23(10): 2849-2858, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402416

RESUMO

Given the high HIV prevalence for men who have sex with men (MSM) and transgender women in South Africa, there is limited understanding of social determinants that influence antiretroviral treatment (ART) adherence. Although universal testing and treatment (UTT) is available, ART adherence remains suboptimal. We conducted focus groups with MSM and transgender women in order to understand factors influencing their ART adherence in Mpumalanga, South Africa. All focus groups were audio-recorded, transcribed and translated for analysis using a constant comparison approach, guided by the concept of Therapeutic Citizenship. We found there is medical mistrust of ART based on differing interpretations of HIV cure that may influence treatment adherence behaviors within social networks, and relationship desire had a significant influence on optimal ART adherence. Our findings suggest that clinics must provide interventions that integrate HIV disclosure and relationship skill-building to support optimal ART adherence for MSM and transgender women under UTT.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/psicologia , Adesão à Medicação , Pessoas Transgênero , Confiança , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Pesquisa Qualitativa , População Rural , Determinantes Sociais da Saúde , Rede Social , África do Sul/epidemiologia , Adulto Jovem
15.
AIDS Behav ; 23(10): 2803-2815, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407211

RESUMO

Although young Black men who have sex with men (YBMSM) are disproportionately affected by HIV, they may be more heterogeneous as a group than is typically appreciated. Thus, the present study used a person-centered data-analytic approach to determine profiles of HIV-related risk among YBMSM and whether these profiles could be distinguished by age, HIV status, and socioeconomic risk (i.e., socioeconomic distress). YBMSM (N = 1808) aged 18 to 29 years completed a survey of sociodemographic characteristics, HIV status, and HIV-related behavioral and attitudinal factors (i.e., safer-sex self-efficacy, negative condom attitudes, being in difficult sexual situations, being in difficult sexual relationships, HIV treatment optimism, perceived HIV stigma). Latent profile analysis was used to identify HIV risk profiles and whether age, HIV status, and socioeconomic distress were associated with these profiles. Four profiles emerged: low-, medium-, and high-risk profiles, respectively, and a mixed profile characterized by a tendency to be in difficult sexual situations and relationships while also reporting high safer-sex self-efficacy and low negative attitudes toward condom use. Difficult sexual situations emerged as the key defining indicator of whether a profile reflected higher or lower risk. Younger age, being HIV-positive, and socioeconomic distress were associated with having a higher-risk profile. Given that unique risk profiles emerged that were differentially predicted by sociodemographic characteristics and HIV status, these findings have implications for tailoring interventions to the needs of different subgroups of YBMSM. Also, disempowering or risky sexual situations and relationships among YBMSM must be addressed.


Assuntos
Afro-Americanos/etnologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/etnologia , Assistência Centrada no Paciente , Profilaxia Pré-Exposição , Autoeficácia , Comportamento Sexual/estatística & dados numéricos , Estigma Social , Adolescente , Adulto , Afro-Americanos/psicologia , Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Fatores de Risco , Sexo Seguro , Inquéritos e Questionários , Texas , Adulto Jovem
16.
AIDS Behav ; 23(Suppl 3): 304-312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456198

RESUMO

Client-level data from two Tennessee-based PrEP navigation demonstration projects reported to the Tennessee Department of Health from January to December 2017 were evaluated to determine the proportion of clients who accepted, were linked to, and were prescribed PrEP. Disparities by age, race, transmission risk, and geographic region as well as trends over time were examined via bivariate and multivariable modified Poisson regression models accounting for potential confounders. Among 1385 PrEP-eligible individuals, 50.5% accepted, 33.4% were linked, and 27.3% were prescribed PrEP. PrEP uptake varied by age, race, and HIV transmission risk, and most disparities persisted across Tennessee throughout evaluation period. Multivariable regression models revealed significant independent associations between age, race/ethnicity, transmission risk, and region and PrEP acceptance and linkage. While differences in PrEP acceptance by race narrowed over time, success among black MSM was limited, underscoring a significant need to improve upstream PrEP continuum outcomes for this important population.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Distribuição por Sexo , Tennessee
17.
AIDS Behav ; 23(11): 3044-3051, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31456200

RESUMO

Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12 months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6 months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.


Assuntos
Afro-Americanos/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Habitação/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adulto , Cidades , Continuidade da Assistência ao Paciente , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , Populações Vulneráveis , Adulto Jovem
18.
BMC Public Health ; 19(1): 1130, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420034

RESUMO

BACKGROUND: In 2014, Vietnam was the first Southeast Asian country to commit to achieving the World Health Organization's 90-90-90 global HIV targets (90% know their HIV status, 90% on sustained treatment, and 90% virally suppressed) by 2020. This pledge represented further confirmation of Vietnam's efforts to respond to the HIV epidemic, one feature of which has been close collaboration with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Starting in 2004, PEPFAR supported community outreach programs targeting high-risk populations (people who inject drugs, men who have sex with men, and sex workers). To provide early evidence on program impact, in 2007-2008 we conducted a nationwide evaluation of PEPFAR-supported outreach programs in Vietnam. The evaluation focused on assessing program effect on HIV knowledge, high-risk behaviors, and HIV testing among high-risk populations-results relevant to Vietnam's push to meet global HIV goals. METHODS: We used a mixed-methods cross-sectional evaluation design. Data collection encompassed a quantitative survey of 2199 individuals, supplemented by 125 in-depth interviews. Participants were members of high-risk populations who reported recent contact with an outreach worker (intervention group) or no recent contact (comparison group). We assessed differences in HIV knowledge, risky behaviors, and HIV testing between groups, and between high-risk populations. RESULTS: Intervention participants knew significantly more about transmission, prevention, and treatment than comparison participants. We found low levels of injection drug-use-related risk behaviors and little evidence of program impact on such behaviors. In contrast, a significantly smaller proportion of intervention than comparison participants reported risky sexual behaviors generally and within each high-risk population. Intervention participants were also more likely to have undergone HIV testing (76.1% vs. 47.0%, p < 0.0001) and to have received pre-test (78.0% vs. 33.7%, p < 0.0001) and post-test counseling (80.9% vs. 60.5%, p < 0.0001). Interviews supported evidence of high impact of outreach among all high-risk populations. CONCLUSIONS: Outreach programs appear to have reduced risky sexual behaviors and increased use of HIV testing services among high-risk populations in Vietnam. These programs can play a key role in reducing gaps in the HIV care cascade, achieving the global 90-90-90 goals, and creating an AIDS-free generation.


Assuntos
Relações Comunidade-Instituição , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/estatística & dados numéricos , Comportamento de Redução do Risco , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Medição de Risco , Assunção de Riscos , Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Inquéritos e Questionários , Vietnã/epidemiologia
19.
AIDS Behav ; 23(10): 2654-2673, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31463711

RESUMO

Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclusion criteria and were categorized into the PrEP care continuum: (1) awareness (n = 16), (2) uptake (n = 9), and (3) adherence (n = 12). Only 26 of the studies presented analytical findings by race/ethnicity. Key barrier themes included cost, HIV-related stigma, and fear of potential side effects. A key facilitator theme identified by black MSM included gaining PrEP awareness from social and sexual networks. There are significant gaps in research on black MSM and PrEP utilization, especially regarding PrEP uptake and adherence. These data are needed to inform interventions to address current inequities in PrEP services, to help improve care outcomes for black MSM.


Assuntos
Afro-Americanos/psicologia , Fármacos Anti-HIV/administração & dosagem , Continuidade da Assistência ao Paciente , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Conscientização , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Retenção nos Cuidados , Comportamento Sexual , Estigma Social
20.
AIDS Behav ; 23(Suppl 3): 266-275, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31463712

RESUMO

Minority stress theory posits that homonegativity-whether experienced, anticipated, or internalized-adversely impacts health. We conducted qualitative interviews with 28 YB-GBMSM living with HIV to explore manifestations of homonegativity over the life course. Thematic analysis identified patterns in the ways that homonegativity was discussed at different points in participants' lives. Stifling, and sometimes traumatic, familial and religious environments led to experienced homonegativity early in life. These experiences led to anticipated and internalized homonegativity, which in turn shaped sexual identity formation processes in adolescence and into young adulthood. Ultimately, many participants distanced themselves from home environments, seeking and often finding extrafamilial support. Most participants eventually reached self-acceptance of both their sexuality and HIV status. In conclusion, experienced, anticipated and internalized homonegativity were pervasive as YB-GBMSM navigated family and religious environments over the life course. Future interventions should work with youth, families, and churches to prevent these harmful experiences.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Africano/psicologia , Bissexualidade/etnologia , Infecções por HIV/diagnóstico , Homossexualidade Masculina/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Bissexualidade/psicologia , Georgia/epidemiologia , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Entrevistas como Assunto , Masculino , Grupos Minoritários , Pesquisa Qualitativa , Comportamento Sexual , Minorias Sexuais e de Gênero/psicologia , Adulto Jovem
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